The course and outcome of pregnancy in the presence of advanced cervical cancer

DOI

https://dx.doi.org/10.18565/aig.2022.6.170-175

Chernyshova А.L., Коlomiets L.А., Ivanova T.V., Usynin E.A., Afanasyev S.G., Shpileva O.V., Dil O.S., Li A.A., Bochkov Yu.A., Devald E.V., Antipov V.A., Krasilnikov S.E.
1) Cancer Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia; 2) Siberian State Medical University, Ministry of Health of Russia, Tomsk, Russia; 3) City Clinical Hospital No. 24, Moscow Healthcare Department, Moscow, Russia; 4) Academician E.N. Meshalkin National Medical Research Center, Ministry of Health of Russia, Novosibirsk, Russia

Background: Cervical cancer occupies a leading position in the pattern of gynecological cancers. The tumor biological uniqueness during pregnancy is the combination of uncontrolled tumor growth and controlled fetoplacental unit growth in one organism. According to statistics, cancer during pregnancy is quite rare: one case per 1,000 pregnancies.
Case report: The authors have presented their own experience in choosing the tactics of follow-up, treatment, and delivery in a patient with stage IV cervical cancer diagnosed in the second trimester of pregnancy. The paper shows the features of the course of the disease, the complexity of pregnancy management, including chemotherapy cycles, as well as the features of delivery and surgical treatment for cervical cancer. It is indicated that for the treatment of cancer during pregnancy, it is necessary to determine and designate the main parameters: the cancer stage, indications for treatment, disease curability, treatment regimens based on modern recommendations, and a multidisciplinary approach to choosing treatment policy.
Conclusion: This clinical case clearly demonstrates the need for complex interaction in decision-making in each individual case of physicians of various specialties: a gynecological oncologist, a morphologist, a radiologist, a chemotherapist, an obstetrician, an anesthesiologist/resuscitator, a neonatologist, as well as a psychologist and a lawyer.

cervical cancer

pregnancy

delivery

chemotherapy

Full text (in Russian)

GLOBOCAN 2018: Estimated cancer incidence, mortality and prevalence worldwide in 2018. IARC. (Internet).
Серов В.Н., Шмаков Р.Г., Полушкина Е.С., Волочаева М.В. Рак и беременность. РМЖ. Мать и дитя. 2015; 20: 1195-7. [Serov V.N., Shmakov R.G., Polushkina E.S., Volochaeva M.V. Cancer and pregnancy. Mother and Child. 2015; 20, , pp. 1195-1197].
Петрова У.Л., Шмаков Р.Г. Новая коронавирусная инфекция 2019 и беременность: что мы знаем? Акушерство и гинекология. 2022; 2: 4-11. [Petrova U.L., Shmakov R.G. The 2019 novel coronavirus infection and pregnancy: What do we know? Obstetrics and Gynecology. 2022; 2: 4-11. (in Russian)]. https://dx.doi.org/10.18565/aig.2022.2.4-11.
Ассоциация онкологов России, Российское общество клинической онкологии. Клинические рекомендации. Рак шейки матки. М.; 2018. [Clinical recommendations. Cervical cancer. 2018. (in Russian)].
Каприн А.Д., Старинский В.В., Петрова Г.В., ред. Злокачественные новообразования в России в 2016 г. (заболеваемость и смертность). М.: МНИОИ им. П.А.Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава России; 2018. 250с. [Kaprin A.D., Starinsky V.V., Petrova G.V. Malignant neoplasms in Russia in 2016 (morbidity and mortality). Moscow: P.A. Herzen Moscow State Medical Research Institute – Branch of the NMRC of Radiology of the Ministry of Health of Russia; 2018. 250 p. (in Russian)].
Айламазян Э.К., Кулаков В.И., Радзинский В.Е., Савельева Г.М., ред. Национальное руководство. Акушерство. М.: ГЭОТАР-Медиа; 2014. 1200с. [Kulakov V.I. National leadership "Obstetrics". 2014. 571 p. (in Russian)].
Вербитская Е.А., Урманчеева А.Ф., Артемьева А.С., Михетько А.А., Новик В.И., Берлев И.В., Микая Н.А., Ульрих Е.А. Беременность, ассоциированная с неинвазивным раком шейки матки. Прогноз для матерей и детей. Опухоли женской репродуктивной системы. 2018; 14(3): 71-6. [Verbitskaya E.A., Urmancheeva A.F., Artemyeva A.S., Mikhetko A.A., Novik V.I., Berlev I.V., Mikaya N.A., Ulrikh E.A. Non-invasive cervical cancer during pregnancy. Prognosis for mothers and children. Tumors of female reproductive system. 2018; 14(3): 71-6. (in Russian)]. https://dx.doi.org/10.17650/1994-4098-2018-14-3-71-76.
Ульрих Е.А. и др. Опухоли репродуктивных органов в сочетании с беременностью. Практические рекомендации. СПб; 2014. 54с. [Ulrikh E.A. et al. Tumors of the reproductive organs in combination with pregnancy: practice guidelines. St. Petersburg; 2014. 54 p. (in Russian)].
Пароконная А.А., ред. Рак и репродукция. М: Галеон; 2012. 208с. [Parokonnaya A.A., ed. Cancer and reproduction. Moscow: Galeon; 2012. 208 p. (in Russian)].
Савельева Г.М., Сухих Г.Т., Серов В.Н., Радзинский В.Е., Манухин И.Б., ред. Гинекология. Национальное руководство. М.: ГЭОТАР-Медиа; 2017. 989с. [Savelyeva G.M., Sukhikh G.T., Serov V.N., Radzinsky V.E., Manukhin I.B., ed. Gynecology. National Guidelines. Moscow: GEOTAR-Media; 2017. 989 p. (in Russian)].
Jeronimo J., Castle P.E., Temin S., Denny L., Gupta V., Kim J.J. et al. Secondary prevention of cervical cancer: ASCO Resource-Stratified Clinical Practice Guideline. J. Glob. Oncol. 2016; 3(5): 635-57. https://dx.doi.org/10.1200/JGO.2016.006577.
An Advisory Committee Statement (ACS), National Advisory Committee on Immunization (NACI). Updated recommendations on human papillomavirus (HPV) vaccines: 9-valent HPV vaccine 2-dose immunization schedule and the use of HPV vaccines in immunocompromised population. May 2017.
Committee Opinion No. 704: Human papillomavirus vaccination. Obstet. Gynecol. 2017; 129(6): 1. https://dx.doi.org/10.1097/AOG.0000000000002052.
Короленкова Л.И. Цервикальные траэпителиальные неоплазии и ранние формы рака шейки матки: клинико-морфологическая концепция цервикального канцерогенеза. М.; 2017. 300с. [Korolenkova L.I. Cervical intraepithelial neoplasia and early forms of cervical cancer: clinical and morphological concept of cervical carcinogenesis. M.; 2017. 300 p. (in Russian)].
Šekoranja D., Repše Fokter A. Triaging atypical squamous cells-cannot exclude HighGrade squamous intraepithelial lesion with p16/Ki67 dual stain. J. Low. Genit. Tract. Dis. 2017; 21(2): 108-11. https://dx.doi.org/10.1097/LGT.0000000000000297.
Bergeron C., Ikenberg H., Sideri M., Denton K., Bogers J., Schmidt D. et al.; PALMS Study Group. Prospective evaluation of p16/Ki-67 dual-stained cytology for managing women with abnormal Papanicolaou cytology: PALMS study results. Cancer Cytopathol. 2015; 123(6): 373-81. https://dx.doi.org/10.1002/cncy.21542.
Chernyshova A., Kolomiets L., Chekalkin T., Chernov V., Sinilkin I., Gunther V. et al. Fertility-sparing surgery using knitted TiNi mesh implants and sentinel lymph nodes: a 10-year experience. J. Invest. Surg. 2021; 34(10): 1110-8. https://dx.doi.org/10.1080/08941939.2020.1745965.
Benhaim Y., Pautier P., Bensaid C., Lhomme C., Haie-Meder C., Morice P. et al. Neoadjuvant chemotherapy for advanced stage cervical cancer in a pregnant patient: report of one case with rapid tumor progression. Eur. J. Obstet. Gynecol. Reprod. Biol. 2018; 136(2): 267-8. https://dx.doi.org/10.1016/j. ejogrb.2006.10.027.

Received 23.03.2022

Accepted 24.05.2022

Alyona L. Chernyshova, Dr. Med. Sci., Professor of the Russian Academy of Sciences, Leading Researcher at the Department of Gynecology, Research Institute of Oncology, Tomsk National Research Medical Center of the Russian Academy of Sciences, +7(913)824-60-72, alacher@list.ru, https://orcid.org/ 0000-0002-8194-2811,
634009, Russia, Tomsk, Kooperativny str., 5.
Larisa A. Kolomiets, Dr. Med. Sci., Professor, Research Institute of Oncology, Tomsk National Research Medical Center of the Russian Academy of Sciences,
+7(913)857-06-35, kolomietsla@oncology.tomsk.ru, https://orcid.org/0000-0002-6854-8940, 634009, Russia, Tomsk, Kooperativny str., 5.
Tatiana V. Ivanova, PhD, Associate Professor, Siberian State Medical University, Ministry of Health of Russia, Itv7@yandex.ru, https://orcid.org/0000-0003-0014-1519,
634050, Russia, Tomsk, Moskovsky trakt str., 2.
Evgeny A. Usynin, Dr. Med. Sci., Head of the Department of General Oncology, Research Institute of Oncology, Tomsk National Research Medical Center of the Russian Academy of Sciences, 7(903)955-29-66, gusi70@list.ru, https://orcid.org/0000-0001-7127-0188, 634009, Russia, Tomsk, Kooperativny str., 5.
Sergey G. Afanasyev, Dr. Med. Sci., Professor, Head of the Department of Abdominal Oncology, Research Institute of Oncology, Tomsk National Research Medical Center
of the Russian Academy of Sciences, +7(903)913-25-74, afanasievsg@oncology.tomsk.ru, https://orcid.org/0000-0002-4701-0375, 634009, Russia, Tomsk, Kooperativny str., 5.
Olga V. Shpileva, Junior Researcher at the Oncology Department No. 4, Research Institute of Oncology, Tomsk National Research Medical Center of the Russian Academy
of Sciences, +7(909)540-54-92, ovshpileva@yandex.ru, https://orcid.org/0000-0003-0617-4688, SPIN code:1441-0681, 634009, Russia, Tomsk, Kooperativny str., 5.
Olga S. Dil, Resident Doctor of the Oncology Department No. 4, Research Institute of Oncology, Tomsk National Research Medical Center of the Russian Academy
of Sciences, +7(913)852-89-60, dilara@tnimc.ru, SPIN code: 7265-4352, 634009, Russia, Tomsk, Kooperativny str., 5.
Andrey A. Li, PhD, Head of the Department of Anesthesiology and Resuscitation, Research Institute of Oncology, Tomsk National Research Medical Center of the Russian Academy of Sciences, +7(913)824-79-46, LiA65@gmail.ru, SPIN code: 1825-9632, 634009, Russia, Tomsk, Kooperativny str., 5.
Yuri A. Bochkov, Assistant at the Department of Anesthesiology and Resuscitation, Siberian State Medical University, +7(909)567-86-76, bua35@mail.ru,
https://orcid.org/0000-0003-3370-3266, Researcher ID (WOS): AFR-9909-2022, 634050, Russia, Tomsk, Moskovsky trakt str., 2.
Edward V. Devald, Assistant at the Department of Anesthesiology and Resuscitation, Siberian State Medical University, Ministry of Health of Russia, +7(905)456-87-54, 634050, Russia, Tomsk, Moskovsky trakt str., 2.
Vitaly A. Antipov, Dr. Med. Sci., Director, VITA CLINIC LLC, +7(963)782-46-72, vitaly-antipov@yandex.ru, https://orcid.org/0000-0003-3522,
127015, Russia, Moscow, Pistsovaya str., 10.
Sergey E. Krasilnikov, Dr. Med. Sci., Professor, Director of the Institute of Oncology, Academician E.N. Meshalkin National Medical Research Center,
Ministry of Health of Russia, +7(913)920-12-25, krasilnikov_s@meshalkin.ru, https://orcid.org/0000-0003-0687-0894, 630055, Russia, Novosibirsk, Rechkunovskaya str., 15.
Corresponding author: Alyona L. Chernyshova, alacher@list.ru

Authors' contributions: Chernyshova А.L. – concept and writing the article, treatment and management of the patient; Коlomiets L.А.: concept of the article; Ivanova T.V., Usynin E.A., Afanasyev S.G., Shpileva O.V., Dil O.S., Li A.A., Bochkov Yu.A., Devald E.V. – surgical treatment of the patient, counselling, editing; Antipov V.A., Krasilnikov S.E. – counselling and editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Ethical Approval: The investigation has been approved by the Ethics Committee of the Cancer Research Institute, Tomsk National Research Medical Center.
Patient Consent for Publication: The patient provided informed consent for the publication of her data.
For citation: Chernyshova А.L., Коlomiets L.А., Ivanova T.V., Usynin E.A., Afanasyev S.G., Shpileva O.V., Dil O.S., Li A.A., Bochkov Yu.A., Devald E.V., Antipov V.A., Krasilnikov S.E. The course and outcome of pregnancy in the presence of advanced cervical cancer.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 6: 170-175 (in Russian)
https://dx.doi.org/10.18565/aig.2022.6.170-175

The course and outcome of pregnancy in the presence of advanced cervical cancer

Chernyshova А.L., Коlomiets L.А., Ivanova T.V., Usynin E.A., Afanasyev S.G., Shpileva O.V., Dil O.S., Li A.A., Bochkov Yu.A., Devald E.V., Antipov V.A., Krasilnikov S.E.

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