Cervical cancer in pregnancy: Analysis of the literature and innovative approaches

Abstract

Cervical cancer is one of the most common gynecological malignancies diagnosed during pregnancy although, fortunately, it is a rare event. In majority of cases, the management of cervical cancer in pregnant women is not different from nonpregnant women and prognosis seems not compromised by pregnancy. The association between cancer and pregnancy appears to be a significant challenge for women and specialists and the decisions about therapy must be individualized and taken by a multidisciplinary team. This review is focused on cervical cancer in pregnancy. The aim is to discuss the diagnosis, potential biomarkers and molecular aspects, therapeutic approaches, and prognosis from intraepithelial cervical neoplasia to invasive cervical cancer (early and advanced stages) in different gestational ages. We provide an overview of the current literature regarding the treatment strategies of concurrent pregnancy and cervical cancer cases and we propose some clinical advices to help clinicians to manage this condition. A mention about the effects of the conservative therapy (as conization) on fertility, the human papillomavirus vaccine in pregnant women and our center's experience with obstetrical and oncological outcomes are reported.

Claudins: New Players in Human Fertility and Reproductive System Cancers

“…About 570,000 new cases are estimated to be diagnosed each year [111]. It is also the most common gynecological cancer diagnosed in pregnancy [112]. Two major types of cervical cancer might be distinguished: squamous cell carcinoma and adenocarcinoma, of which the first one occurs more often.…”

A case of successful maintained pregnancy after neoadjuvant chemotherapy plus radical surgery for stage IB3 cervical cancer diagnosed at 13 weeks

“…It is suggested that delivery should be induced after 37 weeks to avoid neonatal morbidities and to assure the fetal maturity [2]. According to the literature, the pregnancies were mostly terminated by caesarean section ranging 31-38 weeks [1,6]. Given the risks of vaginal delivery including tumor laceration, excessive bleeding, obstruction of the birth canal and implantation of malignant cells in perineum wound scar [27][28][29], caesarean section is indicated for cervical cancer [2].…”

“…Cancer during pregnancy, the incidence of which is expected to rise, is defined as a tumor diagnosed in pregnant women or in the immediate postpartum [1,2]. Cervical cancer is the second neoplasia diagnosed during pregnancy or postpartum, with an incidence arranging from 1.4 to 4.6 per 100,000 pregnancies [2].…”

Quantitative proteomics analysis of differentially expressed proteins induced by astragaloside IV in cervical cancer cell invasion

“…While surgery, chemotherapy, radiotherapy, and vaccine therapy are applied for its treatment, individually or in combination, the survival rate in advanced cervical cancer patients is still very low, and the side effects of the therapies are continuing to increase [3,4]. In addition, the 2-, 4-, and 9-valent HPV vaccines do not show any clinical effectiveness in the treatment of cervical cancer [5][6][7]. Therefore, there is an urgent need to explore more effective drugs to prevent cervical cancer cell invasion and improve the quality of life in cervical cancer patients.…”