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Neoplasms in pregnancy (Breast cancer (Risk factors for breast cancer in…

- - - - CERVICAL BIOPSY (curettage contraindicated!)
        Cervical biopsy under colposcopic control has 75-95% sensitivity, cone biopsy is superior to point biopsy
        
        Conization, optimally LEEP/LETZ – indicated only if one has to distinguish between microinvasive and invasive cervical cancer
        -Complications:
        bleeding (5-10%) – risk increases proportionally to gestational age;
        miscarriage (25%), preterm labor (12%);
        Risk of suboptimal resection – 50%!!
        -Optimally between 14 and 20 weeks; indications to conization decrease with gestational age due to increased risk of pregnancy loss, the highest in the late 2nd trimester and in the 3rd trimester.
  - - - Conization is sufficient approach in stage IA1.
        
        Stage IA2 or IB1, tumor < 2 cm, infiltration corresponding to < 50%: of the stromal thickness
        Recommended lymphadenectomy (laparoscopy or laparotomy),
        = negative lymph nodes --> trachelectomy or radical trachelectomy with cervical cerclage (preferred transvaginal route due to its lower invasiveness; risk for miscarriage unknown due to low number of patients subjected to the procedure);
        = node involvement – routine radical treatment, despite pregnancy.
      - Treatment is determined by duration of pregnancy, colposcopic findings, result of clinical examination, MRI and ultrasonography (tumor size and infiltration depth),
        
        Biopsy in the case of clinically evident tumor;
        
        Treatment delayed until the 2nd trimester – after the 13th week;
        
        Colposcopic evidence for invasive cancer --> diagnostic conization at 12-20 weeks;
      - Stage IB1, tumor > 2 cm, infiltration corresponding to >50% of the stromal thickness:
        Lymphadenectomy (laparoscopy or laparotomy) and chemotherapy (3-6 cycles) before 30-32 weeks – only in lymph node-negative tumors; at 34-36 weeks cesarean section with radical hysterectomy.
        Chemotherapy alone, followed by cesarean section with radical hysterectomy.
      - The aim of neoadjuvant chemotherapy is tumor shrinkage and limitation of its spread,
        
        Platinum derivatives (cisplatin 75mg/m2 or carboplatin AUC 6) combined with paclitaxel (175 mg/m2) or iphosphamide in squamous cell carcinoma, or with doxorubicin (35mg/m2) in adenocarcinoma,
        
        Cisplatin is preferred in pregnancy,
        
        Chemotherapy can be continued up to the 32nd week, followed by 3-week pause before cesarean section and radical radiotherapy (myelosuppression).
      - Labor
        
        Vaginal labor is recommended only in patients without persistent disease;
        
        Although cesarean section is recommended in most cases, there is some evidence for recurrence in the episiotomy or laparotomy scar;
        
        Concomitant cesarean and hysterectomy are associated with high risk of bleeding and postoperative morbidity; performing radical hysterectomy 4-6 weeks after the cesarean is an alternative.
      - Stage IB2 or more advanced cervical cancer:
        radical treatment is recommended irrespective of gestational age.