Management of cancer in pregnancy

Abstract

A multidisciplinary discussion is necessary to tackle a complex and infrequent medical problem such as cancer occurring during pregnancy. Pregnancy does not predispose to cancer, but cancers occurring in women of reproductive age are encountered during pregnancy. Ultrasonography and magnetic resonance imaging are the preferred staging examinations, but also a sentinel node staging procedure is possible during pregnancy. Standard cancer treatment is aimed for. Operations can safely be performed during pregnancy, but surgery of genital cancers can be challenging. The observation that chemotherapy administered during the second or third trimester of pregnancy, that is, after the period of organogenesis, has little effect on the long-term outcome of children adds to the therapeutic armamentarium during pregnancy. Cancer treatment during pregnancy adds in the continuation of the pregnancy and the prevention of prematurity.

Electron Beam Intraoperative Radiotherapy (ELIOT) in Pregnant Women with Breast Cancer: From in Vivo Dosimetry to Clinical Practice

“…As the trend for delaying pregnancy into the later reproductive years continues, this rare association is likely to become more common. The therapeutic management of pregnant women with breast cancer is difficult and should be undertaken by a dedicated multidisciplinary team with sufficient expertise to meet the needs and requests of such a distressing clinical situation [3]. There are few reports in the literature addressing the issues related to radiotherapy during pregnancy [4][5][6].…”

Acinic cell carcinoma of the parotid gland in pregnancy: an approach to cancer in pregnancy

“…It raises complex moral and ethical issues,2 as the goals of preserving both maternal and fetal well-being are often in direct conflict. Given the relative rarity of these cases, an individualised, multidisciplinary management approach should be adopted, taking into account the type and location of tumour; grading, staging and prognosis of disease; sensitivity to chemotherapy and radiotherapy; gestational age at presentation; pre-existing pregnancy complications and patient wishes 2…”

“…This rate is increasing as maternal age increases. Cancer in pregnancy presents complex medical, ethical and psychological challenges and should be managed by a multidisciplinary team 2. The most common cancers seen in pregnancy include: breast cancer, cervical cancer, lymphoma, ovarian cancer and melanoma 1…”

Chemotherapy during Pregnancy: Cases of Hodgkin's and Non-Hodgkin's Lymphoma, Chronic Myeloid Leukemia, Breast Cancer, Nasopharyngeal Cancer, and Choriocarcinoma

“…Exposure during the 1st trimester, in which organogenesis takes place, may result in teratogenesis and spontaneous abortions [3,6]. Some organs and systems, including the eyes and genitalia, the hematopoietic system, and the central nervous system, remain vulnerable throughout pregnancy [7].…”

“…Chemotherapy exposure during pregnancy is a great concern for both the mother and the physician. Due to their relatively low molecular weight, chemotherapeutic agents can cross the placenta and adversely affect the fetus [2][3][4]. Teratologic and other adverse fetal effects are dependent on dosage and the gestational age [5].…”