Cervical cancer in women under age 40: A cohort study of clinicopathological characteristics and fertility-sparing surgery outcomes

Abstract

Objectives

The clinical management of cervical cancer patients under age 40 presents unique challenges, requiring a balance between complete cancer resection and fertility preservation. This study aimed to report on the clinicopathological characteristics of a cohort of young patients, along with the oncologic and reproductive outcomes of those who underwent fertility-sparing surgery (FSS).

Methods

The pathology database at a single institution was searched for women under age 40 who were diagnosed with invasive cervical cancer between 2015 and 2022. Electronic medical charts were reviewed for demographics, tumor characteristics, clinical management, and surveillance. Statistical analysis was performed using Wilcoxon rank-sum test and chi square test.

Results

A total of 57 patients (median age: 34 years; range: 27–40 years) met the inclusion criteria. Cancer histology included squamous cell carcinoma (70 %), adenocarcinoma (28 %), and adenosquamous carcinoma (2 %). The FIGO stage was I (72 %), II (7 %), III (19 %), and IV (2 %). The sensitivity of cytology was 67 %, with notably low significantly for adenocarcinoma (38 %). HPV vaccination documentation was missing for 44 patients (77 %). Among the 16 patients with stage I cancer who underwent FSS, one experienced cancer recurrence (7 %), and four successfully achieved pregnancy.

Conclusions

Our cohort study of young cervical cancer patients highlights deficiencies in cervical cancer prevention, including limitations in cytology-based screening and inconsistent documentation of HPV vaccination. FSS offers a promising approach, with low cancer recurrence rates and encouraging pregnancy outcomes.