All cancers are rare during pregnancy. But, the incidence of cervical cancer and pregnancy rate occurred 0.1- 12.0 per 10.000 pregnancy women. Studies and guidelines on these cases are rare. So the treatment of these cases is difficult.
The cancer cells are found in the cervix, or may also include the tissue of the uterus and the proximal part of the vagina.
Cause of cervical cancer
Human papillomavirus (HPV) plays a role in causing cervical cancer in women. That passed through sexual contact. When HPV affects the body, the immune system defends against the virus’s harm.
Some women are affected by the human papillomavirus. This virus survives for years in their bodies. Cancer cells formed as a result of excessive multiplication caused by HPV.
Cervical healthy cells change their DNA. The cells accumulate as a bloc called a tumour.
Types of cervical cancer
There are many types of cervical cancer. That depends on the tissues that are affected.
Squamous cell carcinoma
Increasingly growing cells in the squamous cells of the cervix. Its shape is thin and flat. This type mainly occurs in cervical cancer and pregnancy at the same time.
Adenocarcinoma
This type begins in the column-shaped gland cells. It is found in the cervical canal.
Risk factors of cervical cancer
Sexual history
Sexual activity in young females under 18 years old.
Women have many sexual partners.
Women have one partner, but he is affected by HPV or has many sexual partners.
Smoking
A smoker not only harms himself but also others. Tobacco may cause many types of cancer, rather than just lung cancer. Smoking women have cervical cancer; the tobacco byproduct is found in the cervical mucus membrane.
Also, smoking decreases immunity. The body can’t defend against HPV infection.
Immunity System
A weak immune system can’t destroy an HPV infection, allowing the cancer cells to spread.
Multiple full-time pregnancies
The studies say that more than three times, full-term pregnancies may be the cause of cervical cancer. Cervical cancer and pregnancy occurred in a small number of cases.
Also, studies show that hormonal changes during pregnancy may suppress the immune system, which allows HPV infection.
Pregnancy in a female under 20 years old
Full-term pregnancy in younger females, less than 20 years old, is more susceptible to HPV infection than older women. So cervical cancer and pregnancy may occur in younger females.
Symptoms of cervical cancer and pregnancy
There is no difference between cervical cancer symptoms in pregnant and non-pregnant women. It is asymptomatic in the beginning stage. It can be diagnosed with a cervical smear.
Painless vaginal bleeding, anomalous vaginal bleeding, discharge, dyspareunia, and/ or an abnormal appearance of the cervix.
Local extension to the pelvic organs may cause hematuria, lower-limb oedema, changes in the bladder and bowel. Bone pain, such as lower back pain.
Other symptoms
Loss of appetite, weight loss, or fatigue. Oliguria and anuria due to renal failure.
Examination and Diagnosis
Cervical screening
The test of cure may be applied, in case of cervical cancer and pregnancy, is delayed after three months postpartum.
Women who require follow-up after treatment of cervical glandular intraepithelial neoplasia (CGIN), or cervical intraepithelial neoplasia (CIN), must make TOC.
Colposcopy and excisional biopsy in pregnancy
Colposcopy is safer during pregnancy. Colposcopic assessment during pregnancy needs a high-skilled specialist.
The physiological changes of pregnancy can be deceptive. These changes include increased cervical mucus, cervical hyperaemia, gland prominence, and eversion of the columnar epithelium.
If an invasive disease is detected by colposcopy, an adequate biopsy to make a diagnosis is an emergency. It is remarkable to know that a punch biopsy diagnosing CIN cannot reliably exclude invasion.
The risk of haemorrhage with a diathermy loop is approximately 25%, so such biopsies should be applied in clinics or operating theatres where appropriate facilities to manage haemorrhage are available.
Stages of cervical cancer
Stage I cervical cancer
In stage I, cervical cancer cells are found in the cervix only. It is divided into stages IA and IB according to the size of the tumour and the deepest point of tumour invasion.
Stage IA
Is subdivided into IA1 and IA2.
Stage IB
It is subdivided into IB1, IB2, and IB3.
Stage II in cervical cancer
Their types are IIA and IIB. When the cancer cells include the proximal two-thirds of the vagina, this is called stage IIA. When the cancer cells spread to the tissue of the uterus, this is stage IIB.
Stage III of cervical cancer
Their types are IIIA, IIIB, and IIIC. The cancer cells arrive at the pelvic wall and cause problems in the kidney and lymph nodes.
Stage IV of cervical cancer
Their types are IVA and IVB. The cancer cells spread to the pelvic organs. Also, reach other body parts.
Treatment of cervical cancer and pregnancy cases
The treatment plan differs according to the stage of cervical cancer and trimester.
Treatment of stage I
The treatment of stage I with slow-growing cervical cancer and pregnancy in the first trimester may be without medication. Oncology therapists’ advice is to continue the pregnancy; you should labour early at 37 weeks.
Labour with a cesarean section is safe and removes the uterus and the cervix at the same time.
The treatment of stage I with fast-growing cervical cancer and pregnancy in the first trimester is an emergency. The treatment may be: Surgical removal of the cervix and the uterus (hysterectomy). So the pregnancy was not completed.
Chemotherapy isn’t safe for the fetus in the first 3 months. Radiation therapy has harmful effects on the fetus.
The treatment of stage I in the second or third trimester is surgical intervention by cold knife conization or radical trachelectomy. This technique maintains the pregnancy.
The labour should apply with a cesarean section. After delivery, a hysterectomy or radiotherapy is applied in case cancer cells remain.
Treatment of stage II, III, and IV
Treatment of stage II, III, and IV cervical cancer and pregnancy in the second or third trimester is chemotherapy. The chemotherapy, such as carboplatin and paclitaxel, can not harm the fetus.
The labour should apply with a cesarean section. Hysterectomy or radiotherapy may be applied postpartum.
All cancers are rare during pregnancy. But, the incidence of cervical cancer and pregnancy rate occurred 0.1- 12.0 per 10.000 pregnancy women. Studies and guidelines on these cases are rare. So the treatment of these cases is difficult. The treatment plan differs according to the stage of cervical cancer and trimester.
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