Cervical cancer during pregnancy presents diagnosis and treatment challenges, but the cancer can be successfully managed with a multidisciplinary treatment team and an individualized treatment strategy that optimizes maternal treatment while considering fetal safety.
Challenges of Diagnosing Cervical Cancer in Pregnancy
A diagnosis of cervical cancer during pregnancy presents significant challenges to the woman, her family, and the medical teams.
A diagnosis of cervical cancer during pregnancy is not very common, and pregnant women who have early cervical cancer typically have no obvious symptoms. Because there are typically no clear manifestations of any symptoms related to cervical cancer during pregnancy, this makes it difficult to diagnose the cancer.
As a result, cervical cancer can be easily confused with pregnancy-related symptoms; the cancer can be easily concealed by the pregnancy status and can be difficult to diagnose.
Beause some pregnant women neglect to have regular prenatal examinations, the rate of misdiagnosis of cervical cancer is higher in pregnant women than in other women. Lack of appropriate gynecologic examimations makes it difficult to detect cancer.
As the woman and her family struggle to come to terms with the emotional devastation that a cancer diagnosis brings, this situation is magnified by the difficulties faced by the treatment team as it navigates the conflicting priorities between optimal cancer treatment for the woman and maintaining the well-being of the fetus.
Cancer, including cervical cancer, during pregnancy raises a complex dilemma for the mother and the fetus, the family, and the medical team. For example, histologic confirmation (examination by a microsope) of the diagnosis is required before treatment can be planned, but doing a biopsy is always associated with a risk of hemorrhage (bleeding) and/or a risk of pregnancy loss.
When deciding on the management of cancer during pregnancy, the prognosis of the mother is of primary importance; if the patient wishes to continue the pregnancy, any treatment that may carry harm for the fetus should be avoided.
Individualized Treatment of Cervical Cancer in Pregnancy
Cancer can be successfully managed during pregnancy with the collaborative efforts of a multidisciplinary team that works to optimize maternal treatment while also considering the safety of the fetus.
However, there has not been a universally accepted guideline for the treatment of pregnant women with cervical cancer. Therefore, an individualized treatment is recommended that is dependent on several factors, such as stage of the cancer, lymph node involvement, duration of pregnancy, the woman’s wish to continue the pregnancy, and future childbearing desire.
Multidisciplinary teams consisting of gynecologists, oncologists, obstetricians, pathologists, and neonatal pediatricians are needed to provide patients with the best individualized treatment strategies. This is especially relevant in the second trimester of pregnancy, when cervical cancer becomes a clinical challenge that requires multidisciplinary expertise to recommend the continuation or termination of the pregnancy.
If the patient wants to continue the pregnancy, the balance between achieving fetal maturity while not delaying cancer treatment (such as surgery) for too long is of great concern to the multidisciplinary team.
However, the navigation of cancer care is always difficult. The balance between doing what is right for the patient with cancer as well as for the unborn baby is never easy. Each case must be considered individually, with the wishes of the woman and her family as the central concern.
According to researchers, in the majority of cases, the management of cervical cancer in pregnant women is not different from that of women who are not pregnant, and the prognosis of these women with cervical cancer is not compromised by pregnancy. Screening for pregnancy during cervical cancer involves the 3‐step model that includes cervical cytology, colposcopy, and cervical biopsy.
Researchers have noted that if cervical cancer is diagnosed in the first trimester, terminatng the pregnancy is preferred in patients whose cancer is advanced. If the patient prefers to preserve the pregnancy, delaying treatment until later in the pregnancy should be considered, but this may complicate the cancer treatment. If the cancer is diagnosed in the late second or third trimester, having a preterm delivery to be able to offer the mother standard chemotherapy and radiotherapy should not be a solution, because of the high risk of death or severe adverse events to the fetus at that stage.
There is, however, good news. Researchers have shown that there are no negative side effects of cervical procedures on subsequent rates of pregnancy. In a 12-year study of 13,767 women who became pregnant after having a diagnostic procedure for precancerous cervical lesions, a higher rate of pregnancies was seen in the women who received treatment for these precancerous lesions compared with the women who did not receive treatment.
Sources:
Beharee N, Shi Z, Wu D, Wang J. Diagnosis and treatment of cervical cancer in pregnant women. Cancer Medicine. 2019;8:5425-5430.
Hecking T, Abramian A, Domrose C, et al. Individual management of cervical cancer in pregnancy. Archives of Gynecology and Obstetrics. 2016;293:931-939.
Naleway AL, Weinmann S, Krishnarajah G, et al. Pregnancy after treatment for cervical cancer precursor lesions in a retrospective matched cohort. PLoS ONE. 2015;10(2):e0117525. doi:10.1371/journal.pone.0117525.
Perrone AM, Bovicelli A, D’Andrilli G, et al. Cervical cancer in pregnancy: analysis of the literature and innovative approaches. Journal of Cellular Physiology. 2019;234:14975-14990.
Roberts K, Rezai N, Edmondson RJ. Cervical cancer in pregnancy: an assault on family and fertility. British Journal of Midwifery. 2007;15:132-136.
