Cervical cancer in pregnancy

Abstract

Background: Cervical cancer is one of the most frequent cancers in pregnant women, despite this combination being a rare condition. More than 70% of cases are diagnosed in early stages and its treatment can be postponed after the delivery. Invasive cancer diagnosis in pregnancy is difficult for a patient, her family and doctors. A multidisciplinary team should take care of the patient and foetus and patient‘s wishes are respected regarding her treatment and pregnancy. Radiotherapy in pregnancy is contraindicated. Neoadjuvant or adjuvant chemotherapy is therefore a main treatment method in patients with high risk disease either during pregnancy, or after the delivery. Neoadjuvant chemotherapy choice, delivery timing and definitive treatment are keys to mother‘s and child‘s health. Palliative treatment during pregnancy is extremely rare and the prognosis is poor. Bevacizumab and pembrolizumab are promising in the palliative treatment of non-pregnant patients. Neither biological therapy by bevacizumab, nor immuno-therapy by pembrolizumab can be administered to pregnant patient due to their mechanisms of action. Purpose: This overview‘s aim is to analyse data of cervical cancer treatment for pregnant women, focusing on diagnostics, therapy and delivery timing and treatment modalities choice according to the stage of the disease and gestational age. Individual approach is always necessary; our aim is, however, to emphasise current evidence-based recommendations in pregnancy.