Invasive cervical carcinoma is the most common malignancy associated with pregnancy. However, it is relatively rare, occurring in approximately one in 200 pregnancies. Half of these cases are diagnosed within six months following delivery. The optimum management of cervical cancer during pregnancy and the puerperium is controversial. Sood and colleagues studied all cases identified by a state cancer registry between 1960 and 1994 to clarify prognosis and aspects of management, particularly cesarean delivery.
They identified 56 women diagnosed with cervical cancer during pregnancy and 27 diagnosed within six months of delivery. These cases were matched by age, stage of disease, year, and type of treatment with other cases of cervical cancer diagnosed at least five years after delivery. Women were followed by gynecologic oncologists every three months for the first year, every four months during the second year, every six months during the third year and then annually. Treatment was individualized based on patient preferences and physician recommendations.
Women diagnosed during pregnancy, those diagnosed during the puerperium and the control subjects did not differ significantly in age, gravidity, parity or smoking status. A much higher percentage of pregnant patients was diagnosed by screening than control subjects (45 percent compared with 25 percent). A significant trend to higher stage of disease was present with diagnosis later in pregnancy and the puerperium. Recurrence rates were related to mode of delivery. One of the seven patients who delivered by cesarean developed a recurrence compared with 10 of the 17 patients who delivered vaginally. In statistical analyses, high stage and vaginal delivery were significant risk factors for recurrence. Patients diagnosed during pregnancy had survival rates similar to control subjects, but survival of women diagnosed during the puerperium was significantly worse than for either of the other groups.
The authors stress that pregnancy presents opportunities for cervical cancer screening before delivery and during the puerperium. Nevertheless, delay in diagnosis occurs, and cancers diagnosed late in pregnancy or during the puerperium tend to be more advanced. They recommend that colposcopy and biopsy be performed on all pregnant and recently pregnant patients with suspicious findings. The authors also conclude that pregnant women with cervical cancer should have cesarean delivery.