CONDUCTS EVALUATION AND Case Presentation OF CERVICAL CANCER IN PREGNANT WITH SECOND TRIMESTER

Presentation: Woman, 37 years, pregnant, with gestational age (GA) of 20 weeks, resident of Aracaju-SE, searched for a surgical oncologys service after the result of moderately differentiated squamous cell carcinoma, infiltrative and eroded, viewed on anatomopathological examination of uterine cervix. Discussion: The cervical cancer occurs in 1 of 1000 gestations and consists in half of neoplasms diagnosed during pregnancy. Frequently, the diagnosis of cancer in pregnant women is late because of: rarity of the disease, anatomophysiological alterations that prejudice the cervical exam; and the similarity between the signals and symptoms of pregnancy and that pathology. The conduct after the discovery should be evaluated in accord with the GA during diagnosis, the stage of the disease, the size of tumor, the patients wish of keeping pregnancy and future reproductive capacity. In carcinomas, there is no evidences that the gestation accelerates the diseases evolution. The GA has a huge impact on the chosen conduct. Before the 20° week, the treatment must be immediate, because waiting for the end of pregnancy can improve morbimortality. After this period, the fetal lung maturity must be awaited to initiate treatment, because literature demonstrates that the defer of treatment in these cases dont affect the maternal prognosis. However, there is a huge divergence on the limit of GA to determinate the wait for fetal maturity or to begin treatment. The values variate from 12° to 20° week. In this patients case, the diagnosis was made on the second trimester. As the literature shows a doubt about the limit GA for waiting the fetal maturation, the chosen conduct was accepting the patients wish to continue the pregnancy. However, it was found an improvement of maternal morbimortality for pregnants with GA until 20 weeks. Thus, the chosen approach was to wait for the 28° week to accelerate the fetal lung maturity and to perform a cesarean associated with a definitive surgery for the tumor. Final comments: The treatment options are variable. However, each case must be individually evaluated, taking into consideration the GA, the stage of disease and the patients desire. It is important the knowledge of management in neoplasms during pregnancy whereas there is little experience of professionals in handling this especial kind of patient. Lastly, besides the chemotherapy offers risks to the fetal health, it is necessary to evaluate the risks to maternal life.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019