Although surgical therapy and radiation are equally efective, radical hysterectomy plus pelvic lymphadenectomy is the preferred treatment for invasive cervical cancer in most young women with stage I and early stage IIA lesions. Disadvantageously, radiotherapy for cervical cancer destroys ovarian and possibly sexual function, and frequently causes intestinal and urinary tract injury. In 49 women with pregnancy-associated stage
IB cancer, a 30-percent severe complication rate accompanied radiotherapy compared with that of only 7 percent with radical surgery (Nisker, 1983). With surgery before 20 weeks' gestation, radical hysterectomy is usually performed with the fetus in situ.
In later pregnancy, however, hysterotomy is oten performed first.
Although less commonly selected during pregnancy, other cers. U ngGr and colleagues (2006) performed abdominal radical in five pregnant women. Yahata and associates (2008) treated four women at 16 to 23 weeks for stage IA1 adenocarcinoma with laser conization, and all delivered at term. Van Calsteren and coworkers (2008) reported similar success.
For more advanced-stage cancer, radiotherapy is given.
External beam radiation in early in pregnancy typically leads to spontaneous abortion. If miscarriage does not ensue, curettage is performed. During the second trimester, spontaneous abortion up to a fourth of cases. his is selected because labor induction or dilation and evacuation may pose serious hemorrhage risks.
Pregnancy does not have a negative efect on the prognosis of cervical cancer, and survival outcomes are similar for preg nant and nonpregnant women (Amant, 2014; Mogos, 2013).
In a case-control study of 44 women with pregnancy-associated cervical cancer, the overall 5-year survival rate approximated (van de' Vange, 1995).
Delivery. Any adverse prognostic efects that vaginal delivery through a cancerous cervix might have are unknown. For this reason, the mode of delivery is controversial, especially for small, early-stage lesions. In some cases of bulky or friable tumors, significant hemorrhage from the cancer may complicate vaginal delivery. Also, recurrences have been reported in the episiotomy scar, which result from tumor cells apparently "seeding" the episiotomy (Goldman, 2003). Thus, most favor cesarean delivery.
Pregnancy ater Radical Trachelectomy. There is growing experience with pregnancy in women who have undergone fertility-sparing radical trachelectomy for stage IB 1 and IB2 cervical cancer before conception. During the typically vaginal procedure, the cervix is amputated at the level of the internal os, and a permanent-suture cerclage is placed around the isthmus for support in future pregnancies. The uterine isthmus is then reconstructed to the vagina. Because of the permanent cerclage, a classical cesarean incision is required for delivery.
Shepherd and colleagues (2006) presented outcomes for 123 such women cared for at their institution. Of 63 women who attempted pregnancy, 19 had 28 live births. All underwent classical cesarean delivery, and one fourth delivered before 32 weeks. Similar findings were reported by Kim (2012) and Park (2014) and their coworkers.
Also known as myomas and somewhat erroneously called ibrois, uterine leiomyomas are common benign smooth-muscle tumors.
heir incidence during pregnancy approximates 2 percent, and the cited range depends on the frequency of routine sonography and population characteristics (Qidwai, 2006; Stout, 2010). In one study of 4271 women, the irst-trimester leiomyoma prevalence was highest in black women-18 percent-and lowest in whites-8 percent (Laughlin, 2009).