Cervical Cancer During Pregnancy

July 25, 2019

Researchers looked at diagnosis, assessment, treatment, and prognosis of women diagnosed with cervical cancer while pregnant.

In a review article published in the Journal of Cellular Physiology, authors surveyed the topic of cervical cancer in pregnancy, including diagnosis, potential biomarkers and molecular aspects, therapeutic approaches, and prognosis at different gestational ages. In addition to proffering an overview of treatment strategies of concurrent pregnancy and cervical cancer cases, the authors provided some clinical advice to aid clinicians with management.

“In the decision‐making about management of cancer during pregnancy, maternal prognosis is of primary importance; if the patient wishes to continue the pregnancy, all potential harm for the fetus should be avoided. To maximize the maternal outcome, cancer treatment should follow the standard treatment protocol as for nonpregnant patients,” wrote authors, led by Anna Myriam Perrone, MD, PhD, Department of Obstetrics and Gynecology, S. Orsola‐Malpighi Hospital, University of Bologna, Bologna.

In an interview with Cancer Network, Sarah Taylor, MD, gynecological oncologist at UPMC Hillman Cancer Center and assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh, provided some thoughts on the review. “It included a comprehensive body of literature. This is a topic that is challenging for anyone who takes care of pregnant women and women with cervical cancer who have the unfortunate luck to be pregnant and have a new cancer diagnosis. It doesn’t happen very frequently so trying to figure out what is best for this patient population-unfortunately for us-will always continue to be challenging because it’s not something we see all the time. And when you have to factor in multiple lives in the treatment of one person, it becomes that much trickier,” she said.

Dr. Taylor reflected on strengths of the article. “One of the nicest things that they did was outline [management] based on gestational age as well as stage of cancer at diagnosis. [They gave an] algorithm based on the compilation of many smaller studies, with the caveat being that nothing is going to be definitive, because it is based on small retrospective data and expert opinion. But what is outlined here is very much in line with what the gynecology community does as a general approach: what imaging can we get, when do we think it’s safest to conservatively manage these patients, and when do we need to counsel these patient about [fetal] termination for their own life,” she told Cancer Network.

Dr. Taylor explained why assessing pregnant patients with cervical cancer is challenging. “We are limited in the imaging modalities that we can order safely during pregnancy, right now we don’t recommend CT scans and PET scans are not routine. But we can certainly use MRI which can give a good amount of info about the tumor,” she noted.

Dr. Taylor expounded on the importance of a multipronged approach in patients with cervical cancer and pregnancy. “It’s important any time you have someone who is pregnant with a cancer, you have to have an approach where it’s not just you and the patient. It’s really important to have yourself, the patient, the obstetrician, and her support system in place, and the patient has a good understanding of what could happen if the cancer goes untreated or what could happen to her or the fetus as a result of the cancer or treatment proposed so that when you make that decision it is as best informed as possible. This should never be done in isolation. It’s really important that you have a team of people coming together,” she said.

“This is a really challenging time," she concluded. "It’s challenging to have cancer, and it’s challenging to be pregnant, and to have both of these things overlap makes it really difficult [for the patient] from not only a physical standpoint but also from a psychological and emotional standpoint.”