What to Do If Cervical Cancer Is Found During Pregnancy?【Supervised by doctor】

Introduction

“What should I do if cervical cancer is found during pregnancy?”
“Is it okay to continue the pregnancy? Will there be any problems for the baby?”

When abnormalities are found during cervical cancer screening in pregnancy, it’s natural to worry not only about the baby but also about your own health. You may wonder if it’s okay to continue the pregnancy or if it would be better to treat the condition after giving birth.

In this article, we will explain in detail how to handle cervical cancer found during pregnancy and whether it has any impact on the baby.

What is Cervical Cancer?

Cervical cancer is a type of cancer that occurs in the cervix, the cylindrical part at the lower end of the uterus. Because it forms near the entrance of the uterus, it is often detected during prenatal checkups.

It is known as a cancer with a good prognosis if detected early since it is relatively easy to treat. However, caution is necessary as it can metastasize. The peak incidence is said to be in the late 30s.

Classification of Cervical Cancer

The development of cervical cancer is classified into three stages: “cervical intraepithelial neoplasia,” “carcinoma in situ,” and “invasive cancer.”

Cervical intraepithelial neoplasia refers to the stage before cancer develops. It ranges from mild dysplasia, which is the very early stage, to severe dysplasia, which is just before the transition to cervical cancer. This stage is also called a precancerous lesion. Although it is not cancer and therefore not malignant, the cells have an abnormal shape compared to normal cells and require observation.

Carcinoma in situ refers to the state where cancer is present only on the surface of the cervix.

Invasive cancer is when the cancer has penetrated the surrounding tissues.

Causes of Cervical Cancer

The primary cause of cervical cancer is said to be infection with the human papillomavirus (HPV). HPV is not a rare virus; it is estimated that over 50% of sexually active women will be infected with HPV at some point in their lives.

This means that anyone can be at risk of infection. However, being infected with HPV does not necessarily lead to the development of cervical cancer. In over 90% of cases, the body’s immune system effectively combats the virus, preventing it from causing harm. In the remaining 10%, the infection persists, and some of these cases may progress to cervical intraepithelial neoplasia.

Cervical Cancer Tests in Early Pregnancy

There are mainly three methods for testing for cervical cancer in early pregnancy.

Cytology

Cytology, also known as a Pap smear, involves collecting cells from the cervix using a specialized spatula or brush and examining them under a microscope. The collected cells are fixed onto a glass slide, stained with dye, and then observed microscopically.

If abnormalities are detected through cytology, a more detailed examination will be conducted. However, it is important to note that not all abnormalities found in cytology are diagnosed as cancer. Cytology is primarily used to determine whether there is a possibility of cervical cancer, not to confirm its presence.

High-Risk HPV Test

The high-risk HPV test checks for infection with the human papillomavirus, which is closely associated with the development of cervical cancer. There are more than 100 types of HPV, but not all of them pose a high risk for causing cervical cancer.

The high-risk HPV test specifically detects infections with 13 types of HPV that are considered to have a particularly high risk, including types 16, 18, and 39.

Colposcopic Biopsy

Colposcopic biopsy is performed when abnormalities are found during cytology. This examination uses a magnifying instrument called a colposcope to closely inspect the cervix. If abnormalities are detected, a biopsy is performed using the colposcope to collect tissue samples.

In addition to these tests, other examinations such as pelvic exams, rectal exams, ultrasound scans, and CT scans may be conducted to determine the extent of the cancer’s spread.

All of these tests are aimed at checking the mother’s condition rather than detecting abnormalities in the baby. If you are concerned about the baby’s health, consider undergoing NIPT (Non-Invasive Prenatal Testing), which can be taken from early pregnancy. This test examines chromosomal abnormalities such as Down syndrome. At Hiro Clinic NIPT, you can undergo NIPT (Non-Invasive Prenatal Testing) as soon as the pregnancy is confirmed by an ultrasound examination.

What to Do If Cervical Cancer Is Found During Pregnancy?

It is not uncommon for cervical cancer to be detected during pregnancy. This is primarily because cervical cancer screening is typically conducted during early prenatal checkups. If cervical cancer is found, the pregnancy can continue while monitoring the condition, or surgery may be performed depending on the situation.

Observation

If the situation is not urgent or if prioritizing the continuation of the pregnancy, observation without surgery will be conducted. However, even if there is a strong desire to continue the pregnancy, surgery may be necessary if the doctor determines that the mother’s life is at risk.

Of course, continuing the pregnancy can delay treatment, and depending on the stage of cancer, it may become life-threatening. It is important to have thorough discussions with the doctor to make the best possible decision.

Surgical Treatment

Early surgical treatments for cervical cancer include conization and laser vaporization, which remove the cancerous lesions from the cervix. Depending on how much the cancer has spread and how deep the lesions have penetrated, it might be possible to delay surgery until after childbirth.

However, in some cases, immediate action is necessary, and continuing the pregnancy may not be an option. This can be a difficult decision, but it is important to consult thoroughly with your doctor to make a choice you will not regret.

Conization

Conization is a surgical procedure where a part of the cervix is removed in a cone shape using a laser or scalpel. It is suitable for early-stage cervical cancer. Since the uterus is left intact, this treatment allows for the preservation of fertility, making it an option for those who wish to conceive after treatment.

However, it is said that conization may shorten the cervical canal, potentially increasing the risk of preterm birth or miscarriage.

Laser Vaporization

Laser vaporization is a procedure performed on patients with cervical intraepithelial neoplasia, specifically those with moderate to severe dysplasia.

Strictly speaking, it is not used to treat cervical cancer but rather the precancerous stage. The treatment involves applying a laser to the affected area to vaporize it. Since it does not affect the cervical canal, the risk of preterm birth or miscarriage remains unchanged.

Effects of Cervical Cancer on the Baby

Cervical cancer can potentially affect the baby. There have been reported cases where cervical cancer cells were inhaled by the baby through the amniotic fluid, leading to cancer development in the child after birth. This means there is a possibility that the mother’s cervical cancer can be transferred to the child.

However, it is important to note that having cervical cancer does not necessarily mean that the baby will be affected. In many cases, there are no impacts on the baby at all.

Cervical Cancer Vaccination During Pregnancy

The safety of administering the cervical cancer vaccine during pregnancy has not yet been firmly established.

There is data suggesting no issues, but the Ministry of Health, Labour and Welfare advises that pregnant women should thoroughly communicate their health status and any particular conditions to their attending physician. They should receive a comprehensive explanation of the necessity, risks, and effects of the vaccination and fully understand this information before deciding to get vaccinated.

Therefore, it is ideal to complete the cervical cancer vaccination before becoming pregnant.

Conclusion

If cervical cancer is detected during pregnancy, it is necessary to decide whether to continue the pregnancy with ongoing observation or to prioritize treatment by terminating the pregnancy. This decision must consider the stage of cervical cancer, its spread, and its depth.

Although it is rare for cervical cancer to have a significant impact on the baby, there have been some reported cases where cancer was transmitted. Discovering cervical cancer during pregnancy can be overwhelming and cause significant anxiety. It is important to consult thoroughly with a trusted doctor to make a decision that you will not regret.

Article Editorial Supervisor

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Dr Hiroshi Oka

NIPT specialist clinic, MD

Graduated from Keio University, School of Medicine