Abstract

Cervical cancer is the most common gynecologic malignancy associated with pregnancy. However, there are no consensus guidelines that define the indications for or the optimal length of expectant management. The subjects were women who had a preexisting invasive cervical cancer or whose cancers were diagnosed during pregnancy or within 12 months after delivery. Thirty-nine consecutive women with cervical cancer, whose ages ranged from 20 to 40 years, were chosen as controls. We performed a retrospective chart review on the maternal profile and perinatal outcome and compared the clinical features between pregnancy- and non-pregnancy-associated cervical cancer in patients. The percentage of asymptomatic cases in which cancer was detected in a routine Papanicolaou test was significantly higher in the pregnant patients. The percentage of induced preterm labor or therapeutic abortions was 50%. Expectant management (mean length, 19.8 weeks) was chosen by 5 patients, and there were no cases of recurrence or death from disease. Seven subjects, including 5 patients whose diagnoses were changed from cervical intraepithelial neoplasm or condyloma to cancer, were managed as "unexpected expectant" because these subjects were not diagnosed as having stage IA/IB cancer during pregnancy. All of these subjects underwent vaginal delivery and included 2 patients with death from disease and lymph node recurrence. The percentage in which disease severity was underestimated was higher in pregnant patients. The option of therapeutic delay should be carefully discussed. Patient counseling should address the issue that risk may not be precisely estimated because of the possibility that disease severity may be underestimated during pregnancy.