Cervical cancer is a malignancy involving the uncontrolled growth of abnormal cells in the cervix, the lower part of the uterus. A miscarriage is defined as the spontaneous loss of a pregnancy before the 20th week of gestation. A cancer diagnosis during pregnancy naturally raises serious concerns about the health of the developing fetus and the stability of the pregnancy. This article explores the relationship between cervical cancer and the risk of pregnancy loss, along with the specific medical approaches used during this complex time.
The Relationship Between Cervical Cancer and Miscarriage Risk
The presence of cervical cancer itself does not typically increase the risk of early miscarriage, which occurs before 20 weeks of pregnancy. Early pregnancy loss is most often linked to chromosomal abnormalities in the fetus or severe hormonal imbalances, neither of which is directly caused by a localized tumor on the cervix. Cervical cancer is generally a slow-growing disease, and in its early stages, it does not interfere with the process of embryo implantation within the uterine wall.
The main concerns associated with cervical cancer during pregnancy center on later complications, rather than a first-trimester loss. As the pregnancy progresses, the cancer can increase the risk of bleeding or lead to complications like preterm labor, which is delivery before 37 weeks. These later issues are often related to changes in the cervical tissue structure or the need for specific treatments.
Screening and Diagnosis During Pregnancy
Cervical screening, such as the Pap test, is considered safe to perform at any point during pregnancy and has not been shown to increase the risk of miscarriage. Pregnancy provides an opportunity for routine screening, and often the test is performed during the initial prenatal care visit. While minor bleeding or spotting after the procedure is more common during pregnancy due to increased blood flow to the cervix, this does not harm the fetus.
If an abnormal screening result suggests a need for further investigation, a procedure called colposcopy can be safely performed. A specialist uses a magnifying device to examine the cervix, and a biopsy can be taken from suspicious areas if invasive cancer is suspected. To ensure fetal safety, the diagnostic procedure known as endocervical curettage, which scrapes cells from high up in the cervical canal, is strictly avoided in pregnant patients.
Managing Cervical Cancer While Pregnant
The management of a confirmed cervical cancer diagnosis during pregnancy requires a complex, multidisciplinary approach involving obstetricians, gynecologic oncologists, and neonatologists. The treatment plan is individualized and depends heavily on the cancer’s stage and the gestational age of the fetus. For early-stage, slow-growing tumors, it is often possible to delay definitive treatment until the fetus reaches viability or full term, sometimes around 37 weeks.
Intense monitoring of the mother and the tumor is required throughout the pregnancy. However, if the cancer is aggressive, fast-growing, or advanced, immediate treatment is necessary, which may mean the pregnancy cannot continue. Chemotherapy is generally avoided during the first trimester due to the high risk of fetal malformation, but it can be an option in the second and third trimesters to control tumor growth while awaiting a safe delivery time. In the most advanced cases, radiation therapy or extensive surgery may be required immediately, necessitating the termination of the pregnancy.
How Prior Cervical Procedures Affect Pregnancy
Women who have previously undergone procedures to treat precancerous cells, such as a Loop Electrosurgical Excision Procedure (LEEP) or a cold knife cone biopsy, may have an altered risk profile in subsequent pregnancies. These procedures remove a section of cervical tissue, which is highly effective in preventing cancer but can sometimes weaken the cervix. This weakening can lead to a condition called cervical insufficiency.
Cervical insufficiency typically presents a risk of late miscarriage, which occurs in the second trimester, or preterm birth. Patients with a history of these excisional procedures are often monitored closely during pregnancy, sometimes through regular measurement of the cervical length via ultrasound. If the cervix is found to be shortening, a cerclage, or a stitch placed in the cervix, may be necessary to help maintain the pregnancy to term.