CHAPTER 33 - PREINVASIVE AND INVASIVE CARCINOMA OF CERVIX 429

Stogewise Treahnent of Cancer of the Cervix 2. Transposition of the ovaries outside the pelvis in case
radiotllet-ap)' is required
Stage Ia l Coniation or exu-afacial 3. OOC)Le and embt)'O Cf)Opreservation prior to chemo•-a-
hysterenomy (Type I) di ation
Stage la2 Modified 1-adical hysterectomy
(Type II)
Or Radical trachelectOmy in CARCINOMA IN PREGNANCY
yo ung wome n
Stage lb l Rad ical h)•Sterectomy (Type Ill ) PREINVASIVE CANCER IN PREGNANCY
Or Rad ical trache lec tomy in When a yo ung woman presents witll bleed ing el uting preg-
yo ung women nancy or postcoital b leeding, it may be a sign of early stage
Stage lb2 Radical hysterecto my (Type lll) disease of ce rvix.
Or Chemoradiation The cervix may appear nonnal or show chro nic cervicitis
Stage Ila Radical h)Sterectomy (Type Ill) or erosio n. Pap smear and colposcop)-directed biopsy con-
O r Chemoradiatio n finn the diagnosis. Cone biopS)' should be avoided in preg-
Stages lib, lil a, Illb Chemoradiation nancy whene,er possible, because of •·isk of postbiopsy
Stage IV Palliative •-adiotherapy bleeding and abo•·tion. Besides, transform ation LOne is usu-
ally clearly visible dut·ing pregnancy for biopsy. In case of
Recu.-rem carcinoma Exenteration operation/ preinvasive lesion and Stage la 1 lesion, the woma n is al-
of the cervix chemotherapy lowed a vaginal deli ve ry, provided invasive lesio n is ex-
cluded. Six wee ks postpartum, ano ther Pap smea r followed
Conservative Surgery in a Young Woman b)' colposcopy will he lp to evaluate Ll1e case for an)' furtl1er
In a yo ung woman d iagnosed lO have ea rly stage cancer treatm ent (Fig. 33.'1 1).
cervix (Stages Ia, lb1) , it is possible LO preserve her uterus INVASIVE CANCER OF THE CERVIX IN PREGNANCY
for fuwre childbearing. ln a )Oung woman wishing to
co nse rve fertility potential , the following measures are The incidence of cancer of tile cervix is reported in 1:2500
recent!) being u;ed: pregnancies.
The woman presents "~th ameparLum haemon·hage.
I. Trachelectomy with lymphadene ctomy and cervical The cervix presents a similar pictu•·e as in the nonpregnant
cerclage condition. Confinnation of diagnosis is based on a cervical

Abnorm al Pap smear in pregnancy

Multiple biopsies/LLETZ/LEEP
Repeat 2-3 monthly
(no cone biopsy)

t !
Normal cytology
l 1
t CIN!Stage lA >Stage lA

Vaginal delivery
l l
l Vaginal delivery
l 1
Repeat Pap smear
in 3-6 months l
Follow w ith repeat
Terminate in
early pregnancy
Near term,
wait for viability

smear in 3112
l
Classical CS and
appropriate to
management
4 weeks later
Rgure 33.41 A bnormal Pap smear In pregnancy.