The Prognosis and Management of Cervical Cancer Associated With Pregnancy

OBJECTIVE:We sought to evaluate the prognosis of patients with stage IB cervical cancer related to pregnancy. METHODS:We reviewed 53 patients from the University of Michigan diagnosed with cervical cancer related to pregnancy between 1960-1989. Patients with stage IB disease were compared with a control group less than 46 years old to determine whether pregnancy influenced survival. RESULTS:The mean age of the patients was 30.5 years (range 22-45). The number of patients treated by 5-year periods decreased from a high of 17 during 1965-1969 to a low of three during 1985-1989. The following cell types and stages were treatedsquamous cell stages IA (four), IB (35), and IIB (six); adenocarcinoma stages IB (five) and IIB (two); and small-cell stage IIB (one). The 35 patients with stage IB disease had a cumulative 5-year survival of 83%. Positive lymph nodes were present in eight of 24 patients. There was no significant difference in 5-year survival according to the time of therapy (P=.45)Ten second-trimester patients had 90% survival, five third-trimester patients had 75% survival, and 20 postpartum patients had 75% survival. Eighteen of 21 patients treated by radical hysterectomy survivedthree of four treated at term, five of five treated in the second trimester, and ten of 12 treated postpartum. Seven of 12 patients treated by radiation therapy survivedone of one treated at term, five of six treated in the second trimester, and one of five treated postpartum. When we compared these patients with 170 nonpregnant women less than 46 years old with stage IB squamous cell cancer, pregnancy did not adversely influence survival (P=.13). CONCLUSIONS:The number of patients diagnosed with invasive cervical cancer related to pregnancy has decreased. Survival is not altered by pregnancy for stage IB disease.