Cervical cancer

Cervical cancer during pregnancy is the most challenging situation since the pregnant organ itself is involved.

The incidence of cervical cancer in pregnancy is estimated to be 1 to 10/10 000 pregnancies, depending on the inclusion of carcinoma in situ and postpartum patients. Also differences according to area or region are likely.Approximately 30% of women diagnosed with cervical cancer are in their reproductive years, whereas 3% of cervical cancers are diagnosed during pregnancy.

Pregnancy represents an exceptional opportunity for the early diagnosis of cervical cancer since visual inspection, cytological examination and bimanual palpation are considered part of routine antenatal care.

When cervical cancer complicates pregnancy, both maternal and fetal considerations will determine management decisions. A decision must be made either to initiate therapy without regard to the fetus or to await fetal viability or maturity. The management of cervical cancer during pregnancy is dependent upon gestational age at diagnosis (the number of weeks necessary to optimize fetal maturity), stage of disease, lesion size, patient's desire for the pregnancy and patient's desire for future fertility. Surgery (conisation, lymphadenectomy) and chemotherapy are the most commonly used treatment modalities for cervical cancer during pregnancy. A multidisciplinary approach is always mandatory, but especially the case when cancer of the cervix is diagnosed.