Abstract | November 18, 2023
A Rare Case of Metastatic Cervical Cancer in Twin Pregnancy
Learning Objectives
- Main objectives: Early disease stages can be asymptomatic, but patients with locally advanced or metastatic disease may present with vaginal bleeding, post-coital bleeding, pelvic pain, urinary symptoms, and bone pain. Staging of cervical cancer involves components such as tumor size and lymph node involvement. The treatment for locally advanced cervical cancer consists of chemoradiation consisting of weekly cisplatin with radiation therapy which the patient did not receive. This case illustrates a comparison of the treatment plan that was offered and what could be deciphered as part of the treatment plan for the patient versus the standard of care. Because cervical cancer recurred during 2nd trimester of pregnancy, treatment options were limited to chemotherapy and radiation during postpartum period. Unfortunately, the delayed management of cervical cancer led to an unfavorable outcome for this patient.
- Recognize signs and symptoms of advanced stage cervical cancer
- Identify the main treatment methods for advanced cervical cancer
- Discuss the management of cervical cancer during pregnancy
Introduction: Cervical cancer is the 4th most common cancer in women worldwide and the 7th most common cancer worldwide. Each year in the US, there are about 13,000 new cases and 4,000 deaths from cervical cancer. It is most frequently diagnosed at age 35-44 with the average age of diagnosis at 50. The incidence of pregnancy complicated by cervical cancer is low. When diagnosed, it is usually confined to the cervix. Some studies suggest that pregnancy may accelerate the progression of cervical cancer, however the cause is still unknown. Although the incidence of cervical cancer has significantly decreased with the implementation of HPV vaccination, it is still a cause of morbidity and mortality.
Case Presentation: This is a 26-year-old G2P1103 African American female who initially presented to establish prenatal care with dichorionic- diamniotic twin pregnancy at 21 weeks gestation. She transferred care from the Bahamas with a history of cervical cancer diagnosed in December 2020. She underwent 5 rounds of chemotherapy without radiation in early 2021. She was found to have recurrence of disease on colposcopy at 17 weeks gestation. Physical exam revealed grossly evident cervical cancer with tumor approximately 4cm and solid mass approximately 6-7cm in the posterior cul-de sac. Imaging revealed a large, lobulated 3.8 x 6.9 cm cervical mass and a large mass in the retroperitoneum, involving the iliopsoas measuring 16 x 9.5 x 19 cm.
Final Diagnosis: Biopsy of the masses confirmed metastatic squamous cell carcinoma.
Management/Outcome: With shared decision making, she carried both fetuses to viability and proceeded with chemoradiation 1 week post-delivery. She delivered 2 viable fetuses at 24 weeks by primary cesarean section. One of her infants passed away on day 3 of life. Post delivery MRI revealed interval enlargement of the cervical and iliopsoas mass with metastasis to the liver, bone, ureter, and bladder. She started chemoradiation with weekly cisplatin with plans for multiple rounds of palliative radiation therapy. This was not completed because the patient returned to the Bahamas and passed away several months later.
References and Resources
- American Cancer Society | Cancer Facts & Statistics. (n.d.). American Cancer Society | Cancer Facts & Statistics. Retrieved March 1, 2023, from https://cancerstatisticscenter.cancer.org/?_ga=2.177611557.1262346180.1675109928-42259284.1675109927#
- Beharee, N., Shi, Z., Wu, D., & Wang, J. (2019). Diagnosis and treatment of cervical cancer in pregnant women. Cancer Medicine, 8(12), 5425–5430. https://doi.org/10.1002/cam4.2435
- Cervical Cancer Statistics. (2019). https://www.cdc.gov/cancer/cervical/statistics/index.htm
- Cervical cancer statistics I World Cancer Research Fund International. (n.d.). WCRF International. https://www.wcrf.org/cancer-trends/cervical-cancer-statistics/
- Cervical Cancer Treatment during Pregnancy – NCI. (2022, October 13). Www.cancer.gov. https://www.cancer.gov/types/cervical/treatment/cancer-treatment-during-pregnancy
- Pang, S. S., Murphy, M., & Markham, M. J. (2022). Current Management of Locally Advanced and Metastatic Cervical Cancer in the United States. JCO Oncology Practice. https://doi.org/10.1200/op.21.00795
