Cancer of the cervix and pregnancy
Is cervical cancer more likely to occur in pregnancy?
No. The behaviour of this type of cancer is the same in pregnancy as in a non-pregnant state. It is one of the commoner malignancies seen during pregnancy, simply because it is a relatively common type of cancer in women of child-bearing age. It is, in fact the commonest cancer diagnosed during pregnancy.
So what are the symptoms of cervical cancer in pregnancy?
The same as in a non-pregnant state, i.e. abnormal vaginal bleeding, abnormal vaginal discharge and vaginal bleeding following sexual intercourse.
There is usually no pain unless the disease is advanced.
What will be done to diagnose the cervical cancer?
If a woman has symptoms suggestive of cancer of the cervix, colposcopic examination of the cervix will be carried out immediately. This is an examination of the cervix, using a special microscope and applying a special chemical to it.
Both the instrument and the chemicals used are perfectly safe in pregnancy. Normally a biopsy (tissue sample) will be taken for histological analysis (a microscopic examination of the tissue sample), which is the only way the diagnosis can be confirmed or refuted. Further treatment will depend on the results.
If cervical cancer is diagnosed, can the pregnancy still be saved?
If cervical cancer is confirmed, termination of the pregnancy is virtually inevitable. This is because both forms of treatment used in this type of cancer are incompatible with continuing pregnancy. Treatment will either be in the form of surgery (where in most cases a hysterectomy will need to be done) or radiotherapy, or occasionally both.
If cervical cancer is discovered in pregnancy and the pregnancy is advanced, is vaginal delivery an option?
Yes. The doctors will need to make a careful assessment of the cancer lesion on the cervix. Because vaginal delivery involves the progressive dilatation (opening) of the cervix in labour, it is important to ensure there is little or no risk of heavy bleeding from the cancer lesion.
Vaginal delivery will not worsen the disease in any way. However, most experts will advise caesarean delivery, because surgery for treating the cancer can be carried out at the same time. This will be in the form of a hysterectomy after delivering the baby.
Is there any form of treatment for cervical cancer that still allows for future pregnancy?
Yes but this is only available for very early disease. Moreover, it is not possible to know for sure upfront whether this operation will be possible (adequate). It is called radical trachelectomy. It involves removal of most of the cervix hence preserving the ability to carry a pregnancy in future.
However, for the vast majority, cervical cancer is either treated by hysterectomy - where the cervix and the rest of the womb is removed - or radiotherapy, which permanently eliminates the ability of the womb to carry a pregnancy.
What are the criteria for choosing surgery or radiotherapy as the form of treatment?
The extent of the disease. In the early stages, both radiotherapy and surgery are equally effective. In the advanced stages, radiotherapy is the best treatment.
Will a woman treated for cervical cancer go into induced menopause?
Not necessarily. Most experts try to preserve ovarian function in a young woman treated for ovarian cancer, so as to avoid premature menopause. This is not always feasible, in which case hormone replacement therapy (HRT) will be necessary. HRT has no adverse effect on the behaviour of the disease.
If cervical cancer is discovered at a stage of pregnancy where the fetus is unlikely to survive, is it safe to wait for a "few weeks" to allow the survival of the baby before beginning treatment?
This is an extremely difficult question. Obviously, if it is early pregnancy (i.e. below twenty weeks), many experts will find it extremely difficult to consider waiting. In cases over twenty weeks of gestation, where waiting will be confined to two to four weeks, the idea could be given serious thought, if this is what the mother wants.
It is impossible to know what is a safe interval between diagnosis and successful treatment of the cancer, as the disease behaves differently in different individuals. Most experts would prefer to start treatment within days of confirming diagnosis, to maximize the chances of a successful treatment.