The cervix is the structure at the upper end of the vagina that dilates to allow a baby to enter the birth canal. Dr. William Rich of the University of California states there are two types of cervical cancer, adenocarcinoma of the lining of the endocervical canal, and squamous cell carcinoma of the outer tip of the cervix. The most predominant is the latter. Cervical cancer is the cancer most associated with pregnancy.
Miscarriage
The discovery of an abnormal Pap smear or the presence of post-coital bleeding is usually followed by a cervical biopsy to determine if cancer is present and what treatment is mandated. Dr. William Rich cautions that any manipulation of the cervix during the first three months, or first trimester, of pregnancy puts the uterus at risk of spontaneous miscarriage. During the third trimester manipulation may cause premature labor. There appears to be little risk during the early part of the second trimester.
Hysterectomy
The Doctor's Guide cites the journal "Gynecologic Oncology", the scientific publication of the Society of Gynecologic Oncologists, as stating that hysterectomy is the preferred choice of treatment in invasive cervical cancer. It adds, if diagnosed in the first or second trimester, fetuses did not survive delivery prior to the hysterectomy. Those cases diagnosed with smaller lesions in the final trimester were given the option to delay surgery to allow the fetus to develop to term. It states cesarean delivery was successful in these cases of the study.
Delay of Treatment
According to the study "Cervical Cancer During Pregnancy" by Dr. S.D. McDonald of Ottawa University, radical surgery is recommended for the early stages of cervical cancer. A 20 week delay in therapy may be considered. He continues by saying that it is imperative that the patient be well informed with supporting data if delay of treatment is opted for in more advanced stages of the disease. The National Cancer Institute refers to increased chances of metastases in advanced cervical cancer. Maternal and fetal mortality may also be a consideration, although delay shows it to be an acceptable option.
