Multimodality therapy for stage IB3 cervical cancer with a delayed diagnosis at 21 weeks of gestation: from neoadjuvant chemotherapy to adjuvant chemoradiotherapy-a case report.
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BACKGROUND: Gestational cervical cancer is rare, with an incidence of 1.4-4.6 per 100,000 pregnancies. Managing locally advanced cervical cancer in the second trimester is challenging, requiring a balance between maternal oncological safety and fetal viability. No standardized protocol exists for stage IB3 cervical cancer diagnosed at 21 weeks of gestation. CASE PRESENTATION: A 27-year-old primigravida at 21 weeks of gestation was diagnosed with stage IB3 cervical squamous cell carcinoma. Initial SCC was 60.15 ng/mL, and MRI was suspicious for stage IIB disease. The patient had no routine prenatal care, and placenta previa on ultrasound contributed to misdiagnosis and delayed recognition. Following multidisciplinary team consultation, she received four cycles of neoadjuvant chemotherapy (nab-paclitaxel 400 mg + cisplatin 140 mg per cycle). Serial SCC showed initial response, a plateau with mild elevation after the third cycle, and a modest decline after the fourth (29.33 ng/mL). At 36 weeks, after dexamethasone for fetal lung maturation, concurrent cesarean section and radical surgery (hysterectomy, lymphadenectomy, ovarian transposition) were performed. A live female neonate (2095g, Apgar 10/10) was delivered. Pathology confirmed moderately differentiated squamous cell carcinoma with intermediate stromal invasion (>1/3 and <2/3) and perineural invasion, without lymphovascular invasion or nodal metastasis. Adjuvant pelvic radiotherapy with concurrent cisplatin and vaginal brachytherapy was given. At last follow-up (June 2026), SCC remained normal with no recurrence, and the child showed normal development. CONCLUSION: Sequential multimodal therapy-NACT, delayed radical surgery at 36 weeks, and adjuvant chemoradiotherapy-is feasible for stage IB3 cervical cancer in the second trimester. Serial SCC monitoring is a useful biomarker for guiding treatment decisions. This case highlights pitfalls including diagnostic delay, radiological overstaging, and false-negative TCT, emphasizing the need for thorough examination and high suspicion in pregnant patients with atypical bleeding.