Prise en charge des volumineux cancers invasifs du col de l’utérus pendant la grossesse

Abstract

The purpose of this study is to update the management of pregnant women with advanced cervical cancer, thanks to a literature review indexed in Medline ® (from 1980 till 2006 using those keywords: advanced cervix cancer, neoadjuvant chemotherapy and pregnancy), ScienceDirect (from 1990 till 2006) and the French Encyclopédie Médico-Chirurgicale. It occurs that pregnancy is a privileged period to diagnose cervical cancer, particularly in early stages. We ought to beware of symptoms such as vaginal bleeding, which could be underestimated during pregnancy. Colposcopically selected biopsies are reference techniques to comfirm the diagnostic. The assessment of extension includes an abdominal and pelvic MRI and echography and a radiography of the chest for locally advanced stages. The decision to interrupt pregnancy should be based on a collegial evaluation and depends on state and histology of disease, patient's desire for pregnancy, as well as gestational age and disease evolution. Cesarean is preferred to natural delivery even though survival rates are the same. The cesarean section prevents from short-term complications and recurrence on the episiotomy, but the hysterotomy type is controversial throughout literature. The prognosis of cervical cancer does not seem to be influenced by pregnancy. Management is the same, even though we have to adapt the treatment from the pregnancy state. No study could show the benefit and the safety of neoadjuvant chemotherapy during pregnancy, due to few cases, but it could be a solution with patients suffering from an advanced cancer and not willing to stop pregnancy. To conclude, the detection by cervical smears should be systematic during pregnancy. When cancer is diagnosed, cesarean section is the favourite way to deliver. Pregnancy does not modify disease's prognosis and the therapeutic choice depends on the stage of the disease.