How to Treat Cervical Cancer in Pregnant Women?

• 19/07/2024
• 0

How to Treat Cervical Cancer in Pregnant Women? Over the last few years, the incidence of gynaecological malignancies during pregnancy has increased, mainly due to the increase in older pregnancies. The most common gynaecological malignancy during pregnancy is cervical cancer.

Being diagnosed with cervical cancer during pregnancy can seem overwhelming and people are likely to worry about their health and the fetus. Treatment options for cervical cancer are available at certain stages during pregnancy and a person can discuss these options with their doctor. Today we will talk about the effect of cervical cancer during pregnancy, how cancer can affect pregnancy, and whether it can cause complications. The incidence of cervical cancer during pregnancy is not very high, and the symptoms are easy to confuse with other pregnancy diseases. During pregnancy, the gynaecological examination is limited and therefore the number of false diagnoses is higher. The treatment of cervical cancer during pregnancy is related to many factors, such as tumour size, pathological type, gestational age, presence of lymph nodes, how many weeks pregnant you are, and the patient’s willingness to keep the pregnancy. These factors make it difficult to determine the optimal treatment.

What is a Cervical Cancer?

The cervix is ​​the lower narrow end of the uterus (womb) that connects the uterus to the vagina (birth canal). Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix undergo changes called dysplasia, where abnormal cells begin to appear in the tissues of the cervix. Over time, if not destroyed or removed, the abnormal cells can become cancerous and begin to grow and spread deeper into the cervix and surrounding areas.

Symptoms include

• Bleeding in between periods and after sexual intercourse
• Foul-smelling
• white discharge 
• Lower abdominal pain
• Low back pain

Diagnosis of Cervical Cancer

Diagnosing cervical cancer during pregnancy usually involves three steps:

• Cervical cytology: This is a rapid diagnostic test that involves examining cell samples from the cervix for abnormalities. It can help diagnose cervical cancer. But it can also cause false positives.
• Colposcopy: This minimally invasive procedure involves using an instrument called a “colposcope” to visually examine the cervix, vagina and external genitalia. Colposcopy can detect signs of cervical cancer, such as lesions and abnormalities. Doctors often recommend the procedure during the first and second trimesters of pregnancy.
• Cervical biopsy: In this surgical procedure removing a small amount of tissue from the cervix is involved to test for signs of cancer or pre-cancer. It does not affect the pregnancy or increase the risk of miscarriage or other pregnancy complications.

Treatment of Cervical Cancer During Pregnancy

Surgical treatment appears to be the safest option during pregnancy. Treatment of cervical cancer during pregnancy depends on several factors, including:

• Administration of chemotherapy in each trimester is recommended due to various compilations in each trimester. On the other hand, there is an increased chance of stillbirth, premature birth, intrauterine growth restriction (IUGR), and low birth weight in the second and third trimesters. To reduce the incidence of congenital malformations, chemotherapy should be delayed until the second trimester, but the implications of this approach should be considered in light of the mother’s health status. Despite some side effects in the second and third trimesters that need to be monitored, chemotherapy is considered quite safe during this time.
• The doctor may recommend giving birth early by cesarean section (C-section). In some cases, your doctor may recommend a hysterectomy along with a Ceserean-section. This depends on several factors, including the size and extent of the cancer and the health and future fertility wishes of the person.
• After delivery, your doctor will likely perform chemotherapy or other aggressive treatment options.
• Your doctor can remove a small tumour with a trachelectomy. This procedure involves removing the upper part of the vagina and most of the cervix tissue.
• For large tumours, the doctor recommends chemotherapy in the second and third trimesters of pregnancy. Chemotherapy kills cancer-causing cells and prevents them from spreading. It can help prevent cancers from growing and spreading.
• Cancer progression can force premature birth. If possible, we hope to give birth after the 37th week of pregnancy. If early delivery cannot be avoided, steroids should be given to stimulate fetal lung maturation. Spontaneous delivery is associated with a negative prognosis and may lead to various complications. Therefore, the preferred mode of delivery in the treatment of invasive cervical cancer is cesarean section followed by definitive therapy

Conclusion

Cervical cancer is the most common gynaecological cancer. Treatment for cervical cancer usually involves chemotherapy. Cervical Cancer treatment in pregnancy in women is a major challenge. Lack of experience in the diagnosis and treatment of tumours in pregnant women can lead to treatment delays and inappropriate treatment. As such, it can harm the health of both the mother and the fetus. The analyzed literature does not define uniform treatment methods, because it is based on general recommendations and small case studies. Therefore, pregnant patients with cervical cancer must be cared for by a board of experienced obstetricians, gynaecologists, neonatologists, and oncologists. 

These issues should be addressed in a future clinical trial to provide the best possible treatment for pregnant cancer patients.