Gynaecological cancer in pregnancy — diagnostic, treatment-timing and delivery framework

A 32-year-old woman at 14 weeks gestation, para 1, is referred after an abnormal cervical screening result and a friable, bleeding lesion on the ectocervix at her booking visit. The biopsy returns moderately differentiated squamous cell carcinoma. She wants this pregnancy. The questions are sharp: how do you stage her, what imaging is safe, when do you operate, when do you give chemotherapy, how do you deliver, and — the question she is really asking — will this cancer, or this treatment, harm her baby? This topic is the framework that answers them.[1][8]

Overview — the surgical-oncology companion

Gynaecological cancer in pregnancy is a malignant tumour of the cervix, ovary, uterus, vulva or vagina diagnosed between conception and delivery — a surgical-oncology subset of cancer in pregnancy. Gestational trophoblastic disease is excluded; it has its own pathway. This page covers the gynaecological-oncology angle. For the broader obstetric depth — the general framework of cancer in pregnancy, the non-gynaecological malignancies (breast, melanoma, haematological), and the antenatal coordination — cross-link malignancy-in-pregnancy.[1][4]

The overall incidence of cancer in pregnancy is approximately 1 in 1000 and is rising as maternal age increases. Breast cancer is the commonest cancer diagnosed in pregnancy overall; among gynaecological cancers, cervical cancer is the commonest, followed by ovarian. Endometrial and vulvar cancers in pregnancy are vanishingly rare.[2][11]