Carcinoma of the cervix coincident with pregnancy

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A study of 3,570 cases of carcinoma of the cervix observed at the Mayo Clinic in approximately thirty-two years revealed that pregnancy was present in twenty-six, or 0.7 per cent, of these cases when the carcinoma was found. This figure does not necessarily indicate the true incidence of carcinoma of the cervix coincident with pregnancy as all of the 3,570 patients came to the clinic because of carcinoma of the cervix and not because of pregnancy. In the same period covered by this study, 8,500 pregnant women were observed at the clinic.The average age of the patients in the twenty-six cases in which carcinoma of the cervix was coincident with pregnancy was 32 years. The youngest patient was twenty-five years of age and the oldest patient was forty-one years of age. The prognosis was no worse in the case of young patients than it was in cases in which the patients were older.The average number of previous pregnancies was 6 and the average number of children was 4. The number of pregnancies apparently did not affect the prognosis. In cases in which the carcinoma was diagnosed in the later months of pregnancy, the lesion usually was well advanced and the prognosis was poor.Pregnancy may occur after carcinoma of the cervix has developed. A family history of carcinoma was elicited in seven, or 35 per cent, of the twenty cases which were observed five or more years prior to 1941. The prognosis in these seven cases was better than the prognosis in the remaining cases.Bleeding was the initial symptom in twenty-three, or 88.5 per cent, of the cases. In 25 per cent of the cases, the patients did not realize that they were pregnant when the diagnosis was made.No definite conclusions can be drawn concerning the relative value of irradiation therapy; however, it appears that operation is preferable in cases in which the lesion is operable and that supplementary irradiation increases the percentage of good results. This is in contrast to the relative value of irradiation therapy and hysterectomy in cases of carcinoma of the cervix in which the patients are not pregnant.We are in general agreement with Strauss concerning treatment of carcinoma of the cervix coincident with pregnancy. If the extent of the lesion permits operation and if the fetus is not yet viable, total hysterectomy is followed by irradiation; if the lesion is operable and the fetus is viable, cesarean section is followed by panhysterectomy and postoperative irradiation.In cases in which the lesion is nonoperable and the fetus is viable, cesarean section is followed by irradiation; in cases in which the lesion is nonoperable and the fetus is not yet viable, sufficient irradiation is employed to treat the lesion; incidentally, abortion occurs.In cases in which the lesion is operable, total abdominal hysterectomy has produced the best results. In 57 per cent of the cases in which this procedure was employed, the patients were free of recurrence five years after the operation.In this series of cases of carcinoma of the cervix coincident with pregnancy, many of which were observed before the present methods of treatment were developed, the prognosis appeared to be at least as favorable as the prognosis of carcinoma of cervix that is not associated with pregnancy. Of the twenty patients who were followed, 30 per cent were free of recurrence five or more years after they had been treated at the clinic.