Study Supports Safety of Performing Surgery for Cervical Cancer During Pregnancy or Delaying Treatment

For women diagnosed with stage I cervical cancer during pregnancy whoare torn between the desire to maintain a healthy pregnancy and the needfor cancer treatment, a recent study offers hope that both desires canbe achieved. The study, reported in the December 5th issue of GynecologicOncology, the scientific publication of the Society of GynecologicOncologists (SGO), supports the safety both of performing surgery for cervicalcancer diagnosed during pregnancy and of delaying surgical treatment forwomen with stage I disease. This delay allows the fetus to mature whilenot adversely affecting the clinical outcome of the mother, according tothe study.

The study was a retrospective, case-controlled analysis of 30 womendiagnosed with cervical cancer during their pregnancy who were surgicallymanaged at the University of Iowa between 1960 to 1994. According to theauthors, the study is the largest case-control study of pregnant patientstreated surgically for cervical cancer. Although affecting .05% of allpregnancies, cervical cancer is still the most common malignancy foundduring pregnancy.

Treatment Recommendations Depend on Stage of Pregnancy

If invasive cancer was diagnosed early in the pregnancy immediate hysterectomywas recommended. Fetuses delivered in the first or second trimester, inconjunction with the hysterectomy, did not survive due to their prematurity.If cervical cancer was detected toward the middle to late part of the pregnancy,timing of surgical treatment depended on the cancer stage, histology, andlesion size. Patients in this category with smaller or earlier-stage lesionswere given the option to delay cancer surgery until the fetus could mature.They were monitored throughout to check for disease progression, however.

Of the 15 women whose cancer was detected in the middle to late partof the pregnancy, 11 patients planned a delay in their cancer surgery untilthe third trimester--an average of 16 weeks after their diagnosis--to givetheir babies time to mature. The babies were delivered by cesarean section,followed immediately by the cancer surgery. All 11 patients and their babiesare alive and all women are disease-free after an average follow-up of118 months. According to the study, the planned delay in treatment forthese patients did not affect outcome for either the fetus or patient.

The remaining four women also had cancer surgery in their third trimester,but did not have a planned delay in their treatment because the stage,histology, or lesion size of their cancer called for immediate cesareansection and cancer surgery. Two of the four infants in this group survivedand two died of complications related to their prematurity.

"Based on our data, pregnant patients with early stage squamouscancers diagnosed in the late second or early third trimester may havetheir cancer therapy delayed to increase the likelihood of a healthy babywithout compromising the mother's prognosis," said lead authors, AnilK. Sood, MD and Joel I. Sorosky, MD, University of Iowa Hospitals and Clinics,Iowa City.

The most common factor leading to a diagnosis of cervical cancer amongthe pregnant patients in the study was an abnormal prenatal Pap smear (64%),whereas postcoital bleeding or other symptoms led to a diagnosis more oftenin the nonpregnant control patients (60%). "Interestingly, pregnancymay provide an opportunity to detect cervical cancer in earlier stagessince prenatal care includes routine Pap smear screening," said SGOPresident David M. Gershenson, MD.