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Although cancer during pregnancy is not a frequent clinical problem, it is not rare. A review of medical records in two Wash ington, DC hospitals placed the incidence at one cancer in 1,008 pregnancies. i Es timating 3.5 million live births in the United States annually and ignoring abortions, one can expect at least 3,472 cases of cancer during pregnancy each year. This repre sents 0.8 percent of the 422,000 women who develop cancers (excluding carci noma in situ and nonmelanotic skin can cers) and 2.2 percent of fertile women, generally conceded to be those between the ages of 15 and 44•2 About one of every 118 women who are found to have cancer will be pregnant at the time.Information from the Third National Cancer Survey indicates that 12.8 percent of all cancers of women occur during re productive life; the site-specific frequency is shown in Table 1.@The cancers most likely to occur during the reproductive years are, in decreasing order of frequency: thy roid, uterine cervix, melanoma of the skin, bones and joints, and lymphomas. For ex ample, almost half (49.8 percent) of all thyroid cancers and more than one third of all uterine cervix cancers occur in women aged 15 to 44. These are not numerically the most frequent, however; the cancers most likely to be seen in pregnant women are those of the breast, followed by uterine cervix, ovary, lymphomas, and the cob rectum, in declining order. The figure shows the age-specific incidence of can cers in women during the ages of 15 to 44. During this period of life, breast cancer has a steep ascendancy, as does genital cancer and cancer of the gastrointestinal tract.Cancer concurrent with pregnancy has long had ominous implications, based largely on scanty, often anecdotal clinical experience. A major reason for suspecting that pregnancy adversely affects the clin ical course of cancer is the immunologic tolerance that characterizes both condi tions. As Gleicher and associates@5 pointed out, normal pregnancy and cancer are the only two biologic conditions in which an tigenic tissue is tolerated by a seemingly intact immune system.Manifestations of immunologic toler ance in the two conditions include:@5 •¿ Depression of cellular immunity. •¿ Presence of circulating serologic block ing factors that permit the tolerance of antigenic tissue, probably an IgG im munoglobulin. •¿ Immunosuppressive effect of various hormones such as estrogen, progester one, and human chorionic gonadotropin. •¿ Presence of suppressor T cells. •¿ Presence of a leukocyte migration en hancement factor.

A nationwide survey of the clinical presentation, pathology, and management of soft tissue sarcomas in adults was carried out under the auspices of the Commission on Cancer of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977-1978 (2355 patients) and 645 institutions in 1983-1984 (3457 patients). Pretreatment findings of interest included some evidence of physician delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for Cancer Staging (AJCSS) system, and major reliance on CT for pretreatment patient evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three fourths of the patients. The other one fourth were primarily patients with distant metastasis at the time of diagnosis. Some increase in multimodal therapy did occur in the second period but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCCS system and the value of complete resection of soft tissue sarcomas. Adverse prognostic factors included positive surgical margins, large tumors, retroperitoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. Patients receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting patients for these therapies. Approximately one half of the treatment failures in the 1977-1978 series were locoregional, whereas 18% were limited to lung metastasis. Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year survival rates.