Being diagnosed with cervical cancer is scary enough on its own — but what if you are diagnosed while you are pregnant? Experts estimate that about 3 percent of cervical cancer cases are diagnosed during pregnancy. Although the odds of this happening to you are small, it's important to be aware of the possibility.
Cervical cancer can be detected by a Pap smear, which is often performed during pregnancy, or from a doctor's exam prompted by symptoms you might be experiencing (such as bleeding). Your pregnancy may affect how your doctor decides to treat the cancer, depending on the stage of the cervical cancer and how far along you are in your pregnancy.
Pregnancy and Early-Stage Cervical Cancer
If your doctor finds cervical cancer in its early stages (e.g., stage IA), you will most likely be able to continue safely with your pregnancy. Treatment will be postponed until several weeks after the baby is delivered; only then will you be treated with a hysterectomy (removal of the uterus and cervix) or cone biopsy (removal of part of the cervix), depending on how much the cancer has progressed.
Some pregnant women do not have cervical cancer, but are diagnosed with having "dysplasia" — mild cervical abnormalities or precancerous cells that could progress to cervical cancer. "We do a colposcopy [a test where doctors use special equipment to get a close-up look at the cervix] and get biopsy confirmation," says Daniel McNeive, MD, an obstetrician-gynecologist in St. Louis. "And if it is indeed dysplasia and not cancer, we just watch it and repeat the Pap smear later in the pregnancy."
Another treatment option at this stage is a loop electrosurgical excision procedure, or LEEP, which can remove the abnormal cells from the cervix before cancer develops. LEEP uses an electrically charged wire loop to cut away abnormal cells from the cervix.
However, a recent study in the medical journal The Lancet found that pregnant women who undergo LEEP are at increased risk of delivering preterm babies or having a low-birth-weight infant. For this reason, researchers suggest that women carefully discuss the risks and benefits of LEEP before deciding to undergo the procedure while they are pregnant. "Women should seek detailed information on [the effectiveness of the procedure], but also on long-term pregnancy-related [problems] before they consent," lead study author Maria Kyrgiou, MD, of Central Lancashire Teaching Hospitals in Preston, England, told HealthDay News Service.
Another problem with LEEP, according to Dr. McNeive, is that the procedure may make it difficult to tell later if all the cancer has been removed. "And we need to be sure," he says.
Pregnancy and Advanced Cervical Cancer
For women whose cervical cancer is more advanced, treatment decisions become more complex. Your doctor will discuss options with you, which may include termination of the pregnancy if an aggressive cervical cancer is diagnosed, or if cancer is diagnosed very early in the pregnancy. "You always have the option of waiting" until after delivery to be treated says McNeive. "But women need to know that a stage IA at 10 weeks of pregnancy could become a stage III [a much more advanced form of cervical cancer] by the time she delivers." This can affect the treatment chosen as well as the rates of survival, he cautions.
For women who have reached their second or third trimester, it may be possible to delay treatment for cervical cancer until the baby is delivered. In this case, delivery will take place as early as is safe for the baby. "If you are far enough along, we may be able to deliver early and treat the cancer after that," McNeive says.
Making the Treatment Decision
If you are diagnosed with cervical cancer while pregnant, you and your doctor will work together to devise a treatment. Your doctor will explain all options, as well as the benefits and risks of each treatment. Since the decision to treat cervical cancer is especially complex in the case of a pregnant woman, you may want to seek a second opinion before deciding.
Last Updated: 2/6/2009