Pregnancy and cervical cancer: Association, treatment options, potential risks
Cervical cancer during pregnancy is an increasingly recognized issue, with an estimated 1 in 1,000 to 1 in 2,000 pregnancies affected worldwide [3]. This rise in incidence can be attributed to delayed childbirth trends [3].
While cervical cancer itself is projected to decline gradually due to improved screening and HPV vaccination programs, the mortality rate remains a concern, particularly in lower-income settings [2][5].
Balancing effective maternal care with fetal safety is crucial when treating cervical cancer during pregnancy. Early-stage cervical cancer can sometimes be managed conservatively to preserve pregnancy and fertility [4]. However, more advanced stages often require more aggressive treatment such as radical surgery or chemoradiotherapy, which may preclude continuation of pregnancy or future childbearing [2][4].
Diagnosing cervical cancer during pregnancy can be challenging due to the overlapping symptoms with pregnancy. Timely, multidisciplinary care involving obstetricians, oncologists, and neonatologists is essential to optimize outcomes for both mother and fetus [3].
Treatment options for cervical cancer during pregnancy vary according to the pregnancy trimester, the cancer stage, the healthcare resources available, and the individual's treatment goals [4]. In the second trimester, treatment options may include lymphadenectomy, conization, trachelectomy, and neoadjuvant chemotherapy [4].
If a pregnant person is diagnosed with cervical cancer, their method of delivery may change, with cesarean section often recommended [6]. In some cases, a hysterectomy may be performed at the same time as a cesarean section [6].
It's important for individuals with cervical cancer during pregnancy to discuss the risks and complications related to treatment and cancer progression with a medical professional [7]. Doctors may recommend surgery or chemotherapy, and people should be aware of the potential effects on their fertility [7]. Certain cancer drugs, such as trastuzumab (Herceptin), are unsafe during pregnancy as they can negatively affect a fetus's kidneys and lungs [7].
Regular pregnancy exams can detect the presence of cervical cancer at an early stage, increasing the chances of successful treatment [8]. People should feel empowered to start conversations about fertility when discussing cancer treatments with their healthcare providers, as doctors may not always initiate these discussions [9].
In rare cases, major cervical surgery may lead to pregnancy loss [7]. People with late-stage cervical cancer may have to opt for assisted reproductive technology (ART) if they wish to become pregnant after treatment [10].
A multidisciplinary team of health professionals, including gynecological oncologists, medical oncologists, radiologists, radiotherapists, perinatologists, neonatologists, obstetricians, pathologists, and nurse specialists, may be involved in the treatment of cervical cancer during pregnancy [10].
Chemotherapy can reduce a person's blood production, which can cause low platelet counts and increase the risk of infections [11]. Chemotherapy may be carried out in the third trimester, but it may increase the risk of premature labor and fetal growth restriction [11].
The effect of cancer treatment on a person's fertility can depend on factors such as their baseline fertility, age, type of cancer treatments, treatment dosage, duration of treatment, time since last treatment, overall health, and the treatments chosen to preserve fertility [12].
The effects of cervical cancer on a person's pregnancy depend on factors such as the type of cancer, tumor size, whether it has spread, the stage of pregnancy, and individual treatment preferences [13].
Current research emphasizes prevention through high-coverage HPV vaccination and improved cervical cancer screening, aiming to reduce cervical cancer incidence significantly by 2034-2044 under different policy scenarios [1]. These advances may lessen the future burden of cervical cancer during pregnancy by preventing cases before conception.
- A patient diagnosed with cervical cancer during pregnancy may require chemotherapy, but some drugs like trastuzumab (Herceptin) are unsafe during pregnancy due to potential negative effects on a fetus's kidneys and lungs.
- Early-stage cervical cancer in pregnancy can sometimes be managed conservatively to preserve pregnancy and fertility, but more advanced stages often require aggressive treatment such as radical surgery or chemoradiotherapy, which may preclude continuation of pregnancy or future childbearing.
- Doctors may recommend Pfizer's chemotherapy treatment for individuals with cervical cancer during pregnancy, but this treatment can block the person's blood production and increase the risk of infections.
- In the health-and-wellness sector, researchers are focusing on prevention through high-coverage HPV vaccination and improved cervical cancer screening to reduce cervical cancer incidence significantly by 2034-2044.
- During pregnancy, patients with cervical cancer are at risk for additional medical-conditions, such as premature labor and fetal growth restriction, when chemotherapy is carried out in the third trimester.
