Introduction
Cervical cancer develops when cancerous cells grow in the cervix, which is part of the lower uterus. Though cervical cancer is relatively uncommon during pregnancy, it is considered one of the more prevalent cancers in pregnant individuals, with an estimated occurrence of one to two cases per 2,000 to 10,000 pregnancies, according to researchers. Recent studies, including a 2019 article, suggest an increasing incidence of cervical cancer in pregnant individuals. This rise may be attributed to more people choosing to become pregnant at later stages of life, considering that the risk of cervical cancer tends to increase with age. The American Cancer Society notes that this condition is most frequently observed in individuals aged 35 to 44, with the average age of diagnosis being 50.
What Is Cervical Cancer?
Cervical cancer originates from the growth of cells in the cervix, the lower part of the uterus connected to the vagina. Most cases of cervical cancer are linked to various strains of the human papillomavirus (HPV), a common infection transmitted through sexual contact. While the body's immune system typically fights off HPV, in a small percentage of individuals, the virus can endure for years, playing a role in the progression of certain cervical cells into cancerous cells.
Reducing the risk of cervical cancer involves undergoing screening tests and receiving a vaccine to protect against HPV infection. In cases where cervical cancer occurs, the primary treatment often involves surgical removal of the cancer. Additional treatment options may include medications to eliminate cancer cells, such as chemotherapy and targeted therapy. Radiation therapy, utilizing powerful energy beams, is also a possible approach. In certain situations, treatment may combine radiation with low-dose chemotherapy.
What Are the Symptoms of Cervical Cancer During Pregnancy?
As per information from the American Cancer Society, early-stage cervical cancer typically does not exhibit any signs or symptoms. Symptoms usually become noticeable once the cancer has increased or spread to nearby tissues. At this point, an individual may encounter the following:
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Unusual vaginal bleeding
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Longer or heavier periods than usual.
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Bleeding or spotting between periods.
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Bleeding after sexual intercourse.
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Bleeding after menopause.
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Abnormal or bloody vaginal discharge.
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Pain during sexual activity.
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Pelvic pain.
In the advanced stages, additional signs and symptoms may emerge, such as:
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Blood in the urine.
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Swelling of the legs.
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Difficulty urinating or having a bowel movement.
If someone experiences symptoms of cervical cancer during pregnancy, they might mistakenly attribute them to other pregnancy-related conditions. Hence, individuals should communicate with their doctor or midwife about any unusual symptoms they encounter while pregnant.
What Is the Diagnostic Procedure for Cervical Cancer During Pregnancy?
In the diagnosis of cervical cancer during pregnancy, a 2019 study outlines a three-step process:
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Cervical Cytology: This quick diagnostic test examines cervical cell samples for abnormalities, aiding in detecting cervical cancer. However, it may yield false-positive results.
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Colposcopy: A minimally invasive procedure utilizing a colposcope to inspect the cervix, vagina, and vulva visually. Colposcopy helps identify signs of cervical cancer, such as lesions and abnormalities. It is often recommended during the first and second trimesters.
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Cervical Biopsy: A surgical procedure involving the removal of a small amount of tissue from the cervix for testing signs of cancer or pre-cancer. Importantly, it does not increase the risk of miscarriage or other pregnancy complications.
Upon diagnosis, the individual and their doctor collaborate to determine an appropriate treatment plan. Considerations include:
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Stage of the cancer.
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Size of the tumor.
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Type of cervical cancer.
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Pregnancy progression.
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Individual preferences for pregnancy and treatment.
What Is the Treatment for Cervical Cancer During Pregnancy?
Cervical cancer occurrence during pregnancy is uncommon. In instances where it does arise, the cancer is typically detected early and confined to the cervix, potentially not requiring immediate treatment. However, fast-growing or advanced-stage cases may necessitate prompt intervention. Before commencing treatment, it is crucial to deliberate on the advantages and drawbacks of various treatment options, considering their impact on the individual, the pregnancy, and future fertility. Personal preferences are taken into account when determining the most suitable treatment.
The treatment approach often depends on the trimester of pregnancy. For slow-growing stage I cervical cancer diagnosed in the first trimester, the recommendation may involve delaying treatment until later in the pregnancy or post-delivery. An early cesarean section, possibly coupled with a hysterectomy, might be proposed around 37 weeks.
In the case of fast-growing or advanced-stage cervical cancer in the first trimester, ongoing tests monitor cancer progression. Immediate treatment, including hysterectomy, chemotherapy, or radiation therapy, may be necessary, but continuation of the pregnancy is not feasible due to potential harm to the fetus.
If stage I cervical cancer is diagnosed in the second or third trimester, surgical options like cold knife conization or radical trachelectomy might be suggested. These procedures are conducted in a hospital setting under general anesthesia. Delivery through cesarean section may be recommended, and additional treatments, such as hysterectomy and radiation therapy, could follow post-delivery if necessary.
For stage II, III, or IV cervical cancer diagnosed in the second or third trimester, the pregnancy may be continued while receiving chemotherapy. Chemotherapy during this period generally does not harm the fetus but may lead to early labor and low birth weight. Early cesarean section may be advised to facilitate other treatments like hysterectomy and radiation therapy.
What Is the Impact of Treatment on the Fetus?
The impact of cancer treatment on a fetus is a complex matter. An older study from 2012 that examined the long-term cognitive outcomes of children exposed to chemotherapy in utero found no detrimental effects on their overall health compared to the general population. However, the study highlighted a correlation between premature birth, often necessary in cases of cervical cancer during pregnancy, and impaired cognitive development. The authors recommend further, extended follow-ups to explore these outcomes more comprehensively.
Doctors generally view chemotherapy as relatively safe in the second and third trimesters. However, certain cancer drugs like Trastuzumab are considered unsafe during pregnancy due to potential harm to the fetus's kidneys and lungs.
Chemotherapy can also impact blood production, decreasing platelet levels and heightened susceptibility to infections, as a 2018 cancer report indicates. In rare instances, significant cervical surgery may result in pregnancy loss. Further research is required to understand how various cancer treatments affect fetuses during pregnancy and post-birth. Individuals facing cervical cancer during pregnancy should engage in discussions with their healthcare provider to weigh their options and assess the potential risks of cancer treatments for both their own and their baby's health.
Conclusion
Addressing the rise in cervical cancer cases during pregnancy requires early detection and thoughtful treatment considerations—screening tests like cervical cytology, colposcopy, and cervical biopsy offer safe diagnostic avenues. Treatment decisions should weigh factors such as cancer stage, pregnancy progression, and individual preferences. While chemotherapy in later trimesters is generally viewed as safe, potential risks, including premature birth, should be acknowledged. Collaborative discussions between patients and healthcare providers are pivotal for navigating the complexities of managing cervical cancer during pregnancy and safeguarding the well-being of both mother and baby.
