Management of cervical cancer in pregnancy

Kim, So Ra; Lee, Jong Min

Abstract

Cervical cancer is the most common gynecologic malignancy diagnosed in pregnancy. Pregnancy represents an opportunity for early diagnosis of cervical cancer, because cervical cytology is considered to be a part of routine antenatal care. An abnormal cervical cytology should generally be managed as in the non-pregnant state. Therefore, colposcopy and directed biopsies, when indicated, should be considered for pregnant patients with abnormal cytology and/or suspicious clinical findings. The only absolute indication for conization in pregnancy is to rule out microinvasive disease or make the diagnosis of invasive carcinoma when such a diagnosis will alter the timing or mode of delivery. Overall, earlier stages of cervical cancer are encountered during pregnancy compared with the general population. In early stage disease, delay in definitive treatment for fetal maturity would be feasible and safe if there is no evidence of disease progression. Treatment of invasive cervical cancer is similar to the non-pregnant state, and should be individualized and undertaken by stage, gestational age and patient's desire to continue the pregnancy. In counseling patients, a multidisciplinary approach coordinated by experts in gynecologic oncology and perinatology is mandatory. After stratifying for stage, the outcome is similar to the non-pregnant state.