Fertility Preservation and Cervical Cancer: Fertility-Sparing Surgery and Cervical Cancer in Pregnancy

About 40% of the diagnoses of cervical cancer occur during the reproductive age. With the increasing age of first pregnancy, both cervical cancer diagnosis during conception attempt and pregnancy are more common events. Although the oncologic outcome is the primary objective of these treatments, in selected women wishing to preserve fertility, a fertility-sparing surgery (FSS) should be considered. Many factors must be evaluated including stage, histological subtype, lymph node status, lymphovascular space invasion, size of the disease, and, nonetheless, the experience of the health care team. We review the indications, techniques, fertility and obstetric outcomes of FSS. Increasing evidence has shown that cervical cancer during pregnancy is a condition that can be treated. However, many issues remain to be discussed: i) how to make a correct diagnosis and staging of the disease; ii) what is the most appropriate treatment; iii) when to start treatment and what is the risk of delaying the treatment to allow for better fetal maturity; iv) what is the preferred mode of delivery; v) how pregnancy affects the progression and prognosis of neoplasia. We have reviewed the tumor factors, gestational age, obstetrical conditions and complications related to cervical cancer during pregnancy. The chapter reviews the evidence for the best possible treatment of this challenging medical condition, including the psychological aspects related to such diagnosis, helping the clinician and the patient clarify their concerns and wishes regarding the continuation of the pregnancy and the cancer treatment.

Keywords: Cancer in pregnancy, Cervical cancer, Chemotherapy in pregnancy, Conization, Fertility, Fertility-sparing surgery, HPV, Radiation therapy in pregnancy, Trachelectomy.