Management of pregnancy in women with cancer

Abstract

As the incidence of cancer in pregnancy has been increasing in recent decades, more specialists are confronted with a complex oncologic–obstetric decision-making process. With the establishment of (inter)national registries, including the International Network on Cancer, Infertility and Pregnancy, and an increasing number of smaller cohort studies, more evidence on the management of cancer during pregnancy is available. As fetal, neonatal, and short-term pediatric outcomes after cancer treatment are reassuring, more women receive treatment during pregnancy. Prenatal treatment should adhere to standard treatment as much as possible to optimize maternal prognosis, always taking into account fetal well-being. In order to guarantee the optimal treatment for both mother and child, a multidisciplinary team of specialists with expertise should be involved. Apart from oncologic treatment, a well-considered obstetric and perinatal management plan discussed with the future parents is crucial. Results of non-invasive prenatal testing are inconclusive in women with cancer and alternatives for prenatal anomaly screening should be used. Especially in women treated with chemotherapy, serial ultrasounds are strongly recommended to follow-up fetal growth and cervical length. After birth, a neonatal assessment allows the identification of any cancer or treatment-related adverse events. In addition, placental histologic examination aims to assess the fetal risk of metastasis, especially in women with malignant melanoma or metastatic disease. Breastfeeding is discouraged when systemic treatment needs to be continued after birth. At least a 3-week interval between the last treatment and nursing is recommended to prevent any treatment-induced neonatal effects from most non-platinum chemotherapeutic agents.

Neoadjuvant Chemotherapy during Pregnancy in Cervical Cancer Patient Followed by Simultaneous Cesarean Section and Radical Hysterectomy: A Case Report

“…Cervical cancer is the most common malignant neoplasm diagnosed during pregnancy and, fortunately, most patients are diagnosed having early stages of the disease [5,[10][11][12]. Treatment for cervical cancer during pregnancy depends on a number of factors, such as the stage of the disease (tumor size), lymph node involvement, gestational age, histological subtype, the patient's desire to continue the pregnancy and the desire for the future fertility spearing [11]. It is important to emphasize that during pregnancy the oncological outcome in patients with cervical cancer are similar in compare with non-pregnant patients, noting that the effect of pregnancy on tumor biology remains until now unclear.…”

“…Final pathology report of hysterectomy specimen showed small evidence of invasive squamous cell carcinoma, grade 2, with depth of invasion 3.5 mm and associated with intrauterine growth retardation, prematurity and low birth weight. In addition, the introduction of chemotherapy within 3 weeks after the intended shipping is not recommended [11]. Our patient, starting from 24 weeks of pregnancy, underwent 3 courses of neoadjuvant cisplatin-containing chemotherapy with an interval of three weeks between courses, with no delay and adverse effects.…”

“…Most patients undergo a Caesarean section. The incidence of Cesarean section in pregnant cancer patients is observed in 30%, which is higher compared with a recorded global rate of 21% [11,13]. Vaginal delivery is contraindicated for the most cervical and vulvar cancers because of the potential for implantation of cancer cells in the vaginal tear/episiotomy site [7].…”

Nanotechnologies in Obstetrics and Cancer during Pregnancy: A Narrative Review

“…Furthermore, with the progressive aging of the female population and the childbearing delay [ 15 ], a significant increase in the incidence of pregnancy-associated breast (and other) cancers has been observed [ 16 , 17 ]. This increase boosts the demand for targeted and safe technologies that can also be used during pregnancy to improve the accuracy of diagnosis and the treatment of neoplastic pathologies.…”

Proximal airway obstruction caused by adenoid cystic carcinoma in a pregnant woman: A case report

“…breast, cervical, skin (melanoma), ovarian, and haematological malignancies. [3 , 4] This is a report of the airway management of a young primiparous woman with tracheal ACC and airway obstruction during pregnancy who underwent definitive surgery after delivery.…”