Invasive cervical cancer complicating pregnancy. How to manage the dilemma.

Pregnancy presents an ideal time for cervical cancer screening, and all pregnant women presenting for prenatal care should be carefully examined. Most patients with pregnancy-associated cervical cancer present with early-stage disease. The prognosis for pregnant patients after stratification for stage is similar to that for nonpregnant patients. A management algorithm is presented in Figure 2. Patients with early-stage squamous cancers diagnosed in the late second and early third trimester may have cancer treatment delayed to increase the likelihood of fetal maturity without compromising maternal prognosis. Cesarean section in patients with pregnancy-associated cervical cancer should be the delivery method of choice. Early-stage cervical cancer should initially be treated surgically. In patients with advanced disease, primary radiation therapy is a safe and effective modality. In the first and second trimester, radiation therapy should be performed without hysterotomy.