Cervical Cancer in Pregnancy

Cervical cancer is one of the cancers diagnosed most often in pregnancy. For every 10,000 pregnancies, there are one to 10 cases of cervical cancer. Screening in the U.S. has helped lower the incidence of this disease.

Pre-Invasive Disease

Pap smears are a routine part of pre-natal care. Along with biopsies, they are used to diagnose pre-invasive disease. Neither procedure will affect the fetus. Treatment of pre-invasive disease is usually delayed until after the pregnancy. This is thought to be safe for mothers. Still, a woman who plans to get pregnant should have regular Pap smears. That way, pre-invasive disease can be treated before she gets pregnant.

A physician concerned about invasive disease, may recommend a cone biopsy. Ideally, this would be done in the second trimester.

Invasive Disease

When a pregnant woman is diagnosed with cervical cancer, the right choice of treatment for cervical cancer differs from woman to woman. The choice is based on:

  • how far along the pregnancy is
  • tumor size
  • tumor stage
  • the patient’s desires about the pregnancy

A woman may choose to end a pregnancy that is undesired and less than 24 weeks along. If she does, she can then have therapy for her cancer. If the fetus is close to maturity, the woman and her doctors may decide to wait. In that case, they would postpone cancer treatment until the baby can be delivered safely. The decision can be very difficult. It should be made with the help of both the obstetrician and gynecologic oncologist. A neonatologist should also be involved especially when the planned delivery may be premature. This is a doctor who specializes in caring for premature infants.

Cervical cancer can be treated with surgery, radiation (with or without chemotherapy), or both. The choice depends on the stage and size of the tumor. If surgery is done, it can be done at the time of cesarean section. After delivery, surgery consists of a radical hysterectomy. It also includes removal of pelvic lymph nodes. Pregnant patients with advanced disease should undergo primary radiation therapy.