Over 11,000 American women are diagnosed with cervical cancer every year. The average age at diagnosis is in the early forties, so a significant portion of cervical cancer patients is still in their child-bearing years. Additionally, since many women are now waiting well into their thirties before becoming pregnant, fertility preservation has become a major concern for many who are facing cervical cancer.
Thanks to modern treatment methods, it is possible for some women to become pregnant after being diagnosed with cervical cancer. However, the ability to get pregnant and deliver a child largely depends on how advanced the cancer is at diagnosis. As you may guess, when cervical cancer is caught in the early stages, the patient has a better chance of preserved fertility. When the cancer is not discovered until a later stage, future pregnancy may not be possible due to the cancer treatment.
Here are further specifics on pregnancy after a cervical cancer diagnosis.
Although every case is unique, the standard treatment for cervical cancer where fertility is not a concern, such as for a postmenopausal patient, consists of surgery that may be accompanied by radiation. This treatment often involves a radical hysterectomy, where the uterus, cervix, and a portion of the vagina are removed. A radical hysterectomy renders a woman unable to bear children.
However, extensive surgery and/or radiation therapy may be necessary for younger women with late-stage cervical cancer. In these situations, the patient may choose to freeze her eggs before treatment. Called oocyte cryopreservation, this procedure allows the eggs to be preserved for possible in vitro fertilization (IVF) and surrogacy (a method of assisted reproduction where a gestational surrogate mother is used to carry a baby until birth) down the line. The patient will not be able to bear the child herself, but she may still be able to have genetic offspring.
Treatment Possibilities in Early Stage Cervical Cancer
If cervical cancer is identified in an early stage, then a treatment plan that is less harmful to a woman’s fertility may be available. Although the exact options depend on a number of medical factors, possibilities treatments include conization (a large biopsy of the cervix) and trachelectomy (removal of the cervix and surround tissue).
Conization is sometimes referred to as a deep cone biopsy. This outpatient procedure is only a treatment option in the very early stages of cervical cancer. It involves the removal of a cone-shaped area of the cervix, including the cancer cells. Women who undergo cervical conization can typically expect to be able to become pregnant and carry the pregnancy to term.
If the cancer has progressed too far for conization but is still in an early stage overall, a simple trachelectomy may be an appropriate treatment choice. A simple trachelectomy involves the surgical removal of the majority of the cervix. Like conization, a simple trachelectomy is usually an outpatient procedure. In comparison, a radical trachelectomy removes virtually the entire cervix and some surrounding connective tissue. A radical trachelectomy may be an outpatient procedure or require brief hospitalization.
There is 50-70% rate of successful pregnancies after trachelectomy. However, the surgery increases the chances of miscarriage. Additionally, the opening of the uterus is sutured closed in a trachelectomy. This means there is no way for the fetus to pass from the uterus, through the cervix, and into the birth canal. So, vaginal birth is not possible after a trachelectomy, and a cesarean delivery will be necessary.
The typical total recovery time after a trachelectomy is four to six weeks, depending on the exact procedure used and the patient’s health. Women who have had a trachelectomy are recommended to delay pregnancy until cleared by their surgeon and OB-GYN.
Cervical Cancer Screening and Prevention
Regular Pap smears, pelvic examinations and HPV testing in women over the age of 30 are crucially important. By having these routine screenings, a woman can greatly increase the chance of early cervical cancer detection.
Furthermore, under new medical guidelines, women under the age of 45 should receive the HPV vaccine. In October 2018, the FDA approved this vaccination in women aged 27-45. As over 90% of cervical cases can be linked to HPV, the vaccine can dramatically lower the likelihood of developing this disease.
Talk with your OB-GYN
If you have concerns about cervical cancer, want to talk about fertility options, or have any questions at all, your OB-GYN is the place to start. They can provide you with accurate information and refer you to a fertility specialist, oncologist, or another physician if necessary.
About the Connecticut OBGYN Practice
Dr. John Garofalo, M.D., is a CT OBGYN based in Fairfield County, providing care for Norwalk, Darien, New Canaan, Weston, Rowayton and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.
Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Women undergoing signs and symptoms of menopause can make an appointment with Laury for Hormone Replacement Therapy. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.