Cervical Cancer - Treatment for CIN and Carcinoma in Situ

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• Pelvic exenteration if cancer has spread to only local areas. This involves surgical removal of the cervix, uterus, vagina, and perhaps the bladder, lower colon, or rectum.
• Chemotherapy or radiation if cancer has spread to distant area.

Treatment of Pregnant Women with Cervical Cancer

Cervical cancer is one of the most common cancers diagnosed during pregnancy. To diagnose the condition, a cervical biopsy, in which a small amount of tissue is removed for diagnosis, can be performed anytime during the pregnancy. However, a cone biopsy (conization), which removes larger amounts of tissue, is typically delayed until after the first trimester to reduce the risk of causing a miscarriage. Conization does increase the risk for preterm delivery and may increase this risk for future pregnancies. The loop electrosurgical excision procedure (LEEP/LLETZ) may be performed in centers equipped to handle it, but should be reserved only for patients in whom invasive disease is strongly suspected.

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Treatment of cervical cancer depends in part on whether a patient wishes to continue the pregnancy, and her desire for future fertility. For pregnant women who want to continue the pregnancy, and preserve fertility when possible, treatment options may include:

• If the abnormality is diagnosed as dysplasia or pre-invasive cancer, treatment is usually delayed until after the mother gives birth. The baby is delivered vaginally. It is rare for cervical cancer to progress from pre-invasive to invasive within the space of 1 - 2 trimesters.
• For stage 1A1, a cesarean section is performed at term, or earlier if the fetus is viable. After delivery, LEEP/LLETZ or conization is performed.
• For stages IA2 and IB1, a cesarean section and radical hysterectomy is performed when the fetus is viable. After delivery, radiation and chemotherapy is given.
• For stages IB2 - IVA, a cesarean section is performed as soon as possible. Treatment should not be delayed beyond weeks 32 - 34. For patients who have a delayed cesarean, chemotherapy may be given. After delivery, the patient is treated with radiation and chemotherapy.
• For stage IVB, pregnancy less than 20 weeks are terminated, and the patient is treated with chemotherapy. For pregnancies more than 20 weeks, a cesarean may be delayed while the woman receives chemotherapy.

Review Date: 10/21/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).