Cervical cancer during pregnancy poses a rare and complex clinical and ethical challenge, particularly in low- and middle-income countries such as the Philippines. The dual obligation to preserve maternal life while protecting fetal viability requires a nuanced balance between medical science, ethics, and cultural values.This commentary explores the ethical implications of treating cervical cancer in pregnancy using Intensity Modulated Radiation Therapy (IMRT) at reduced standard radiation volumes, highlighting how medical innovation intersects with the principles of biomedical ethics.

Human ; Neoplasms ; Pregnancy ; Radiotherapy ; Radiation ; Ethics, Medical ; Bioethics ; Fetal Viability ; Life

Neural tube defects are reported one of the important congenital malformation in the world, with an incidence of 1.4 to 2 per 1000 pregnancies. Maternal serum AFP at the second trimester is used as screening test. But this is associated with numerous causes, including twins, fetal death, misdated pregnancies, cystic hygromas, teratomas, renal abnormalities, esophageal atresia and aberrations in the placenta. If the AFP level was elevated, targeted ultrasonography should be evaluated for confirming the gestational age and fetal viability, fetal number. Then if the ultrasonographic examination is nondiagnostic, or if an NTD is suspected, amniotic fluid AFP should be measured with acetylcholinesterase. But the false positive rate of the AF-AFP is high, and there is 0.3% of the false positive rate in amniotic acetylcholinesterase. This time the women with normal ultrasonographic examination continue the pregnancy after counseling of family history, past history with follow up of ultrasonography. We report a case with elevated second trimester MS-AFP, AF-AFP and positive amniotic acetylcholinesterase, but in which repeated sonographic findings were normal and result in delivery of a healthy baby without anomalies.
Acetylcholinesterase* ; Amniotic Fluid ; Counseling ; Esophageal Atresia ; Female ; Fetal Death ; Fetal Viability ; Follow-Up Studies ; Gestational Age ; Humans ; Incidence ; Lymphangioma, Cystic ; Mass Screening ; Neural Tube Defects ; Placenta ; Pregnancy Trimester, Second ; Pregnancy* ; Teratoma ; Ultrasonography

When the cervical cancer is diagnosed in early stage during pregnancy, the treatment can be postponed for fetal viability. This case presents a patient diagnosed as cervical cancer stage Ib1 during her pregnancy. The patient had 2 cycles of neoadjuvant chemotherapy (Paclitaxel-cisplatin) formerly and cesarean section was done at 33rd weeks of intrauterine pregnancy, then radical abdominal hysterectomy with bilateral pelvic lymph node dissection and paraaortic lymph node biopsy was immediately performed right after the delivery. For the baby born, there was neither complication nor congenital anomaly but mild bilateral ventriculomegaly seen on brain CT taken on 3 days after birth. This case offers a better chance for both mother and fetus while conserving fetal viability and managing the early cervical cancer during pregnancy through close follow up.
Biopsy ; Brain ; Cesarean Section ; Drug Therapy* ; Female ; Fetal Viability ; Fetus ; Follow-Up Studies ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Mothers ; Parturition ; Pregnancy* ; Uterine Cervical Neoplasms

Invasive carcinoma of the cervix during the pregnancy is relatively uncommon , It must be considered fetal viability, tumor control as well. If the carcinoma is diagnosed in the first or second trimester, treatment should be undertaken immediately. At the third trimester, treatment should be undertaken until the fetus is viable.
Cervix Uteri ; Female ; Fetal Viability ; Fetus ; Humans ; Pregnancy Trimester, Second ; Pregnancy Trimester, Third ; Pregnancy* ; Uterine Cervical Neoplasms