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196 Locally advanced cancer of the cervix in pregnancy: peculiarities of presentation and challenges of management in a resource-poor setting

Objectives Cancer of the cervix is the commonest female malignancy in north-western Nigeria. In resource poor settings where cancer screening is not readily available, accessible and affordable, advanced cervical cancer can be diagnosed for the first time in pregnancy. The objective of this report is to highlight the peculiarities of presentation and management challenges of cervical cancer in pregnancy in our setting. Methods A retrospective review of case folders of the four patients with cervical cancer in pregnancy, diagnosed and managed in our institution, over a one-year period was carried out. Results Seventy-seven cases of newly diagnosed cervical cancer were seen. Of these, four (5.2%) were diagnosed in pregnancy. They were unbooked grandmultiparae, never had cervical cancer screening, presented in the third trimester with antepartum haemorrhage and abnormal vaginal discharge, and all of them had locally advanced disease. Two had neoadjuvant chemotherapy and all of them were delivered via caesarean section. None of them could access radiotherapy postpartum. Two patients died from complications of renal failure within four months of diagnosis, and one has been lost to follow up.Management challenges varied from financial constraint to lack of existing protocol for management, to lack of facilities for investigation and treatment (no functional CT scan and radiotherapy), and sociocultural and religious beliefs. Conclusions The clinical course of cancer of the cervix in pregnancy, though said to be similar to non-pregnant patients, could be more aggressive. A prospective multicenter study in our setting will be needed. The management challenges, though numerous, are surmountable.