Management of stage I cervical cancer in pregnancy

Although cervical carcinoma is the most common gynecologic malignancy assoc iated with pregnancy, its occurrence is rare with an incidence of approxima tely 1 per 1,200 to 10,000 pregnancies. There are inadequate data addressin g both the obstetric implications of the diagnostic evaluation and the impa ct of intervention on maternal and infant outcomes. Certain conclusions and recommendations, however, can be drawn from the available data. Diagnostic evaluation includes cytological screening, colposcopy and if necessary, bi opsy, and selective conization, Staging of the pregnant patient is modified to minimize radiation exposure to the developing fetus. The treatment sche ma for patients with stage I cervical cancer in pregnancy varies with the s tage of disease and gestational age at diagnosis. With close surveillance, deliberate delay of therapy to achieve fetal maturity is a reasonable optio n for patients with microinvasive and early stage IB cervical cancer. Tumor characteristics and maternal survival are not adversely affected by pregna ncy. Conversely, cervical cancer does not seem adversely to affect pregnanc y. However, timing and type of therapy may have a significant influence on the fate of the fetus. In counseling patients with cervical cancer during p regnancy, many factors must be considered, including the patient's desire f or the pregnancy, stage of disease, and gestational age at diagnosis. Pregn ant patients with stage I cervical cancer should be fully informed of all p ossible treatment options and consequences. The care of these patients shou ld be closely coordinated by experts in perinatology and gynecologic oncolo gy. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be a ble to describe the signs and symptoms of cervical cancer during pregnancy and the indications for conization during pregnancy, as well as being able to outline management strategies for the various stages of cervical cancer during pregnancy.