Surgical issues in the management of carcinoma of the cervix in pregnancy.

Incorporating effective screening into preventive health care for women would theoretically eliminate the diagnosis of cervical cancer in pregnancy. Until this goal is reached, our management decisions are limited by the relatively small and retrospective studies that form the basis for our pertinent knowledge and the ethical issues that would complicate randomized trials of treatment in pregnancy. Limited data suggest that radical hysterectomy with pelvic lymphadenectomy might carry a more favorable therapeutic index than radiation therapy in early-stage disease. In general, improvements in neonatal management may allow earlier intervention, shortening the time between diagnosis and treatment in hope of improving maternal outcome. The actual survival impact of this information remains to be demonstrated. An algorithm has been provided in Figure 3 which summarizes the salient features of the clinical management of significantly abnormal cervical cytology in pregnancy. At many institutions the rate of "atypical" or other nonspecified cytologic abnormalities exceeds 10%, and low-grade dysplastic changes are common and less threatening. These conditions place the responsibility for cervical cancer detection firmly upon the clinician and his or her index of suspicion that a significant abnormality exists. Those directing prenatal care must remain compulsive in the proper use of cytologic screening and careful clinical examination. A diagnosis should be rapidly and vigorously pursued when a diagnosis of cancer is suspected, with timely referral when needed. These practices may have the most immediate impact upon both maternal and fetal outcome when facing cervical cancer in pregnancy.