Treatment of Stage I Cervical Cancer During Pregnancy

Pregnancy does not alter the course of cervical cancer. As a result, in certain cases, patients may elect to postpone treatment until its effects on the pregnancy are minimized. This approach may be considered for patients with the more common and less aggressive histological subtypes: squamous, adenocarcinoma, and adenosquamous. Patients with high-risk subtypes, such as small cell or neuroendocrine tumors, should consider immediate treatment despite the effects on the fetus, given their risk of progression.

Patients with early-stage disease (IA) may safely undergo fertility-sparing treatments, including cervical conization or radical trachelectomy, as indicated. The optimal timing for this procedure is in the second trimester, before fetal viability. Some authors have suggested waiting until the completion of pregnancy to initiate treatment.[1] For patients with stages IA2 and IB disease, such a delay may be safe, but lymph node status should first be assessed because of a risk of lymphatic spread. The status is best determined surgically via a laparoscopic or open lymph-node dissection, which can be safely performed up to approximately 20 weeks of pregnancy.[2,3] Patients without lymphatic spread can wait for fetal viability before initiating treatment. Patients with positive lymph nodes should consider immediate treatment.