Difficulty of cervical cancer diagnosis during pregnancy: A case series analysis of the clinicopathological characteristics and prognosis of cervical cancer diagnosed during pregnancy or within 6 months after parturition

Sonoda,Kenzo; Ohgami,Tatsuhiro; Hachisuga,Masahiro; Fujita,Yasuyuki; Okugawa,Kaoru; Yahata,Hideaki; Kato,Kiyoko

doi:10.3892/mco.2021.2229

Difficulty of cervical cancer diagnosis during pregnancy: A case series analysis of the clinicopathological characteristics and prognosis of cervical cancer diagnosed during pregnancy or within 6 months after parturition

Authors:
- Kenzo Sonoda
- Tatsuhiro Ohgami
- Masahiro Hachisuga
- Yasuyuki Fujita
- Kaoru Okugawa
- Hideaki Yahata
- Kiyoko Kato
View Affiliations

Affiliations: Gynecology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka 811‑1395, Japan, Department of Obstetrics and Gynecology, Graduate School of Medical Sciences and University Hospital, Fukuoka 812‑8582, Japan
Published online on: February 8, 2021 https://doi.org/10.3892/mco.2021.2229
Article Number: 67
Copyright: © Sonoda et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Due to the recent trend of women having children at an older age, the number of pregnancies complicated by cervical cancer has increased. In the present study, the clinical characteristics of patients with cervical cancer complicated by pregnancy were analyzed. The clinicopathological characteristics and prognosis of patients with cervical cancer during pregnancy who underwent treatment at Kyushu University Hospital from January 2008 to December 2017 were assessed retrospectively from their medical records. The medical information of patients diagnosed within 6 months after parturition was also evaluated as these patients were considered to be affected by cervical cancer during pregnancy. A total of 19 women were diagnosed with cervical cancer during pregnancy (median age, 33 years), three of whom were diagnosed as negative for intraepithelial lesion or malignancy at the initial visit to a previous clinic after pregnancy. The tumor stage was IA1 in one patient, IB1 in 16 patients, IB2 in one patient and IVB in one patient. The median gestational age at the time of cervical cancer diagnosis was 13 weeks. One patient died of cervical cancer during the follow‑up period. An additional 12 patients were diagnosed within 6 months after parturition. The median age of these patients was 35.5 years. Cancer screening was performed in 10 patients during pregnancy, none of whom were diagnosed with cervical cancer, including three patients who were negative for intraepithelial lesion or malignancy. Of the 12 patients, one had tumor stage IA1, eight had IB1, two had IB2 and one had IIB. Three patients experienced recurrence, of whom one died of cervical cancer. Advanced cervical cancer was diagnosed both during pregnancy and within 6 months after parturition. Diagnosis of cervical cancer during pregnancy is difficult even at an advanced stage; however, rapid diagnosis and prompt multidisciplinary treatment are critical. Therefore, it is necessary to improve the accuracy of cervical cancer diagnosis, and to characterize tumor cells and their microenvironment, during pregnancy.

View Figures

View References

1	Hecking T, Abramian A, Domröse C, Engeln T, Thiesler T, Leutner C, Gembruch U, Keyver-Paik MD, Kuhn W and Kübler K: Individual management of cervical cancer in pregnancy. Arch Gynecol Obstet. 293:931–939. 2016.PubMed/NCBI View Article : Google Scholar
2	de Haan J, Verheecke M, Van Calsteren K, Van Calster B, Shmakov RG, Mhallem Gziri M, Halaska MJ, Fruscio R, Lok CAR, Boere IA, et al: Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: A 20-year international cohort study of 1170 patients. Lancet Oncol. 19:337–346. 2018.PubMed/NCBI View Article : Google Scholar
3	World Health Organization/International Agency for Research on Cancer. Cervix uteri. Source: Globocan 2018. Available from: http://gco.iarc.fr/today/data/factsheets/cancers/23-Cervix-uteri-fact-sheet.pdf. Accessed October 31, 2020.
4	Cancer Registry and Statistics. Cancer Information Service, National Cancer Center, Japan (Monitoring of Cancer Incidence in Japan (MCIJ)). Cancer incidence. Available from: https://ganjoho.jp/en/professional/statistics/table_download.html. Accessed October 31, 2020.
5	Lynge E, Rygaard C, Baillet MV, Dugué PA, Sander BB, Bonde J and Rebolj M: Cervical cancer screening at crossroads. APMIS. 122:667–673. 2014.PubMed/NCBI View Article : Google Scholar
6	National Comprehensive Cancer Network. Guidelines version 1.2021 for cervical cancer. Available from: https://www.nccn.org/professionals/physician_gls/default.aspx. Accessed October 31, 2020.
7	Ebina Y, Mikami M, Nagase S, Tabata T, Kaneuchi M, Tashiro H, Mandai M, Enomoto T, Kobayashi Y, Katabuchi H, et al: Japan society of gynecologic oncology guidelines 2017 for the treatment of uterine cervical cancer. Int J Clin Oncol. 24:1–19. 2019.PubMed/NCBI View Article : Google Scholar
8	Origoni M, Salvatore S, Perino A, Cucinella G and Candiani M: Cervical intraepithelial neoplasia (CIN) in pregnancy: The state of the art. Eur Rev Med Pharmacol Sci. 18:851–860. 2014.PubMed/NCBI
9	Sonoda K, Kobayashi H and Wake N: Cervical carcinoma surveillance counterpoint. In: Patient Surveillance After Cancer Treatment. Johnson FE, Maehara Y, Browman GP, Margenthaler JA, Audisio RA, Thompson JF, Johnson DY, Earle CC and Virgo KS (eds). Springer Science Business Media, New York, NY, pp335-340, 2013.
10	Van Calsteren K, Vergote I and Amant F: Cervical neoplasia during pregnancy: Diagnosis, management and prognosis. Best Pract Res Clin Obstet Gynaecol. 19:611–630. 2005.PubMed/NCBI View Article : Google Scholar
11	Palle C, Bangsbøll S and Andreasson B: Cervical intraepithelial neoplasia in pregnancy. Acta Obstet Gynecol Scand. 79:306–310. 2000.PubMed/NCBI
12	Smith LH, Dalrymple JL, Leiserowitz GS, Danielsen B and Gilbert WM: Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol. 184:1504–1513. 2001.PubMed/NCBI View Article : Google Scholar
13	Amant F, Berveiller P, Boere IA, Cardonick E, Fruscio R, Fumagalli M, Halaska MJ, Hasenburg A, Johansson ALV, Lambertini M, et al: Gynecologic cancers in pregnancy: Guidelines based on a third international consensus meeting. Ann Oncol. 30:1601–1612. 2019.PubMed/NCBI View Article : Google Scholar
14	Morice P, Uzan C, Gouy S, Verschraegen C and Haie-Meder C: Gynaecological cancers in pregnancy. Lancet. 379:558–569. 2012.PubMed/NCBI View Article : Google Scholar
15	Douligeris A, Prodromidou A, Psomiadou V, Iavazzo C and Vorgias G: Abdominal radical trachelectomy during pregnancy: A systematic review of the literature. J Gynecol Obstet Hum Reprod. 49(101607)2020.PubMed/NCBI View Article : Google Scholar
16	Han SN, Kesic VI, Van Calsteren K, Petkovic S and Amant F: ESGO ‘Cancer in Pregnancy’ Task Force. Cancer in pregnancy: A survey of current clinical practice. Eur J Obstet Gynecol Reprod Biol. 167:18–23. 2013.PubMed/NCBI View Article : Google Scholar
17	Van Calsteren K, Heyns L, De Smet F, Van Eycken L, Gziri MM, Van Gemert W, Halaska M, Vergote I, Ottevanger N and Amant F: Cancer during pregnancy: An analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol. 28:683–689. 2010.PubMed/NCBI View Article : Google Scholar
18	Suzuki K, Furuhashi M, Kawamura T, Kubo M, Osato K and Yamawaki T: Comparing papanicolaou test results obtained during pregnancy and post-partum. J Obstet Gynaecol Res. 43:705–709. 2017.PubMed/NCBI View Article : Google Scholar
19	Onuma K, Saad RS, Kanbour-Shakir A, Kanbour AI and Dabbs DJ: Clinical implications of the diagnosis ‘atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion’ in pregnant women. Cancer. 108:282–287. 2006.PubMed/NCBI View Article : Google Scholar
20	Trutnovsky G, Kolovetsiou-Kreiner V and Reich O: p16/Ki-67 dual-stained cytology testing may predict postpartum outcome in patients with abnormal papanicolaou cytology during pregnancy. Acta Cytol. 58:293–296. 2014.PubMed/NCBI View Article : Google Scholar
21	Holt J, Stiltner L, Jamieson B and Fashner J: Clinical inquiries. Should a nylon brush be used for Pap smears from pregnant women? J Fam Pract. 54:463–464. 2005.PubMed/NCBI
22	Sood AK, Sorosky JI, Mayr N, Anderson B, Buller RE and Niebyl J: Cervical cancer diagnosed shortly after pregnancy: Prognostic variables and delivery routes. Obstet Gynecol. 95:832–838. 2000.PubMed/NCBI View Article : Google Scholar
23	Carocha AI, Pedroso C, Correia L, Gomes A and Jorge AF: Glassy cell carcinoma of the cervix and metastasis in episiotomy scar: A case report. J Low Genit Tract Dis. 19:e31–e34. 2015.PubMed/NCBI View Article : Google Scholar
24	Nobbenhuis MA, Helmerhorst TJ, van den Brule AJ, Rozendaal L, Bezemer PD, Voorhorst FJ and Meijer CJ: High-risk human papillomavirus clearance in pregnant women: Trends for lower clearance during pregnancy with a catch-up postpartum. Br J Cancer. 87:75–80. 2002.PubMed/NCBI View Article : Google Scholar
25	Coppolillo EF, DE Ruda, Vega HM, Brizuela J, Eliseth MC, Barata A and Perazzi BE: High-grade cervical neoplasia during pregnancy: Diagnosis, management and postpartum findings. Acta Obstet Gynecol Scand. 92:293–297. 2013.PubMed/NCBI View Article : Google Scholar
26	Frega A, Scirpa P, Corosu R, Verrico M, Scarciglia ML, Primieri MR, Palazzo A, Iacovelli R and Moscarini M: Clinical management and follow-up of squamous intraepithelial cervical lesions during pregnancy and postpartum. Anticancer Res. 27:2743–2746. 2007.PubMed/NCBI