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Obstetrical Oncology: Care for the Pregnant Cancer Patient

Considerations should also be made for young women who are pregnant at the time of cancer diagnosis to achieve a healthy pregnancy. By 2002, the incidence of pregnancy-associated breast cancer had increased to 37.4 per 100,000 deliveries, up from 16.0 in 19631. The co-existence of pregnancy and cancer is expected to rise in the future with the trend to delay childbearing. Thus, the clinical community should increase their understanding of best treatment practices for this complex diagnosis.

Incidence
  • A cancer diagnosis occurs in 0.7 to 1 out of every 1000 pregnancies2.
  • The most common sites of primary cancers in pregnant women mirror those of non-pregnant women of reproductive age include breast cancer, cervical cancer, Hodgkin lymphoma, and melanoma.
  • Large prospective studies are difficult to execute and clinical expertise in this patient population is rare.
Treatment Considerations The goal of cancer treatment during pregnancy remains the same as for any other patient, to prevent metastasis and control the disease but additional guidelines should be taken to prevent harm to the fetus.

  • Abdominal and pelvic radiation should be avoided.
  • Most chemotherapeutics are FDA category D due to positive evidence for fetal risk but varies throughout gestation.
Timing cancer treatment during pregnancy
  • The risk of spontaneous abortions, fetal malformations, and fetal death are highest during the critical period of organogenesis in the first trimester
  • The first trimester risk for malformation alone is reported to be 17% for single agent therapy and 25% for combination chemotherapy3.
  • There is no evidence of increased risk of malformations from chemotherapy administered during the second or third trimester4-7.
  • Chemotherapy should be ceased 3-4 weeks prior for delivery of the infant to avoid potential adverse effects, such as myelospression and associated complications.
  • To date, no reported significant long-term health concerns in the children exposed in utero to chemotherapy7.

Given the complex nature of cancer during pregnancy, a recent review article calls for the multidisciplinary management of pregnant cancer patients to provide optimal care for mother, fetus, and future fertility between obstetricians, gynecologists, and oncology specialists8.

References

  1. Andersson TM, Johansson AL, Hsieh CC, Cnattingius S, Lambe M. Increasing incidence of pregnancy-associated breast cancer in Sweden. Obstet Gynecol 2009;114:568-72.
  2. Sutcliffe SB. Treatment of neoplastic disease during pregnancy: maternal and fetal effects. Clin Invest Med 1985;8:333-8.
  3. Doll DC, Ringenberg QS, Yarbro JW. Management of cancer during pregnancy. Arch Intern Med 1988;148:2058-64.
  4. Zemlickis D LM, Koren G. Review of fetal effects of cancer chemotherapeutic agents. In: Koren G LM, Farine D, ed. Cancer in pregnancy. Cambridge, Engl: Cambridge University Press; 1996:168-80.
  5. Doll DC, Ringenberg QS, Yarbro JW. Antineoplastic agents and pregnancy. Semin Oncol 1989;16:337-46.
  6. Cardonick E, Dougherty R, Grana G, Gilmandyar D, Ghaffar S, Usmani A. Breast cancer during pregnancy: maternal and fetal outcomes. Cancer J 2010;16:76-82.
  7. Hahn KM, Johnson PH, Gordon N, et al. Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer 2006;107:1219-26.
  8. Kong BY, Skory RM, Woodruff TK. Creating a continuum of care: integrating obstetricians and gynecologists in the care of young cancer patients. Clin Obstet Gynecol. 2011 Dec;54(4):619-32.

Page last updated March 14, 2012.

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