Cervical Cancer Treatment During Pregnancy (PDQ®): Treatment - Health Professional Information [NCI]

General Information About Cervical Cancer Treatment During Pregnancy

Cervical cancer is relatively rare but is diagnosed most frequently in women aged 35 to 44 years.[1] The incidence of cervical cancer during pregnancy is 1 to 12 cases per 10,000 pregnancies.[2]

During pregnancy, no therapy is warranted for preinvasive lesions of the cervix, including carcinoma in situ, although expert colposcopy is recommended to exclude invasive cancer.

Diagnosis

Treatment of cervical cancer during pregnancy depends on the extent of disease and the gestational age at diagnosis. To enable the most informed choices, patients should undergo biopsy as needed and imaging to establish the extent of disease. The most appropriate imaging modality in pregnancy is magnetic resonance imaging, when indicated.

References:

1. National Cancer Institute: SEER Cancer Stat Facts: Cervical Cancer. Bethesda, Md: National Cancer Institute. Available online. Last accessed February 28, 2025.
2. Morice P, Uzan C, Gouy S, et al.: Gynaecological cancers in pregnancy. Lancet 379 (9815): 558-69, 2012.

Stage Information for Cervical Cancer During Pregnancy

For information, see the Stage Information for Cervical Cancer section in Cervical Cancer Treatment.

Treatment of Stage I Cervical Cancer During Pregnancy

Pregnancy does not alter the course of cervical cancer. As a result, in certain cases, patients may elect to postpone treatment until its effects on the pregnancy are minimized. This approach may be considered for patients with the more common and less aggressive histological subtypes: squamous, adenocarcinoma, and adenosquamous. Patients with high-risk subtypes, such as small cell or neuroendocrine tumors, should consider immediate treatment despite the effects on the fetus, given their risk of progression.

Patients with early-stage disease (IA) may safely undergo fertility-sparing treatments, including cervical conization or radical trachelectomy, as indicated. The optimal timing for this procedure is in the second trimester, before fetal viability. Some authors have suggested waiting until the completion of pregnancy to initiate treatment.[1] For patients with stages IA2 and IB disease, such a delay may be safe, but lymph node status should first be assessed because of a risk of lymphatic spread. The status is best determined surgically via a laparoscopic or open lymph-node dissection, which can be safely performed up to approximately 20 weeks of pregnancy.[2,3] Patients without lymphatic spread can wait for fetal viability before initiating treatment. Patients with positive lymph nodes should consider immediate treatment.

Current Clinical Trials

Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.

References:

1. Morice P, Uzan C, Gouy S, et al.: Gynaecological cancers in pregnancy. Lancet 379 (9815): 558-69, 2012.
2. Alouini S, Rida K, Mathevet P: Cervical cancer complicating pregnancy: implications of laparoscopic lymphadenectomy. Gynecol Oncol 108 (3): 472-7, 2008.
3. Favero G, Chiantera V, Oleszczuk A, et al.: Invasive cervical cancer during pregnancy: laparoscopic nodal evaluation before oncologic treatment delay. Gynecol Oncol 118 (2): 123-7, 2010.

Treatment of Stages II, III, and IV Cervical Cancer During Pregnancy

For patients with stage II or greater disease, delaying treatment until fetal viability is generally not appropriate.[1] The standard of care is curative-intent chemotherapy and radiation therapy. This treatment is toxic to the fetus and, without ovarian transposition, will render the ovaries nonfunctional after treatment. Evacuation of the fetus should be performed before radiation therapy is initiated. When this is not possible, the radiation will generally cause a spontaneous abortion 3 to 5 weeks after initiating treatment.

Current Clinical Trials

Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.

References:

1. Hunter MI, Tewari K, Monk BJ: Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease. Am J Obstet Gynecol 199 (1): 10-8, 2008.

Neoadjuvant Chemotherapy for Cervical Cancer During Pregnancy

Neoadjuvant chemotherapy has been offered to patients with locally advanced disease as a way to initiate treatment while maintaining the pregnancy.[1] Most chemotherapy agents can be given safely in the second trimester of pregnancy and beyond. Mild growth restriction of the fetus is the most common side effect. Restriction of fetal growth has been reported in a relatively small number of patients, and data are lacking on long-term outcomes for these women. As a result, this strategy should be considered with caution. Most of the patients in the reports underwent standard treatment (either surgery or radiation therapy) after completion of the pregnancy.

References:

1. Morice P, Uzan C, Gouy S, et al.: Gynaecological cancers in pregnancy. Lancet 379 (9815): 558-69, 2012.

Latest Updates to This Summary (03 / 21 / 2025)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

This is a new summary.

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About This PDQ Summary

Purpose of This Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of cervical cancer during pregnancy. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.

Reviewers and Updates

This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).

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Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.

The lead reviewers for Cervical Cancer Treatment During Pregnancy are:

• Fumiko Chino, MD (MD Anderson Cancer Center)
• Olga T. Filippova, MD (Lenox Hill Hospital)

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PDQ® Adult Treatment Editorial Board. PDQ Cervical Cancer Treatment During Pregnancy. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/cervical/hp/treatment-during-pregnancy-pdq . Accessed <MM/DD/YYYY>. [PMID: 26389493]

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Last Revised: 2025-03-21