Newswise — A team of researchers in the Gynecologic Oncology Unit of the University Hospital of Bologna, in collaboration with Professor Antonio Giordano from the Sbarro Health Research Organization, has published a revision of the literature about cases of cervical cancer in pregnancy, with the addition of new cases treated at the University Hospital of Bologna. Their work appears in the Journal of Cellular Physiology.
“Cancer during pregnancy is defined as a tumor diagnosed in pregnant women, or in the immediate postpartum,” says Myriam Perrone MD, PhD of the Gynecologic Oncologic Unit and first author of the manuscript. “In the last decade, we observed an increase in incidence of this condition, largely due to later childbearing, and although it has been hypothesized that hormones and growth factors necessary for fetal development may accelerate tumor growth, evidence suggests that pregnancy is not necessarily a poor prognostic factor for patients’ survival.
“Cervical cancer is the second most common form of cancer or pre-cancer diagnosed during pregnancy or postpartum, and occurs in approximately 0.004-0.1% of pregnant women. The rarity of the condition makes large trial studies impossible, and guidelines up to now are based on small case and expert opinions,” Perrone concludes.
“For these reasons, today, diagnostic tools and treatment are similar in pregnant and non pregnant women, with some differences,” explains Alessandro Bovicelli, MD, PhD of the Gynecologic Oncology Unit of the University of Bologna and co-author of the manuscript. “In pregnant women, conservative surgery can be proposed as primary treatment of early stage cervical cancer, such as cone and lymphadenectomy. However, in women with advanced stage, neoadjuvant chemotherapy is a possible option of treatment.”
“Individualized therapies are strongly recommended and the treatment decision should be made collaboratively with a multidisciplinary team consisting of obstetricians, gynecologists, oncologists, pediatricians, and psychologists,” adds Professor Pierandrea De Iaco, Director of Gynecologic Oncology Unit of University Hospital of Bologna. “Over the years and with the publication of new studies, the treatment strategy has gradually changed to a more conservative treatment, particularly for patients in second or third trimester with early stage cancer. Furthermore, it has been reported that neoadjuvant chemotherapy has been successful at controlling the disease and delaying delivery until fetal maturity, without serious adverse effects on the mother and foetus.
“Time of delivery must be evaluated with obstetricians, as the point of fetal maturity is the main issue,” concludes De Iaco.
“Cancer in pregnancy is not an acute emergency and clinicians should take all the time necessary to study the case and offer the best diagnosis and therapy,” says Perrone. “Treatment of patients with cancer in pregnancy should be offered in gynecologic oncology centers associated with experienced perinatal centers to provide patients with expertise in all needed aspects.
“In the future, the development of molecular markers and their routine use could help in the clinical decision making,” concludes Perrone.
About the Sbarro Health Research Organization
The Sbarro Health Research Organization (SHRO) is non-profit charity committed to funding excellence in basic genetic research to cure and diagnose cancer, cardiovascular diseases, diabetes and other chronic illnesses and to foster the training of young doctors in a spirit of professionalism and humanism. To learn more about the SHRO please visit www.shro.org
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