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.
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 during pregnancy.
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, Iowa City.
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.