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A 39-year-old para 4 cis-woman presents with a history of an office loop electroexcision procedure (LEEP) one year ago. She was told that they “got everything” during her LEEP. At her one-year follow-up appointment, her cervical cytology and human papillomavirus (HPV) testing were abnormal. She reports that a hysterectomy was recommended for recurrent dysplasia. She desires future fertility. She presents for a second opinion as she did not feel heard at her last doctor’s visit. She reports she is otherwise doing well. She is sexually active with male and female partners and uses condoms regularly. Menses are five days long and occur monthly. Her flow is heavy, but this does not bother her. She is a former smoker, with a 10-year pack history, and uses marijuana regularly. She has no other significant past surgical history. She is currently taking cetirizine and is allergic to sulfa antibiotics.
This chapter describes the diagnosis, treatment, and prognosis for cervical cancer in pregnancy. The majority of women with early cervical cancer are asymptomatic and are diagnosed by abnormal cytology. Patients with advanced or disseminated disease can have a wide variety of symptoms including pelvic pain, flank pain, and respiratory distress. Conization during pregnancy should be viewed as diagnostic and not therapeutic due to a high rate of positive margins and residual disease as demonstrated by E. V. Hannigan. The clinical staging may include plain film radiographs, an intravenous pyelogram (IVP), or a barium enema, but not findings at the time of surgery, computerized tomography (CT), or magnetic resonance imaging (MRI). CT scanning can be performed with minimal risk in the pregnant patient and is helpful in determining the presence of lymphadenopathy or hydronephrosis. The effect of pregnancy on prognosis is controversial, especially in the higher stages of the disease.
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