Cervical Cancer in Pregnancy

Carcinoma of the uterine cervix is one of the most common malignant neoplasms among women and remains the leading female malignancy in Thai women. Cervical cancer diagnosed during pregnancy remains a therapeutic challenge for physicians. Pregnant women should have cervical cytology screening at their first prenatal visit. In cases of cytological abnormality, colposcopy is indicated. Cervical conization is used for the diagnostic role only. The management of invasive cancer depends on the gestational age at diagnosis, stage of disease, patient’s desire of pregnancy, ethics and religious belief s including family and decision making by multidisciplinary teams. Siriraj Med J 2010;62:47-51 E-journal: http://www.sirirajmedj.com During the past decade, epidemiologic evidence has accumulated, implicating infection with high-risk types of genital human papillomavirus (HPV) as a necessary cause of squamous cell carcinoma the cervix and related precursor lesions. Previous studies have indicated a proportionately higher frequency of cervical HPV infection in pregnant women compared with the expected frequency in non-pregnant controls. The down-regulation of cell-mediated immunity during pregnancy and pregnancy-related active metaplasia of the cervical epithelium are likely contributing factors to these observations. Cytologic screening The concept of utilizing exfoliative cytology to identify women with invasive cervical cancer was introduced by Papanicolaou and Babes in the 1920s. Pap smear has proven to be the most efficacious and costeffective method of cancer screening. In the 1960s, cervical cytology began to be widely used in many developed countries as a technique for cervical cancer prevention and has decreased both the incidence and mortality from cervical cancer. With the incorporation of cervical cytology into routine prenatal screening, clinicians are frequently presented with management decisions regarding cervical abnormalities during pregnancy. In general, 1.3% to 2.2% of pregnant women will have cervical cytologic abnormalities detected during pregnancy, although the exact incidence is highly dependent on the population screened and the referral base of the reporting institution. Pregnant women should receive cervical cytology screening at their first prenatal visit and samples should be collected from both the ectocervix and the endocervical canal. Abnormal cytology and management All women with a cytologic cervical abnormality