Cervical cancer develops in the cells of the cervix, the lower part of the uterus connecting to the vagina. It progresses slowly and may not present with immediate symptoms. A miscarriage refers to the unexpected loss of a pregnancy before 20 weeks of gestation. Most miscarriages occur in the first trimester, often due to chromosomal abnormalities where the fetus does not develop properly.
How Cervical Cancer Affects Pregnancy
Cervical cancer rarely causes a miscarriage in early pregnancy. While a tumor does not typically lead to direct pregnancy loss, it can influence pregnancy. A tumor might physically obstruct the cervix or cause cervical insufficiency, potentially leading to preterm labor rather than an early miscarriage.
The cancer can also cause abnormal vaginal bleeding, which might be mistaken for miscarriage symptoms. This bleeding, however, does not necessarily indicate a pregnancy loss. The tumor’s presence could increase local inflammation or susceptibility to infection, which might contribute to adverse pregnancy outcomes.
Beyond miscarriage, cervical cancer can lead to other complications during pregnancy, such as an increased risk of preterm birth. A cesarean section may become necessary for delivery due to cervical obstruction.
Diagnosing Cervical Cancer During Pregnancy
Cervical cancer is detected during pregnancy through routine prenatal care. Pap tests are part of this routine and are safe during pregnancy. These tests screen for changes in cervical cells that could indicate cancer or pre-cancerous conditions.
Symptoms such as abnormal vaginal bleeding, discharge, or pelvic pain prompt further investigation. While these symptoms can be non-specific and sometimes mimic common pregnancy discomforts, they warrant attention. If an abnormal Pap test result or suspicious symptoms arise, diagnostic procedures like colposcopy and directed biopsy are performed.
Colposcopy, a procedure to examine the cervix, vagina, and vulva, is safe during pregnancy. If needed, a biopsy, which involves taking a small tissue sample, can be performed with minimal risk to the pregnancy, though there is a slight chance of increased bleeding. Endocervical curettage, however, is not recommended due to a slight risk of pregnancy complications.
Managing Cervical Cancer During Pregnancy
Managing cervical cancer during pregnancy involves balancing maternal health and fetal well-being. Treatment decisions are influenced by several factors, including the cancer’s stage, the gestational age of the pregnancy, and the patient’s preferences.
For early-stage cancers, especially in the first trimester, treatment can be delayed until after delivery to protect the fetus. Surgical options like conization (removing a cone-shaped piece of the cervix) or trachelectomy (removing the cervix) can be performed to remove cancerous tissue while preserving the uterus. These procedures can increase the risk of preterm birth or future miscarriage due to cervical changes.
Chemotherapy and radiation therapy are avoided in early pregnancy due to harm to the developing fetus, including an increased risk of miscarriage. In later stages of pregnancy or for more advanced cancers, chemotherapy can be considered, often prompting discussions about early delivery. A multidisciplinary team of oncologists, obstetricians, and other specialists is important to navigate these complex treatment choices.
Prognosis and Future Health
The prognosis for a mother diagnosed with cervical cancer during pregnancy depends on the cancer’s stage at diagnosis and the effectiveness of treatment. Pregnancy itself does not negatively affect the mother’s survival rate when compared to non-pregnant individuals with similar cancer stages. Early detection, often facilitated by routine prenatal screenings, can contribute to a favorable outlook.
Babies born to mothers with cervical cancer have good outcomes, particularly if delivered at or near term. However, treatment interventions can lead to complications such as preterm birth or low birth weight. A cesarean section is recommended for delivery to avoid complications related to the cervix.
For future pregnancies, the implications depend on the specific treatments received. Procedures like hysterectomy, which removes the uterus, eliminate the possibility of future pregnancies. Fertility-sparing surgeries, such as conization or trachelectomy, aim to preserve the ability to conceive, though they can increase the risk of miscarriage or preterm birth in subsequent pregnancies due to cervical changes. Ongoing follow-up care is important for both maternal health and any future reproductive plans.