What is cervical cancer?
It is cancer that affects the cervix, an organ that connects the womb to the vagina. There are two main types of cervical cancer-squamous cell carcinoma and adenocarcinoma. Both can happen during pregnancy. However, they do not affect pregnancy or its outcome. Approximately 80 to 90 per cent of cervical cancers are squamous cell carcinomas. These cancers are from the squamous cells that cover the surface next to the vagina.
Under microscopic observation, squamous cell carcinoma is seen as having cells that are thin and flattened. Squamous cell carcinomas most often begin where the part next to the vagina (exocervix) joins the part next to the body of the uterus (endocervix). The 10 to 20 per cent of cervical cancers that are adenocarcinomas are more common in women aged between 20 to 30 years. Cervical adenocarcinoma develops from the mucus-producing gland cells of the inner cervix.
How often does it occur in pregnancy?
In pregnancy, the incidence of cervical cancer occurring is 0.02 per cent to 0.9 per cent of all pregnancies. It is the most common cancer in pregnancy. The signs present themselves at early stages of the disease. Diagnosis is safely done by colposcopy, a medical diagnostic procedure to examine a clear, magnified view of the cervix. A Pap smear test can also be done but the evaluation is modified to accommodate the pregnancy state. There is no urgency to diagnose pre-malignant conditions during pregnancy. It can wait until six weeks after delivery for evaluation and treatment.
How is cervical cancer treated during pregnancy?
Delay in treatment may be done to allow time for fetal maturity and viability. This is achievable at 32 to 36 weeks of pregnancy. Abnormal cytological smear (a thin tissue or blood sample spread on a glass slide and stained for examination) may thus be subjected to conservative management. First-trimester cone biopsy is delayed and usually done in the early second trimester to prevent abortions. In the third trimester, cone biopsy can increase the chances of premature labour. After delivery, hysterectomy (a surgical operation to remove a womb) may be done after six weeks.
For stage IA (the earliest form of cancerous cells in the cervix) of cervical cancer, treatment is delayed until the foetus is mature. A decision on whether the delivery should be vaginal or Caesarean largely depends on the stage of the disease, the stage of gestation and the preference of the parents. For stage 1B, II, III or IV, radiotherapy is the treatment of choice. For the viable foetus, C-section is recommended before treatment to prevent radiation from affecting the foetus.
Is therapeutic abortion recommended?
When the diagnosis is made in the first trimester, this is an important consideration. The stage of the disease, its curability and the nature of treatment needed are taken into account. Therapeutic abortion could then be recommended when the cancer is totaIIy advanced.
Signs & Symptoms of Cervical Cancer
Abnormal bleeding
Women with cervical cancer may experience abnormal vaginal bleeding. This can be heavy or light bleeding during the month.
Unusual heavy discharge
An increased vaginal discharge is also a symptom of cervical cancer. It may be foul smelling, watery, thick. or contain mucus. it varies from woman to woman. It is important to report any unusual vaginal discharge to your doctor.
Pelvic pain
Pelvic pain that is not related to the normal menstrual cycle can be a cervical cancer symptom. Many women describe them ranging from a dull ache to sharp pains that can last hours. It can be mild or severe.
Pain during urination
Bladder pain or pain during urination can be a symptom of advanced cervical cancer. This cervical cancer symptom usually occurs when cancer has spread to the bladder.
Bleeding
This can happen between regular menstrual periods, after sexual intercourse, douching, or pelvic exam.
This is due to the irritation of the cervix during these activities. While a healthy cervix may have a very small amount of bleeding, many conditions may cause bleeding after activities like sex.
Note: These cervical cancer symptoms are also symptoms of many other illnesses. If you are experiencing these cervical cancer symptoms, please see a doctor. He or she will most likely do a pelvic exam and may order further tests.
