Challenges in managing cervical cancer in pregnancy: Three case reports

Cervical cancer in pregnancy is a rare but increasingly recognised condition, affecting approximately 0.1-12.0 per 10,000 pregnancies annually. Symptoms such as vaginal bleeding, discharge, dyspareunia, and pelvic pain may overlap with normal pregnancy-related changes, often leading to delayed diagnosis. Speculum and bimanual examination is essential in pregnant women presenting with vaginal bleeding. Urgent colposcopy referral (for example, in the UK through the two-week wait pathway) is essential. Management strategies depend on cancer stage, gestational age, and patient preferences. Options include pregnancy termination with immediate treatment or consideration of neoadjuvant chemotherapy during pregnancy in women who wish to postpone definitive therapies until after delivery. Pelvic lymphadenectomy for staging is considered safe prior to 22 weeks of gestation. Neoadjuvant chemotherapy is contraindicated in the first trimester but may be administered safely later in pregnancy. Serial magnetic resonance imaging is valuable for monitoring tumour progression and informing treatment plans. This case series highlights the clinical and ethical complexities in managing cervical cancer in pregnancy and underscores the importance of specialist, multidisciplinary, and individualised care. Further research is necessary to develop standardised, evidence-based guidelines for this challenging clinical scenario.