For women diagnosed with stage I cervical cancer during pregnancy who
are torn between the desire to maintain a healthy pregnancy and the need
for cancer treatment, a recent study offers hope that both desires can
be achieved. The study, reported in the December 5th issue of Gynecologic
Oncology, the scientific publication of the Society of Gynecologic
Oncologists (SGO), supports the safety both of performing surgery for cervical
cancer diagnosed during pregnancy and of delaying surgical treatment for
women with stage I disease. This delay allows the fetus to mature while
not adversely affecting the clinical outcome of the mother, according to
The study was a retrospective, case-controlled analysis of 30 women
diagnosed with cervical cancer during their pregnancy who were surgically
managed at the University of Iowa between 1960 to 1994. According to the
authors, the study is the largest case-control study of pregnant patients
treated surgically for cervical cancer. Although affecting .05% of all
pregnancies, cervical cancer is still the most common malignancy found
Treatment Recommendations Depend on Stage of Pregnancy
If invasive cancer was diagnosed early in the pregnancy immediate hysterectomy
was recommended. Fetuses delivered in the first or second trimester, in
conjunction with the hysterectomy, did not survive due to their prematurity.
If cervical cancer was detected toward the middle to late part of the pregnancy,
timing of surgical treatment depended on the cancer stage, histology, and
lesion size. Patients in this category with smaller or earlier-stage lesions
were given the option to delay cancer surgery until the fetus could mature.
They were monitored throughout to check for disease progression, however.
Of the 15 women whose cancer was detected in the middle to late part
of the pregnancy, 11 patients planned a delay in their cancer surgery until
the third trimester--an average of 16 weeks after their diagnosis--to give
their babies time to mature. The babies were delivered by cesarean section,
followed immediately by the cancer surgery. All 11 patients and their babies
are alive and all women are disease-free after an average follow-up of
118 months. According to the study, the planned delay in treatment for
these patients did not affect outcome for either the fetus or patient.
The remaining four women also had cancer surgery in their third trimester,
but did not have a planned delay in their treatment because the stage,
histology, or lesion size of their cancer called for immediate cesarean
section and cancer surgery. Two of the four infants in this group survived
and two died of complications related to their prematurity.
"Based on our data, pregnant patients with early stage squamous
cancers diagnosed in the late second or early third trimester may have
their cancer therapy delayed to increase the likelihood of a healthy baby
without compromising the mother's prognosis," said lead authors, Anil
K. Sood, MD and Joel I. Sorosky, MD, University of Iowa Hospitals and Clinics,
The most common factor leading to a diagnosis of cervical cancer among
the pregnant patients in the study was an abnormal prenatal Pap smear (64%),
whereas postcoital bleeding or other symptoms led to a diagnosis more often
in the nonpregnant control patients (60%). "Interestingly, pregnancy
may provide an opportunity to detect cervical cancer in earlier stages
since prenatal care includes routine Pap smear screening," said SGO
President David M. Gershenson, MD.