Cervical Cancer During Pregnancy

Unlike most other types of cancer, cervical cancer is a type of cancer that can be treated if it is detected and prevented early-on. Many countries include a cervical cancer diagnosis before providing consultations for pregnancy, thus lowering the risk of cervical cancer and ensuring a hassle-free pregnancy. Cervical cancer, by nature, does not affect the baby or influence the delivery in any way in the early stages, however, in the later stages treatment becomes a necessity as it has been known to be harmful to mothers during its advanced stages.

What is Cervical Cancer?

Cervical cancer is basically cancer of the uterus. The ailment starts when the cells in the cervix start multiplying unhindered. They grow and reach a pre-cancerous stage, from where they soon begin multiplying rapidly. In some cases, these cancer cells multiply to an extreme stage really fast within a year, while usual case reports indicate that it takes years for the cells to go from pre-cancerous to cancerous stage.

How Common is Cervical Cancer During Pregnancy?

The odds of developing cervical cancer in pregnancy is small and, usually, 3% of pregnant mothers find themselves having cervical cancer during pregnancies after a diagnostic test. More than 11,000 mothers in America are diagnosed with cervical cancer every year.

Stages of Cervical Cancer

The stages of cancer are diagnosed by the extent to which tumour cells mature and spread within the cervix. Here are the stages of commonly seen in cervical cancer

1. Stage 1 – This is the earliest stage when the cancer is found in the neck of the womb. It is divided into two sub-stages:
   • Stage 1A – Here the growth of the cancer is very small and is only found through examination under a microscope.
   • Stage 1B – In this stage, the cancer is in the cervical tissues but hasn’t spread out any further to other internal organs.
2. Stage 2- This is the stage when cancer begins to spread outside from the cervix to surrounding healthy tissues. Stage 2 is also divided into two sub-stages:
   • Stage 2A – Here, cancer spreads out over to the top of the vagina
   • Stage 2B – In this stage, cancer affects the surrounding tissues of the cervix
3. Stage 3- This is when cervical cancer progresses from the cervix into the surrounding structures of the pelvic area. It is further divided into:
   • Stage 3A – This is when cancer spreads to the lower region of the vagina
   • Stage 3B – Here, cancer grows into the pelvic wall and blocks the tubes that drain the kidneys
4. Stage 4- This is the advanced stage of cervical cancer. This is when cancer spreads to internal organs outside the womb. This stage is further divided into:
   • Stage 4A – Here cancer spreads to nearby internal organs like the bladder and rectum
   • Stage 4B – At this stage, cancer spreads over to organs which are far from the womb area, such as the lungs.

Causes of Cervical Cancer in Pregnancy

In a healthy system, cells divide and die. When cells stop dying and start multiplying rapidly they cause abnormal growth. Lumps form in the cervix and eventually mature into tumour cells. These cells become cancerous later on, thus leading to cervical cancer in women.

There are several causes of cervical cancer in pregnancy. They are:

• Having multiple sexual partners
• Becoming sexually active early on
• Weak Immune System
• HIV or AIDs
• Self-destructive behaviours like drinking/drugs and long-term mental stress
• Several pregnancies
• STDs (Sexually Transmitted Diseases) like Chlamydia, gonorrhoea, and syphilis
• Early pregnancy beforehand (usually before the age of 17 years)
• Smoking
• Taking birth control pills
• HPV (Human Papillomavirus) Infections

There are 100 types of HPV infections and 13 of these are known to contribute to the development of cervical cancer.

Symptoms of Cervical Cancer

Symptoms of cervical cancer range from:

• Pain during sexual intercourse
• Pain in the lower belly and pelvis
• Abnormal Vaginal bleeding during douching, sex, or in between menstrual periods
• Abnormal vaginal discharge

 

Diagnosis

Cervical cancer is diagnosed during pregnancy through a pap smear test. The doctor uses a special magnifying instrument known as the colposcope to scrape for cells from the cervix which are then tested. Women aged 21 and below usually undergo a diagnostic test to check for precancerous cells, irrespective of pregnancy.

For obtaining tissue samples, your doctor may use:

• Punch Biopsy – A sharp tool is used to pinch out small samples of cervical tissue
• Endocervical Curettage – A curet (spoon-shaped instrument) or thin brush is used to scrape off tissue samples from the cervix
• Electrical Wire Loop – A low-voltage electrical wire is slipped into the cervix for collecting tissue samples. Local anaesthesia is used in this method.
• Cone Biopsy – A procedure that goes into the deeper layers of the cervix for collecting tissue samples for laboratory testing. It is performed in hospitals under general anaesthesia.

Another form of diagnosis is the HPV DNA Infection test which scans for abnormalities in cells that match with any of the types of HPV infections. HPV infections are known to lead to cervical cancer and testing for HPV abnormalities in cervix cells is the second type of diagnosis.

If your doctor detects cervical cancer through laboratory testing or hospital diagnosis, then a further diagnosis will be carried out to determine the stage and extent of your cervical cancer. Common staging exams are:

• Imaging Tests – X-rays, CT scans, Magnetic Resistance Imaging (MRI) and positron emission tomography (PET) for determining how far cancer has spread from the cervix.
• Visual Examination – Special scopes are used for scanning areas inside the bladder and rectum to check the extent and condition of cervical cancer

What is Cervical Dysplasia?

When abnormal cell growth occurs in the outer lining of the cervix, this condition is referred to as a Cervical Dysplasia. Cervical Dysplasia is a precancerous stage and is heavily associated with the sexually transmitted Human Papillomavirus (HPV) infection. It is known to develop at any age and commonly found in women aged 30 and below. Cervical Dysplasia usually has no symptoms and is detected through routine Pap tests during pregnancy.

Cervical dysplasia, when left unchecked, later transitions into full-blown cervical cancer.

What Happens After Diagnosis?

Treatment after a diagnosis depends on the severity and extent of cervical dysplasia. For mild conditions, continued routine monitoring with repeat Pap tests ensue while for severe conditions, treatments such as cryosurgery, Electro-cauterization, and laser surgery are used.

After treatment, follow-up with respective doctors is necessary along with a repeat Pap test or an HPV DNA test between six to twelve months.

Can Chemotherapy Affect the Unborn Baby?

Chemotherapy during the first trimester of pregnancy is harmful to the foetus as the organs are developing during that stage. Chemotherapy does not affect the baby during the second trimester as the placenta acts as a barrier that protects the baby from the side effects of chemotherapy treatment and prevents certain drugs from entering the bloodstream.

During the later stages of pregnancy, chemotherapy may indirectly harm the unborn baby by causing side effects in the mother.

Risk Factors

Risk factors associated with chemotherapy treatment include:

• Loss of foetus
• Birth defects in newborn
• Low blood cell count during delivery
• Increased risk of cervical infections

Treatment Options

Alternative treatment options for chemotherapy treatment include:

• Chemotherapy combined with radiation therapy treatment
• Herbs and certain vitamins
• Changing your diet
• Acupuncture and massage
• Clinical trials

Clinical trials involve special untested procedures used in research studies to discover alternative methods of cancer treatment. Although useful, they may also prove to be dangerous.

Do speak with your doctor or concerned medical specialist before opting for any of these alternative treatment methods as some of them are complementary and may not be medically-approved.

Treatment of Cervical Cancer Based on Different Stages of Pregnancy

The treatment of cervical cancer is based on the location of the tumour, the stage of cervical cancer, your overall health, and the particular trimester of pregnancy you’re currently in. Here are following treatment modes for the different stages of pregnancy for mothers affected by cervical cancer.

1. Treatment of Cervical Cancer in Early Stages of Pregnancy

Routine Pap tests followed by a biopsy are used for the treatment of cervical cancer in the early stages of pregnancy. Surgery may be done during this stage which involves removing the tumour and surrounding healthy tissue in the cervix. This is non-invasive and poses little risk to the mother and the baby.

If your cervical cancer is in its earliest stages during pregnancy, your doctor may postpone treatment after a healthy delivery due to no threat to the pregnancy. After pregnancy, you may be subject to a hysterectomy (removal of the uterus) based on how far cancer has progressed after your pregnancy.

2. Treatment of Cervical Cancer in Second and Third Trimester

Chemotherapy may be combined with radiation therapy to provide the necessary treatment during this stage. These treatment methods are usually safe and do not harm the foetus during the second and third trimesters.

3. Pregnant Women Who Have a Small Tumour

For small tumours, there are two treatment options available for mothers-to-be: a cone biopsy, and a trachelectomy. Since a trachelectomy poses a risk to the unborn baby and may cause foetal demise during the operation, it is avoided during pregnancy. A cone biopsy is the preferred method. In this method, a conical section of tissue is removed from the cervix for examination and diagnosis.

4. Pregnant Women Having Large Tumour

Your doctor will recommend chemotherapy for treating large tumours. You will either be advised to opt for early delivery or wait until the second or third trimester to start with this treatment.

Precautions

There are no treatment methods known for completely treating cervical cancer in pregnant mothers. Treatment methods will vary based on the stage and extent of cancer along with the overall health of the patient. Findings from studies and data from clinical trials performed on previous non-pregnant cervical cancer victims are used to assist with treatment or delay cervical cancer therapies during pregnancy.

Your doctor may advise you to abort the pregnancy if your cervical cancer has progressed to the most advanced stages of your pregnancy.

Prevention

There are many ways to prevent cervical cancer from developing. The primary method is treating it as soon as it is detected, if possible, before the pre-cancerous stage and not letting it mature any further. The most common methods of prevention are:

• Using condoms during sexual intercourse
• Avoiding early sexual contact or not having sex with multiple partners
• Eliminating smoking/drug abuse
• Avoiding skin-to-skin contact with someone who already has an HPV infection
• Routine HPV vaccination starting between ages 9 to 12

It is recommended that every woman should undergo routine Pap testing (Pap smear) or HPV DNA Testing to diagnose signs/symptoms of cervical cancer. Routine vaccination is even recommended for those who have sex with multiple partners even beyond the age of 21 and above to prevent pre-cancerous stages from developing.

Make an appointment with your doctor and attend regular Pap screening tests to prevent the chances of cervical cancer from developing. By adopting a healthy lifestyle, not smoking, and ensuring you’re not sexually active before 21, you will greatly diminish the probability of Cervical Dysplasia from occurring. Routine vaccinations are also important for the prevention of HPV infections and cervical dysplasia.

During treatment, you may ask your doctor for palliative care which is known to provide relief from pain and other symptoms of serious illnesses.

We recommend you ask for a second healthcare provider’s opinion when considering attending an examination for the diagnosis of cervical cancer. Sit with your doctor and ask about the treatment options available to you if you are diagnosed with cervical cancer during pregnancy since treatment methods differ according to individual medical profiles.