A 31-year-old woman was diagnosed cervicalcancer after pregnancy, facing the dilemma of saving the child or radicaltreatment of the cancer. Kaijiang Liu from Department of Gynecological Oncologyof Renji Hospital elaborated a "two-step" treatment program. Underthe condition that the patient had successfully given birth to a baby boy inOctober, the uterus which had served its useful purpose was successfully cutoff together with the cancer on November 23, to achieve a happy ending of "tohave both fish and bear's paw".

A 31-year-old patient called Mrs. Wanghad been pregnant for 26 weeks in August this year. She came to Renji Hospital toseek help from Professor Kaijiang Liu, Director of Department of Gynecological Oncology,for her vaginal bleeding. Ultrasound and pelvic MRI showed that there was a 4cmlocal tumor in Mrs. Wang’s cervix uteri, with a clear diagnosis of"pregnancy with cervical squamous cell carcinoma ⅠB2 phase".When the patient was diagnosed, she had been pregnant for 26 weeks and thecervical tumor was locally large. It was necessary to remove the uterus to curethe cervical cancer immediately. However, organ development of the 26-weeks-fetusis immature; fetus through premature cesarean section also can not survive.Fortunately, after a series of inspections, Director Kaijiang Liu found that thetumor is still confined to the cervix, without distant metastasis.

 After a discussion within thedepartment, the doctors decided to use chemotherapy to control the cancer firstlyand meanwhile preventing miscarriage. According to Kaijiang Liu, as most of theorgans have been developed well for most fetuses in late pregnancy, neoadjuvantchemotherapy drugs rarely lead to fetal malformations. Therefore, 1-2 monthsafter chemotherapy, when the fetus was mature the child could be removed throughcesarean section, and then a wide range of laparoscopic hysterectomy can beperformed. As a result, Director Kaijiang Liu developed a treatment strategy "tohave both fish and bear's paw" for the patient. That is, after threecourses of neoadjuvant chemotherapy, the gestational age can be extended to 34weeks. Cesarean section can be performed until the fetal lung developed moremature. After another course of chemotherapy in the puerperal regimen, pelviccongestion and edema can be reduced, so that laparoscopic wide-hysterectomy canbe performed.

 After three months ofneoadjuvant chemotherapy, coupled with close monitoring of the cancer duringpregnancy, the 34-weeks-pregnant patient had caesarean section at a localhospital and successfully delivered a healthy baby boy on October 17. Then Mrs.Wang used another 4 courses of neoadjuvant chemotherapy, and returned to Departmentof Gynecological Oncology of Shanghai Renji Hospital on November 14. Reexaminationshowed that the local tumor has been effectively controlled and no distantmetastasis was found.

 On the morning of November 23, DirectorKaijiang Liu carried out laparoscopic radical hysterectomy and pelvic lymphnode dissection for the patient. Director Kaijiang Liu introduced that just onemonth after birth, the patient’s uterus has not fully returned to normal after caesareansection. Severe edema and pelvic congestion could easily lead to intraoperativebleeding. Laparoscopic radical hysterectomy and lymph node dissectionsignificantly reduced the patient's trauma, to improve the patient's recovery. Thesuccessful surgery lasted 2 hours, with only 10ml bleeding. The protracted war lastedmonths, the patient not only round the "mother's dream", and the cervicalcancer which scared the patient all along the pregnancy was completely eradicated.Mrs. Wang said that although she knew that she would have a hysterectomy, shewas much calmer now because her baby was not only born a month ago but was ingood condition, so she no longer regreted.

  It is reported thatcervical cancer is the most common gynecological malignancy in developingcountries, including China, and the age of onset got gradually younger. Theprevalence age has been advanced from 50-60 years old in the past to thepresent 40-50 years old; of which 5% -10% of patients have not had childbirth. DirectorKaijiang Liu introduced that, with the increasingly widespread application of theconcept of minimally invasive treatment of gynecologic cancers, currently laparoscopicsurgery rate is more than 95% for a variety of gynecological benign tumors in Departmentof Gynecological Oncology of Renji Hospital. Laparoscopic surgery rate is morethan 90% for common gynecological malignant tumors, such as endometrial cancer,cervical cancer, early ovarian cancer and other malignancies, ranking thecountry's leading position. In particular, he pointed out that the Departmentof Gynecological Oncology has carried out more than 100 cases of laparoscopicreproductive-functional cervical cancer surgeries in the past eight years andranks among the top hospitals in the country. Currently, nearly 20% of thepatients successfully got pregnant after surgery. (Reporter Shan Tan and HuiyunYuan / Translator Weiwei Zhang)