Cervical cancer can impact people before and during pregnancy. Early screening and comprehensive care from a multidisciplinary medical team can help many people with cervical cancer experience a healthy pregnancy and delivery.

Cervical cancer occurs when cancerous cells grow in the cervix, a part of the lower uterus. According to researchers, it is one of the most common cancers during pregnancy, but cervical cancer during pregnancy is uncommon overall. They estimate there are 1–2 cases per 2,000–10,000 pregnancies.

According to a 2019 article, the incidence of cervical cancer in pregnant people has increased in recent years. This may be due to more people becoming pregnant later in life, as cervical cancer risk increases with age. The American Cancer Society states that the condition is most common in people aged 35–44, and the average age at diagnosis is 50.

This article looks at the link between cervical cancer and pregnancy, treatment options for pregnant people with cervical cancer, the symptoms of cervical cancer, and more.

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Doctors typically identify cervical cancer in pregnant people at an early stage. Early detection of cervical cancer increases the chances of successful treatment.

How cervical cancer affects a person’s pregnancy will depend on several factors, such as:

  • the type of cervical cancer
  • the size of the tumor
  • whether the cancer has spread
  • how many weeks pregnant a person is
  • the wishes of the individual regarding treatment and continuing their pregnancy

Method of delivery

If a pregnant person receives a diagnosis of cervical cancer, their method of delivery may change. For instance, doctors typically recommend a cesarean section for people with the condition. This is because vaginal delivery can carry increased risks for people with cervical cancer, such as heavy bleeding and metastatic cancer. Doctors may also recommend an early delivery to allow a person to begin the standard treatment for cervical cancer as soon as possible.

Treatment types

Doctors may recommend surgery or chemotherapy to treat a person’s cancer, which they may carry out during or after pregnancy, depending on the individual case. A person will work with a doctor to determine which chemotherapy drugs will be safe for them to use, as the timing of chemotherapy treatment and the type of drug can present safety risks, such as an increased risk of infections.

Medical team

Every case of cervical cancer during pregnancy is different and will involve a multidisciplinary team of health professionals.

Doctors a person might work with include:

  • gynecological oncologists, specialists in cancers of the female reproductive system
  • medical oncologists, specialists in cancer drug treatments
  • radiologists
  • radiotherapists
  • perinatologists, specialists in the care of pregnant people and fetuses
  • neonatologists, specialists in the care of newborn babies

Cancer Research UK suggests that a person might also work with an obstetrician, pathologist, and nurse specialist.

Working with a team of medical professionals will help a person understand how the condition might affect their pregnancy.

After a cervical cancer diagnosis, people may worry about their ability to have children in the future. The National Cancer Institute states that the effect of cancer treatment on a person’s fertility can depend on:

  • their baseline fertility
  • their age
  • the type of cancer treatments they have
  • the treatment dosage
  • the duration of treatment
  • the time since a person’s last treatment
  • an individual’s overall health

A person with early stage cancer may be able to have treatments that can preserve their fertility if they wish to have children. These target the cervix but not the uterus and include:

  • conization, which involves removing a piece of the cervix
  • simple trachelectomy, which involves removing a larger portion of the cervix
  • radical trachelectomy, which means removing the cervix and nearby tissue

A 2016 study suggests that people with late stage cancer may have to opt for assisted reproductive technology (ART) if they wish to become pregnant. ART includes in vitro fertilization, although a person will have to work with a doctor to determine whether they will be able to successfully become pregnant with ART.

The National Cancer Institute states that doctors may not always initiate a conversation about fertility when discussing cancer treatments. People should feel empowered to start this conversation themselves if they wish to.

Some people may not learn that they have cervical cancer until they are pregnant. Regular pregnancy exams can detect the presence of cervical cancer.

In many cases, infertility only becomes a risk after certain treatments, such as chemotherapy or surgeries such as a total hysterectomy. Pregnant people with cervical cancer may choose to pursue less invasive therapies to reduce this risk. After delivery, these individuals can continue with standard cervical cancer treatments.

Fertility rates vary between people and over time. Anyone trying to become pregnant after a cervical cancer diagnosis should consult with a medical professional.

Choosing a treatment course for cancer during pregnancy is a complex and highly personal decision that will involve a multidisciplinary medical team. Treatment plans can vary according to the pregnancy trimester.

It is important to note that doctors consider cancer treatment during pregnancy experimental as it is rare and research is still developing.

Below is an explanation of the treatment options available during each trimester of pregnancy.

First trimester

According to Cancer Research UK, doctors will not treat a person with chemotherapy in the first trimester as it can cause damage to the growing fetus or pregnancy loss.

The organization also notes that it is sometimes possible for a person to have small tumors removed with a cone biopsy or trachelectomy. However, it warns that a trachelectomy comes with a risk of bleeding and miscarriage.

If a person is less than 3 months pregnant, doctors may recommend getting treatment immediately. At this early stage, a person may need to choose to end their pregnancy. Their medical team will support them through this decision.

If a person chooses to continue with their pregnancy, they will start treatment once they are 3 months pregnant, in the second trimester.

Second trimester

A 2013 overview of cervical cancer treatment during pregnancy states that treatments in the second trimester can include lymphadenectomy, conization, trachelectomy, and neoadjuvant chemotherapy.

If a person receives a cervical cancer diagnosis during the second trimester, doctors may suggest they continue with the pregnancy and have an early cesarean section delivery.

A person may have a hysterectomy at the same time as their cesarean section. They can then begin chemotherapy or radiation treatment.

According to a 2018 cancer overview, people who have chemotherapy may be at a higher risk of premature labor and fetal growth restriction.

Third trimester

In the third trimester, a person may continue any chemotherapy treatments that their medical team considers safe.

A doctor may carry out an early delivery through a cesarean section. Doctors will aim to deliver the baby after 37 weeks of pregnancy. However, they will consider the health of the pregnant individual and the fetus carefully when deciding when delivery would be safest.

After delivery, a person can begin or continue their chosen treatment plan for cervical cancer.

An older study from 2012 analyzing the long-term cognitive outcomes for children exposed to chemotherapy in the womb found no negative impacts on their overall health compared with the general population. However, it notes a link between premature birth, which is generally necessary in cases of cervical cancer in pregnancy, and impaired cognitive development. The authors suggest there is a need for longer follow-ups to investigate these outcomes further.

Doctors generally consider chemotherapy relatively safe in the second and third trimesters. That said, certain cancer drugs, such as trastuzumab (Herceptin), are unsafe during pregnancy because they can negatively affect a fetus’s kidneys and lungs.

Chemotherapy can also reduce a person’s blood production, which can cause low platelet counts and increase the risk of infections, according to a 2018 cancer report.

In rare cases, major cervical surgery may lead to pregnancy loss.

More research is needed to determine how cancer treatments affect fetuses during pregnancy and after birth. People experiencing cervical cancer during pregnancy should talk with a doctor about their options and the risks of cancer treatments for their and their baby’s health.

People may experience no symptoms during the early stages of cervical cancer. As the condition progresses, symptoms can become more pronounced. These may include:

A few of these symptoms may overlap with early signs of pregnancy. People in the early stages of pregnancy may experience:

Changes in vaginal discharge can indicate a variety of conditions. People experiencing such changes should contact a doctor to determine the cause.

Doctors typically divide cervical cancer into four main stages:

  • Stage 1: During this stage, cancer occurs in the cervix and uterus.
  • Stage 2: Cancer has spread to other areas in the pelvic area, such as the vagina.
  • Stage 3: At this stage, cervical cancer may include tumors in the lower vagina or pelvic wall. It may affect kidney function or nearby lymph nodes.
  • Stage 4: The tumor has spread to parts of the body even further away.

Early stage cancers are generally manageable during pregnancy. Doctors may recommend immediate, deferred, or no treatment depending on the cancer stage, pregnancy trimester, and the individual’s goals for care.

People with more advanced cervical cancer may need surgery during pregnancy.

If a person wishes to continue their pregnancy and needs surgery to treat their cancer, they should work with a doctor to consider the risks of cancer progression alongside the health and development of the fetus.

Cervical cancer during pregnancy can carry a risk of extra complications caused by the cancer itself and the treatments and diagnostic procedures a person may need. For instance, a biopsy of cervical cancer tissue could cause bleeding that may harm the fetus. Invasive surgery can also cause bleeding that may negatively affect pregnancy.

Researchers generally consider chemotherapy safe in the second and third trimesters, although there is a limited number of studies in this area.

People with cervical cancer during pregnancy should discuss the risks and complications related to treatment and cancer progression with a medical professional.

Cervical cancer is a serious condition, but it is relatively rare in pregnancy. Doctors typically identify cervical cancer during pregnancy in the early stages of the disease. This improves the likelihood of a person having a healthy pregnancy and delivery.

Cervical cancer treatment varies according to the pregnancy trimester, the cancer stage, the healthcare resources available to a person, and their goals for treatment.

Individuals with cervical cancer during pregnancy should regularly visit a medical professional and work closely with a multidisciplinary team to choose a treatment plan that is right for them.