ical cancer, nor does it change the course of the disease. The rate of cervical cancer in pregnant patients is similar to that in non-pregnant patients of the same age. In patients with concurrent cervical malignancy and pregnancy, the major dilemma is diagnosis and treatment. Diagnosis begins with colposcopic-directed biopsy followed by confirmatory cone biopsy, which carries increased risks of hemorrhage and poor peri-natal outcome. The treatment is a matter of concern to many patients because of the risk to the fetus of exposure to ionizing radiation. There is no evidence of risk to the fetus if the dose of radiation is less than 5 rads. Using “one shot” intravenous pyelograms and substituting MRI for CT scanning can achieve this dosage level. The recommended treatments for pregnant and non-pregnant patients are the same.

Before 20 weeks of gestation, radical hysterectomy should be performed with the fetus in situ; beyond 20 weeks, evacuation of the fetus before surgery is recommended. In patients with a pre-viable fetus, delaying therapy until fetal survival is assured is a reasonable option in early disease but is not recommended in patients with more advanced disease. Delivery should be performed as soon as pulmonary maturity of the fetus is demonstrated, although the route of delivery is highly debated. Most experts advocate cesarean delivery, because recurrence of the disease at the site of episiotomy is possible, and delivery through a cervix with advanced cervical cancer increases the risk for hemorrhage, obstructed labor and infection. Squamous cell cancer antigen and other proteins specific to cervical cancer are currently under investigation. The usefulness of these markers in diagnosis continues to be an area of active investigation.

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