Cervival ca in pregnancy / and CIN

Question 1

Management of 1A1 cervical ca in pregnancy?

Answer 1

Cone biopsy between 14-20 weeks

Question 2

Management of 1A2/1B1 cervical ca in pregnancy <22w?

Answer 2

Staging lymphadenectomy -

if positive then consider TOP. If want to continue pregnancy - neoadjuvant chemo

If negative - trachelectomy or delay in treatment until after delivery

Question 3

Management of 1A2/1B1 cervical ca in pregnancy >22w?

Answer 3

Neoadjuvant chemo OR delay treatment until delivery

Question 4

Risks of antenatal trachelectomy?

Answer 4

20-30% pre-term delivery

Evidence that it shouldn’t be done in pregnancy due to EBL/fetal outcomes

Question 5

Management of 1B2 cervical ca in pregnancy <22w

Answer 5

TOP, radical hyst and PLND

If wanting to continue pregnancy NACT may help to shrink disease

Question 6

Management of 1B2 cervical ca in pregnancy >22w

Answer 6

NACT and deliver baby by CS at appropriate gestation with radical hyst and PLND

Question 7

When is chemo contraindicated and why?

Answer 7

1st trimester
10-20% risk of major malformations

Question 8

Recommended gap between chemo and CS and why?

Answer 8

3 weeks / stop at 35 weeks
to ensure maternal bone marrow recovery and reduce risk of neutropenia at delivery

Question 9

If NACT used, when should you deliver and what mode?

Answer 9

34-36 weeks
CS preferred due to risk of cervical ca obstructing labour and episiotomy scar cancer

Question 10

Can you breastfeed with chemo?

Answer 10

No, chemo crosses into breast milk and can cause neonatal leucopenia/infection
14 day gap advised

Question 11

Cervical cancer 4mm