Invasive Cervical Cancer in Pregnancy

EDITORIAL COMMENT": Readers are advised to give this paper careful attention. It reports a large experience of treatment of invasive carcinoma of the cervix during pregnancy and within 1 year of confinement. The authors emphasize the importance of performing a Papanicolaou cervical smear on all pregnant patients and their results show that adequate investigation including cone biopsy of the cervix is possible during pregnancy and that in the vast majority of women, treatment of the disease is possible without compromise to fetal or maternal life or health. To appreciate this paper the tables must be studied closely. It is interesting that the incidence of the disease was only 1 in 4,419 pregnancies, especially when 11 of the 22 cases had microinvasive disease with a depth of invasion of 3 mm or less. The recommended method of delivery in women with microinvasive squamous carcinoma of the cervix who have had cone biopsy during pregnancy is still not clear‐cut. Certainly vaginal delivery is possible in these women as was shown in 4 patients in this series. Further follow‐up is required to confirm the safety of this finesse. Summary: Cervical cancer is the commonest malignancy which complicates pregnancy, but the management remains controversial. We reviewed our patients in an attempt to identify the best management options which resulted in long‐term survival for the mother and a live baby. The total number of pregnancies managed between January, 1981 and March, 1995 was obtained from the hospital records, and patients with invasive cervical cancer diagnosed during pregnancy or within 12 months of delivery were identified. The case records were reviewed. Between January, 1981 and March, 1995 there were 22 cases of cervical cancer diagnosed either during pregnancy or within 12 months postpartum. This gave an incidence of cervical cancer associated with pregnancy of 1 in 3,817 pregnancies or 0.26 per 1,000 pregnancies. Eleven patients had microinvasive disease. Nine were treated by cone biopsy and 2 by radical hysterectomy. Nine patients had Stage IB and 1 had Stage 2A disease and all were treated with radical hysterectomy. One patient had Stage 3B disease and was treated witfi radiotherapy and chemotherapy followed by simple hysterectomy. Fourteen patients delivered vaginally. Twenty of the 22 patients were delivered of live babies which survived. The patients have been followed from 1 month to 13 years with only 1 recurrence, and all 22 remain alive. We conclude that all pregnant women should have a Pap smear performed antenatally. Cone biopsy can be safely performed in pregnancy and may be adequate treatment for microinvasive squamous cell carcinomas. Treatment, including the timing of delivery, must be individualized, with the patient playing an important decisionmaking role.