title: Early invasive cervical cancer during pregnancy: different therapeutic options to preserve fertility.
abstract: BACKGROUND
  Cervical cancer is the second most common cancer diagnosed during pregnancy. Conservative management is possible, and different options should be discussed with patients. The main decision parameters are stage of disease, lymph node status, trimester of pregnancy and wishes of the patient. We reviewed our experience on cases of early-stage cervical cancer discovered during pregnancy and treated with different options of fertility-sparing management.
  
  
  METHODS
  Between 1990 and 2010, 5 patients with early-stage cervical cancer diagnosed during pregnancy were referred to our department for fertility-sparing treatment. The mean age at diagnosis was 28.6 years (range, 26-30 years). The stages of the tumors according to the International Federation of Gynecology and Obstetrics were IA2 in 2 women and IB1 in 3 women. The histological type was squamous carcinoma in 3 cases and adenocarcinoma in 2 cases. All patients willing to preserve their fertility were treated with vaginal radical trachelectomy (VRT) and pelvic lymph nodes dissection (PLN-D).
  
  
  RESULTS
  Three procedures were performed in the first trimester: 1 patient was treated with medical abortion and then VRT and PLN-D, 2 patients were submitted to VRT and PLN-D during the first trimester, and 1 patient's case was complicated by spontaneous abortion. One patient was observed during the second trimester (20 weeks of gestation) and treated with VRT and PLN-D during pregnancy. Because this patient had pelvic lymph nodes positive for cancer, a cesarean delivery (CD) with radical hysterectomy and para-aortic lymph nodes dissection was performed followed by chemoradiotherapy. The last patient was evaluated during the third trimester of her pregnancy. Treatment included CD followed by VRT and PLN-D, which was delayed, to allow fetal maturity.
  
  
  CONCLUSIONS
  Diagnosis of cervical cancer can occur during pregnancy. Different options of fertility-sparing treatment can be discussed on the basis of several factors: tumor stage, gestational age, and the patient's desire regarding fertility and pregnancy sparing.
authors.affiliation: Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Genoa, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Ferraioli
authors.forename: Domenico
authors.initials: D
authors.lastname: Ferriaoli
authors.forename: Annie
authors.initials: A
authors.lastname: Buenerd
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Marchiolè
authors.forename: Sergio
authors.initials: S
authors.lastname: Constantini
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Venturini
authors.forename: Patrice
authors.initials: P
authors.lastname: Mathevet
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control*; D010535:Laparoscopy; D008197:Lymph Node Excision; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000517:prevention & control*; D011379:Prognosis; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*