Minimally invasive approach could be considered before 14–16 weeks of gestation; however, the sentinel node biopsy concept using indocyanine green is still experimental [IV, C]. Radiotherapy can be considered as an alternative modality to surgical treatment, considering the risk-benefit of repeat surgery [IV, C].

Fertility-sparing treatment should be performed exclusively in gynaecological-oncological centers with comprehensive expertise in all types of these surgical procedures [IV, A]. Founded in 1980, ESTRO, the European Society for Radiotherapy & Oncology (ESTRO), is a non-profit and scientific organisation that aims at reinforcing radiation oncology as a core partner in multidisciplinary cancer care and at guaranteeing accessible and high-value radiation therapy for all cancer patients who need it. Amanda Webster (UK), Ben Slotman (NL), Daan Nevens (BE), Ester Hammond (UK), Ina Schulz-Jurgenliemk (NL), Jens Overgaard (DK), Ludvig Muren (DK), Ludwig Van den Berghe (BE), Marianne Aznar (UK), Michael Baumann (DE), Michelle Leech (IE), Pierre Blanchard (FR) Suggested Use: Infuse 2 teaspoons in an 8oz serving of spring water. Boil water, then steep the blend for 15 minutes before serving.Applicants should have proven experience in their subject of choice, which should be demonstrated by peer-reviewed publications on the field, participation in relevant study groups, clinical trial groups, other scientific committees or similar activities. In early stages managed primarily by surgery, surgical/pathological staging of pelvic lymph node (PLN) is the standard criterion to assess the prognosis and to guide treatment (except for T1a1 and T1a2 without LVSI) [III, A]. Patients with multiple nodal/distant metastases (ie, not oligometastatic disease) or multifocal local disease with extensive pelvic wall involvement should not be considered as candidates for radical treatment [IV, D]. Tumor involvement of suspicious nodes should be histologically confirmed because of its prognostic significance and the impact on the management up to 24 weeks of gestation (fetal viability) [IV, A]. Spontaneous delivery appears to have negative prognostic impact in patients with cervical cancer in pregnancy. Thus, cesarean section is the recommended mode of delivery [IV, B].

Every patient diagnosed with cervical cancer in pregnancy must be counseled by a multidisciplinary team. This team should consist of experts in the fields of gynecological oncology, neonatology, obstetrics, pathology, anesthesiology, radiation oncology, medical oncology, psycho-oncology, and, spiritual and ethical counseling. National or international tumor board counseling may be considered [V, A]. In case of intraoperatively proven PLN involvement, fertility-sparing surgery should be abandoned and patients should be referred for CTRT and BT [IV, B]. PALND, at least up to inferior mesenteric artery, may be considered for staging purposes [IV, C]. Ovarian transposition cannot be recommended in N1 status [IV, D]. Definitive CTRT and image-guided brachytherapy (IGBT) represent an alternative treatment option [IV, B].Diindolylmethane (DIM) Can help balance your hormones by improving menopausal symptoms, PCOS, weight loss and hormonal acne . Work with consultants and suppliers to create visually engaging materials, including infographics, printed materials, and videos in line with ESTRO branding. Previous pertinent histological exams of the cervical lesion/cancer, even if diagnosed in another institution, should be revised and integrated in the final report (eg, cone biopsy and hysterectomy specimen) Radical surgery or definitive CTRT according to the disease stage as recommended outside pregnancy, if the woman decides not to preserve the pregnancy. Pregnancy termination is recommended before any treatment after the first trimester, and fetus evacuation before CTRT, if possible.