Neuroendocrine cervical cancers are rare, the reported incidence was 0.06 per 10,000 women and were even less commonly seen during pregnancy. Most neuroendocrine tumours are aggressive with lymphovascular metastasis and overall prognosis are poor. To date, not many cases have been reported.

We report a case of late presentation of bleeding cervical cancer in pregnancy. A 34 years old Malay lady, gravida 7 para 6, no comorbidity had multiple visits to district hospital with the complaint of persistent per vaginal bleeding.  She had required multiple blood transfusions due to symptomatic anaemia. She was noted to have cervical mass and had an early referral to Gynaecology Oncologist but defaulted.  She only presented herself at 33 weeks of gestational due to premature contraction.  Clinical assessment revealed exophytic cauliflower like growth involving the whole circumference of the cervix measuring about 8 cm x 7 cm, fornices, vaginal walls, both parametrium and pelvic side walls were free.  The impression was cervical cancer stage 1B2 clinically with premature contraction. An emergency classical Caesarean section followed by Wertheim’s hysterectomy and pelvic nodes dissection was performed.  A live baby boy with a birth weight of 1.82 kg was delivered and the baby was admitted to NICU for observation. She was discharged well day 6 postoperatively.

Histopathological examination revealed a huge fungating mass with irregular surface protruding from cervical canal measuring 105 x 95 x 62 mm arising from the endocervical tissue. It was a high grade neuroendocrine carcinoma, features consistent with cervical small cell carcinoma with extensive lymphovascular permeation, closed surgical margin with pelvic lymph nodes metastases. Unfortunately, the patient and her husband had refused adjuvant therapy despite being counselled on the risk of recurrent and distant metastasis.

To date, there is no established guideline to specifically address its management. The management of small cell carcinoma and the impact of surgery, chemotherapy and radiotherapy to the survival rate have only been studied in a small number of patients. As such, managing such a case especially in a pregnant lady whom presented in labour without proper tissue diagnosis posed a great dilemma for Gynaecology Oncologist.

In conclusion, recognition of cervical cancer in pregnancy preoperatively is important for operative planning and subsequent adjuvant therapy postoperatively. Furthermore, patient’s counselling is of paramount important particularly when patient is pregnant.