Conservative treatment of stage IA1 adenocarcinoma of the cervix during pregnancy.

OBJECTIVE: The incidence of glandular neoplasms of the uterine cervix has been steadily increasing over the past 2 decades. These lesions tend to arise in women of childbearing age. Few reports have described the treatment of glandular neoplasms of the cervix in gravid women. This report describes the preliminary results of treating stage IA1 cervical adenocarcinoma by cervical conization during pregnancy.

METHODS: All patients diagnosed to have FIGO stage IA1 cervical adenocarcinoma between 1990 and 2006 were reviewed and patients diagnosed during pregnancy were identified. Information was abstracted on the clinical data including the presence or absence of disease at the margins of conization, pregnancy outcome, and the follow-up.

RESULTS: Sixteen patients with stage IA1 cervical adenocarcinoma were identified. Four out of the 16 patients were diagnosed during pregnancy. Four women ages 29-37 underwent KTP LASER conization and vaporization at 16 to 23 weeks' gestation. The histology showed that all of the tumors were endocervical type adenocarcinoma. None had lymph-vascular space invasion. All of these patients expressed a strong desire to continue their pregnancy. Two patients had positive conization margins for invasive cancer and underwent a second conization at 20 weeks' gestation and 5 weeks after delivery, respectively. No residual disease was identified in the second conization specimens. All patients delivered at term. One patient was treated with cervical conization alone and 3 patients were treated with an extended radical hysterectomy with pelvic lymph nodes dissection after delivery. No patient had residual invasive cancer in a subsequent surgical specimen. None of the patients had developed recurrent disease after a 2-13-year follow-up.

CONCLUSION: These preliminary data suggest that patients with FIGO stage IA1 cervical adenocarcinoma may be treated conservatively by cervical conization during pregnancy. Although a hysterectomy should be considered at the completion of childbearing, fertility sparing postpartum management could be an option for selected patients.