Return To Main Index
Cervical Cancer Guide
|Cervical Dysplasia - Early Signs
During pregnancy cervical dysplasia or CIN (also referred to as carcinoma in situ) is a more common occurrence than invasive cancer of the cervix, as might be expected, since patients who ultimately develop invasive cancer will have had CIN for some years beforehand. It is the usual practice to take a Pap smear from pregnant women during their first prenatal examination. If abnormal cells are found the cervix is carefully examined with a speculum to exclude invasive cancer (see, cervical cancer diagnosis for details). If the cervix appears normal on ordinary inspection, a colposcopy (a special illuminated microscope which is inserted into the vagina and magnifies the cells) should be performed to locate the areas on the cervix from which the abnormal cells have originated. After this, a colposcopically directed biopsy, taking only a small amount of tissue, can be carried out. If a diagnosis of dysplasia or carcinoma in situ is established, and invasive cancer excluded, treatment can safely be left until after delivery. If any patient has not had a Pap smear examination during pregnancy this must be done postpartum.
Invasive Cancer (Carcinoma)
Invasive cancer of the cervix is a rare complication of pregnancy because the disease most often arises in the later years of menstrual life, when pregnancy is less likely to occur. About 1 to 3 percent of women are pregnant at the time of diagnosis. About half are diagnosed during pregnancy and the reminder within 12 months postpartum. Apart from early diagnosis by Pap smear, when there may be no symptoms of cervical cancer, the disease is first discovered because of slight bleeding from the cervix, sometimes after sex or vaginal examination. Usually there is a delay in diagnosis by up to 5 months because these symptoms are mistaken for pregnancy symptoms. It quickly progresses in the same way as in the non-pregnant woman, with vaginal bleeding and discharge from an ulcerated lesion on the cervix. When there is any doubt about the nature of the lesion, a biopsy is essential. If the growth is restricted to the cervix, intermittent bleeding will be the only symptom at first, and delay in diagnosis can occur because this is mistaken for a threatened miscarriage or hemorrhage.
This depends on the stage of pregnancy at which the diagnosis is made. In early pregnancy therapeutic termination should be carried out and the cervical lesion should then be treated by radiotherapy or surgery in the usual way (see treatment for cervical cancer). In late pregnancy caesarean section should be performed and may be combined with a radical hysterectomy. It is difficult to know what to do when the diagnosis is made in mid-pregnancy before the fetus is viable. In such cases treatment may sometimes be postponed for a short time to allow the fetus to grow to a size and maturity at which it has hope of survival. Such a postponement should not exceed four weeks and can only be agreed to after consultation with the patient and her partner. The reason for speed is that early stage cervical cancer (stage 1a) could become stage 3 by the end of the third trimester (see stages of cervical cancer to understand what this means). Delaying treatment can threaten the life of the mother. The possibility that the delay may adversely affect the prognosis for the woman must be discussed. A compromise solution can usually be found, although in some cases this will involve sacrificing the baby, for example by hysterectomy followed by radiotherapy or radical hysterectomy.
Bottom Line: The decision to treat cervical cancer is particularly complex in the case of a pregnant woman. If you find yourself in this situation, always seek a second opinion before deciding your course of action.
What is the prognosis? Cervical cancer survival rates.
What are the chances it will come back? Cervical cancer recurrence.
If you are worried about your risks: Cervical cancer prevention.
What causes the disease? Cervical cancer causes.
Personal Stories: Biopsy And Colposcopy Tests While Pregnant
I had some abnormal tests in the Pap a few months ago when I was 3 months pregnant. The doctor performed a colposcopy a few weeks later when the results came back. He swabbed my cervix with white vinegar and studied my cells under a high powered microscope. As I’m pregnant he said he didn’t want to cut anything out (biopsy) unnecessarily. I lucked out; the abnormal cells were gone so I didn’t need a biopsy. He said the type of abnormal cells I had are quite common and were probably caused by poor nutrition (I had severe morning sickness at the time and was throwing up several times a day). Anyway, it all worked out fine.
Sinead, New Jersey
I had a colposcopy in the first trimester after an abnormal Pap test result. It didn’t look good so I had to have a biopsy. It was fine, I had a brownish discharge for a day afterwards but no other problems. I had another colposcopy 8 weeks later as a follow up, they are keeping an eye on how things develop. The doctor says I’ll need LEEP surgery but has decided to wait until after the birth in 9 weeks time.
I had a colposcopy and biopsy performed a few weeks ago when I was 18 weeks pregnant. The doctor didn’t want to perform a biopsy if he didn’t have to, but decided it was best. He took the tiniest sample he could. I didn’t cramp or bleed or feel a thing, it was fine. More importantly it will give me some peace of mind knowing whether I just have precancer CIN or if it’s the real thing. Doctors do know what they are doing. I’m still waiting for my test results to come back, I’m really nervous. The cells they found are high-grade, and apparently these are the ones most likely to turn cancerous.
I had the colposcopy and biopsy when I was pregnant, the biopsy really scared me. I bled and cramped for 2 days after. Now, having read more about it, I wish I had said yes to the colposcopy but no to the biopsy. My results came back negative which is great. But even if you come back with squamous cells they can’t do anything about it until after delivery. They might consider inducing you a few weeks early if the biopsy looks particularly scary.