Pregnancy with Cervical Cancer Stage III B

Abstract

The most common gynecological malignant tumors in pregnancy are cervical cancer, accounting for 71.6%, followed by ovarian malignant tumors, accounting for 7.0%. During pregnancy, gynecological examination is limited, and therefore, the rate of misdiagnosis is higher. Estimated incidence of 0.8 to 1.5 cases per 10 000 births. Estrogen, progesterone and human chorionic gonadotropin during pregnancy has positive correlation with HPV 16 and HPV 18 infections, besides that increased vascularization and lymphatic circulation in the cervical region pregnancy showed increased development of cervical cancer. The treatment of cervical cancer during pregnancy is related to many factors, such as tumor size, pathological type, period of gestation, lymph node involvement, and fertility sparing. This case report aims to discuss the diagnostic challenges, etiology, management strategies, and outcomes associated with the condition of pregnancy with cervical cancer. A woman, 36 years old, 36-37 weeks gestational pregnancy, came to outpatient at Ulin Hospital, Banjarmasin with not in labor. During antenatal care the patient wes complained of vaginal bleeding at 12 weeks gestational was told to have a low-lying placenta but bleeding continued and became increased severe until 5xpads/day and received blood transfusion and then underwent a cervical biopsy examination for result of adenocarcinoma. Patient was evaluated staging oncogynecologist with diagnosis cervical cancer IIIB and suggested to chemotherapy at 28 weeks gestational age (early May 2024) but patient refused. Then patient had evaluated US MFM result Fetal, Single, Live, Intra Uterine, Cephalic Presentation, Gestational Age ~35-36 weeks , placenta implantation in corpus posterior Gr II- III with sufficient amniotic fluid. Hypohyperechoic mass size 7.93 x 6.47 cm in cervical region suggest to ca cervix. Patients suggest to mode of delivery perabdominal and treatment ca cervix according to oncogynecologist. Pregnancy with cervical cancer is not typical and resembles other diseases in pregnancy. Some researchers say that pregnancy accelerates the occurrence of metastasis and cancer development. This causes increased vascularization and lymphatic circulation in the cervix which indicates pregnancy promotes the development of cervical cancer as well as estrogen, progesterone and HCG levels which prevent infection with HPV 16 and 18. It is safe to confirm cervical cancer with high lesions using cervical biopsy . Management of pregnancy with cervical cancer according to mass size, histology results, gestational age and fertility-saving staging.