Cervical cancer during pregnancy

Cervical cancer is one of the most common cancers diagnosed during pregnancy, with an incidence of 1.5 to 12 per 100,000 pregnancies [1–3]. It is estimated that between 1% and 3% of patients with invasive cervical cancer are pregnant at the time of diagnosis [4,5]. The cervix plays an extremely important role in the continuation of a successful term pregnancy. This, together with the vulnerability of the fetus to common cancer treatment modalities, results in an exceedingly challenging dilemma for the physician and patient. Unfortunately, randomized controlled trials are almost impossible to perform due to the obvious ethical considerations and relative rarity of the disease. Thus, treatment guidelines are lacking. Most of the published data are composed of small series mainly focusing on evaluating treatment efficacy and safety. It is important to note that the progression of pre-invasive disease to cervical carcinoma during the course of a pregnancy is rare. In fact, the opposite process is more common. Nevertheless, it is imperative that a proper histologic diagnosis be made in situations of possible invasive disease. Symptoms and signs The majority of women with early cervical cancer are asymptomatic and are diagnosed by abnormal cytology [6,7]. Other patients may have symptoms similar to the nonpregnant population, that is, vaginal bleeding, discharge, and pain. Lee et al [8]. reported no symptoms in any of the patients diagnosed with a stage IA lesion, and Smutek et al [9]. reported vaginal discharge in 29% of patients and postcoital bleeding or spotting in 59% of patients with stage IB lesions during pregnancy. In another series, 63% of patients with stage I disease presented with an abnormal Papanicolaou (Pap) smear, whereas only 20% presented with postcoital bleeding [10]. Patients with advanced or disseminated disease can have a wide variety of symptoms including pelvic pain, flank pain, sciatica, chronic anemia, and even intestinal obstruction and/or respiratory distress. However, presentation at this late stage is increasingly less common [11].