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Pregnancy and Childbirth: The answers

Cancer of the cervix in Pregnancy

 

The behavior of cervical cancer is the same in preg­nancy as in a non-pregnant state. It is one of the commoner malignancies seen during pregnancy, simply because it is a relatively common type of cancer in women of child-bearing age.

 

Symptoms of cervical cancer in pregnancy

The symptoms of cervical cancer are the same during pregnancy as in a non-pregnant state. These are

v Abnormal vaginal bleeding,

v Abnormal vaginal discharge and

v Vaginal bleeding following sexual intercourse.

There is usually no pain unless the disease is advanced.

 

Diagnosing cervical cancer in pregnancy

If a woman has symptoms suggestive of cancer of the cervix, colposcopic examination of the cervix will be carried out immediately. This is an examination using a special microscope after applying a special chemical to it.

 

Both the instrument and the chemicals used are perfectly safe in pregnancy. Normally a biopsy (tissue sample) will be taken for histological analysis (a microscopic examination of the tissue sample) by a pathologist. This is the only way the diagnosis can be confirmed or refuted. Treatment, if any, will depend on the results.

 

Fate of pregnancy after a diagnosis of cervical cancer

If cervical cancer is confirmed, termination of the pregnancy is virtually inevitable. This is because both forms of treatment used in this type of cancer are incompatible with continuing pregnancy. Treatment will either be in the form of surgery (where in most cases a hysterectomy will need to be done) or radiotherapy, or occasionally both.

 

Vaginal delivery with cervical cancer

When the diagnosis is made with the pregnancy at an advanced stage, delivery needs to take place to allow treatment to go ahead. If vaginal delivery is desired, the doctors will need to make a careful assessment of the cancer lesion on the cervix. Because vaginal delivery involves the progressive dilatation (opening) of the cervix in labor, it is important to ensure there is little or no risk of heavy bleeding from the cancer lesion.

 

Vaginal delivery will not worsen the disease in any way. However, most experts will advise caesarean delivery, because surgery for treating the cancer can be carried out at the same time. This will be in the form of a hysterectomy after delivering the baby.

 

Preserving fertility after treatment of cervical cancer

In some cases, it is possible to preserve fertility after cervical cancer treatment. However, this is only available for very early disease. Moreover, it is not possible to know for sure upfront whether this operation will be possible (adequate).

 

The procedure is called radical trachelectomy. It involves removal of most of the cervix but conserving the womb hence preserving the ability to carry a pregnancy in future.

 

For the vast majority, cervical cancer is either treated by hysterectomy - where the cervix and the rest of the womb is removed - or radiotherapy. Radiotherapy permanently eliminates the ability of the womb to carry a pregnancy.

 

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