Developing different kinds of minor complications during the stage of pregnancy is not uncommon. But getting diagnosed with cancer when you are pregnant is an entirely different situation. It’s very unlikely that the growing baby will get affected when the mother is diagnosed with cancer, but some kinds of treatment may affect the baby. There is a very minute chance that you or your doctor may have to make the difficult choice of treating cervical cancer at the cost of the baby. And, it should be said here, that it is a clinical challenge for the health care team.
Cervical cancer diagnosis
Cervical cancer is one of the most frequently diagnosed cancers during pregnancy.

What Is Cervical Cancer?

Cervical cancer is a condition in which the cells lining the cervix grow out of control. The cervix is the lower part of the uterus which is generally known as ‘neck of the womb’. There are two main types of cervical cancer:

  • Squamous cell cancer, which affects the cells that line the outer surface of the cervix
  • Adenocarcinoma, which affects the passage leading to the womb

What Are The Stages Of Cervical Cancer?

There are four stages of cervical cancer:

  • Stage 1: When cancer is just in the neck of womb, Stage 1 is again divided into-
    • Stage 1A: The growth is so small that it can be found only through a microscope.
    • Stage 1B: The growth is larger than stage 1A but still in tissue of the cervix and not spread yet.
  • Stage 2: When cancer begins to spread outside the cervix to the surrounding tissues. Stage 2 is further divided into-
    • Stage 2A: The cancer is spread to the top of the vagina.
    • Stage 2B: The cancer is spread to the surrounding tissues of the cervix.
  • Stage 3: Cancer spread away from the cervix into the surrounding structures in the pelvic area. Stage 3 is again divided into-
    • Stage 3A: The cancer is spread to lower part of vagina
    • Stage 3B: The cancer is grown to the pelvic wall blocking the tubes that drain kidney
  • Stage 4: This is the advanced stage of cancer. Cancer is spread to other body organs outside the womb. Stage 4 is further divided into-
    • Stage 4A: The cancer is spread to nearby organs such as bladder or rectum
    • Stage 4B: The cancer is spread to far away organs like lungs

How Does Cervical Cancer Harmonize With Pregnancy?

Women diagnosed with cervical cancer is around 0.8%. About 3% percent of these women diagnosed with cervical cancer are pregnant. One case out of thousand to five thousand pregnancies is reported to be diagnosed with cervical cancer.
But in most cases cervical cancer during pregnancy is detected in the early stage as the pregnant women undergo cervical examination and tests conducted as the part of routine checkups.

What Are The Symptoms Of Cervical Cancer?

The symptoms and signs of cervical cancer during pregnancy are:

  • Vaginal bleeding, without or after sexual intercourse
  • Pelvic pain
  • Back pain
  • Vaginal discharge with unpleasant smell
  • Pain during sex
  • Problems during urinating

Cervical cancer in pregnancy

How Is Cervical Cancer Diagnosed?

Some cancer symptoms such as vaginal bleeding are common during pregnancy. Sometimes a routine Pap test done as a part of pregnancy care can uncover cancer. Infact a Pap test should be done regularly to stay safe from cervical cancer.
Once any abnormality is detected in Pap test, to diagnose cancer:

  • Inspection of the uterine cervix is conducted
  • Cytological test (study the cells) is conducted
  • Colposcopy (examine the vagina and cervix using colposcope – an instrument that permits to observe living cell by magnifying it) is referred when the cytological test result is positive for cancer
  • A biopsy is usually recommended in exceptional cases when the progression of the cancer is suspected. This is to avoid the further risk of bleeding

What Is Cervical Dysplasia?

It is the mild cervical abnormalities that could develop into cervical cancer if not treated in the early stage. Usually, no treatment is suggested when a woman is diagnosed with cervical dysplasia. Close observation and repeating the Pap test during the pregnancy till delivery is preferred.

What Happens When Cervical Cancer Is Diagnosed During Pregnancy?

Once the cervical cancer is diagnosed during pregnancy, the next step is determined by:

  • Type of cervical cancer diagnosed
  • The stage of the cancer
  • The stage of pregnancy

Chances of cancer effecting the pregnancy depends more on the treatment that is decided to be followed by the medical team.

What Situations Influence The Course Of Treating Cervical Cancer During Pregnancy?

Following are the situations that influence the treatment of cervical cancer during pregnancy:

  • When cancer is in the early stage the pregnancy can be continued safely, treatment can be post pone till delivery as cancer won’t grow or spread fast
  • When cancer is in the advanced stage, the treatment decision becomes more complicated as the 2A stage cancer during the first trimester of pregnancy can progress to 3A or 3B by the time of delivery
  • When the woman is in her first trimester of pregnancy, after undergoing the tests and considering the stage of cancer if the medical team decides six months or more is a long period to leave cancer untreated, they may advice to terminate the pregnancy
  • When the woman is in her second or third trimester, most probably the medical team will decide to continue the pregnancy and may opt for an early C-Section depending up on the stage of cancer and then will start the treatment
  • When the tumor is small, detained treatment is considered to be safe as the cancer is in early stage and also if there is no evidence of progressive spreading
  • When the tumor is large, medical teams are found to suggest for chemotherapy if the pregnancy is passed the first-trimester mark. This will help to shrink the tumor or control cancer until the baby is born

So far no increased risk of birth defects is detected when the women in her second or third trimester undergo chemotherapy as the placenta stood as a barrier between the mother and baby. Some of the drugs used in chemotherapy won’t pass through the placenta. If it passes the amount will be in extremely small amount.

What Is Chemotherapy?

Chemotherapy is basically the process that involves destroying the cancer cells by interrupting the ability of the cell to grow and divide by using drugs.

How Does Chemotherapy Affect The Unborn Baby?

Chemotherapy will result in low blood count of the mother which make her prone to infection. This infection could harm the unborn baby. Thus, chemotherapy can effect baby indirectly.

What Should I Do When If I Get Diagnosed With Cervical Cancer?

Your pregnancy will fall under ‘high-risk pregnancy’ type once you are diagnosed with cervical cancer. Therefore, your medical team must include an oncologist as well as a well-trained obstetrician who could handle high-risk pregnancy.

Make sure that you will get an opportunity to ask all your doubt to your medical team. If needed, you can go for a second opinion too.