Cancer During Pregnancy: The Oncologist Overview

Hepner, Adriana; Negrini, Daniel; Hase, Eliane Azeka; Exman, Pedro; Testa, Laura; Trinconi, Angela Francisca; Filassi, José Roberto; Francisco, Rossana Pulcineli Vieira; Zugaib, Marcelo; O’Connor, Tracey; Martin, Michael

doi:10.14740/wjon1177

Cited by 93 publications

(79 citation statements)

References 53 publications

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“…Hence the decision-making related to chemotherapy whenever appropriate, should be left primarily to the patient herself. Radiotherapy is not useful in colon cancer and is especially avoided in pregnancy [1]. In the first half of pregnancy, abortion is offered, should the patient no longer wish to proceed with the pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Chemotherapy is avoided in the first trimester due to harmful effects on organogenesis. 5-fluorouracil-based chemotherapy regimens are frequently utilized due to its relative safety in the second and third trimesters, with a lower risk of abortion and fetal malformation [ 1 , 17 ]. However, stillbirth, intrauterine growth restriction, and fetal toxicities are found to occur more frequently in patients who received chemotherapy after the first trimester [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most frequent cancers associated with pregnancy are melanoma, breast cancer, cervical cancer, lymphomas, and leukemias, in the order of decreasing frequency [1]. Although colorectal carcinoma (CRC) is the second most common cancer in women worldwide, colorectal carcinoma in pregnancy (CRC-p) is rare and is often associated with poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

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Adenocarcinoma of Sigmoid Colon Diagnosed in Pregnancy: A Case Report

Sravanthi

Kumaran

Palle³

et al. 2020

Cureus

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With more women getting pregnant at later ages than in the past, the incidence of malignancies in pregnancy is on the rise. Common malignancies of pregnancy are melanoma, breast cancer, cervical cancer, lymphomas, and leukemias. Colorectal carcinoma is rare in pregnancy, with an estimated incidence of 1 in 13',000 cases. We describe such a case of colorectal carcinoma in pregnancy (CRC-p), in a 31-year-old patient. She presented in the 21 st week of her second pregnancy with constipation of two weeks duration despite appropriate medical management. This prompted further evaluation with abdominal imaging revealing partial small bowel obstruction of unclear etiology. She was treated surgically with subtotal colectomy with ileostomy. Pathologic evaluation revealed Stage III B: pT3N2a adenocarcinoma with mucinous features of the sigmoid colon with lymph node metastases. Adjuvant FOLFOX chemotherapy was started in the third trimester and was continued postpartum for a total of 12 cycles. She is doing well, and ileostomy reversal is being planned at the time of writing this. Advancing maternal age is a significant risk factor for CRC-p. Common presenting symptoms in CRC-p include bleeding per rectum, abdominal pain, vomiting, and constipation. The frequent occurrence of many of these symptoms, as well as risks and restrictions associated with diagnostic modalities such as computed tomography scan and colonoscopy during pregnancy, makes the diagnosis challenging. Colonoscopy, followed by pathology evaluation, remains the standard diagnostic method in CRC-p. Management of CRC-p is determined by multiple variables such as the stage of the disease, gestational age, and most importantly, patient wishes. Surgical resection is performed following the diagnosis if the gestational age is less than 20 weeks and delayed until after delivery if gestational age is above 20 weeks. 5fluorouracil based chemotherapy regimens are used in second and third trimesters, in patients with stage III CRC-p. Prognosis has been reported variably. Despite advanced stages at presentation, most of the studies indicate a similar prognosis compared to CRC in the nonpregnant population. Two-year survival was found to be 64.4% in one case series.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adenocarcinoma of Sigmoid Colon Diagnosed in Pregnancy: A Case Report

Sravanthi

Kumaran

Palle³

et al. 2020

Cureus

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“…There is a paucity of information about the use of oncology drugs in special populations, including pediatric patients with cancer, older adults, individuals with comorbidities or organ dysfunction, and pregnant women . Eligibility criteria in oncology clinical trials often limit participation of special populations in clinical research, particularly very young children or those with very rare diseases .…”

Section: Special Populationsmentioning

confidence: 99%

Challenges and Opportunities to Updating Prescribing Information for Longstanding Oncology Drugs

et al. 2019

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A number of important drugs used to treat cancer—many of which serve as the backbone of modern chemotherapy regimens—have outdated prescribing information in their drug labeling. The Food and Drug Administration is undertaking a pilot project to develop a process and criteria for updating prescribing information for longstanding oncology drugs, based on the breadth of knowledge the cancer community has accumulated with the use of these drugs over time. This article highlights a number of considerations for labeling updates, including selecting priorities for updating; data sources and evidentiary criteria; as well as the risks, challenges, and opportunities for iterative review to ensure prescribing information for oncology drugs remains relevant to current clinical practice.

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“…It is the second most common cause of death in women of reproductive age. The incidence of pregnancy-associated breast cancer is increasing as women are delaying childbirth until later [1,[4][5][6]. Recent data shows incidence of breast cancer during pregnancy as 1 in 3,000 to 10,000 birth deliveries, positioning these diagnosis as common as cervical uterine cancer [1,3,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

The Safety of Viscum Album L. in A Murine Model: A Reproductive Toxicity Study

Ghelman¹,

Cernach²,

Ishigai³

et al. 2020

Preprint

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Abstract Background: The use of antineoplasic drugs in pregnancy poses a huge safety challenge because of the risk of teratogenicity, mutagenicity and carcinogenicity. The rational use of the herbal medicine Viscum album (VA) has shown promising results in several tumor lines as part of the strategy of immunotherapy and anti-angiogenesis in integrative oncology. The safety of intrauterine fetal exposure to VA is however unknown and can be further evidenced for therapeutic doses in pregnant cancer patients.Methods: 47 pregnant Wistar rats and 399 fetuses bred following exposure to VA were investigated. The rats were randomized into five groups. Control group (CG) received no treatment and stress group (SG) received daily vehicle subcutaneous injections alone in same volume as the treatment groups from day zero until the twentieth day of pregnancy. There were three treatments groups: therapeutic dose group (TG) received the usual therapeutic dose (UTD) of 0.013 mg/kg BW; high dose group (HG) received 12.5 mg/kg BW and very high dose group (VHG) received 25mg/kg BW, daily.Results: Weight gain was greater in the rats, placentas and fetuses in the TG and HG compared to SG. Histology of the placentas showed a greater inflammatory process in HG and VHG.Conclusion: Since no cases of abortion, embryotoxicity, natimortality or teratogenicity were found in the fetuses and histology detected no lesions in the tissues evaluated, it is reasonable to conclude that this drug is safe for use in pregnant rats.

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Cancer During Pregnancy: The Oncologist Overview

Cited by 93 publications

References 53 publications

Adenocarcinoma of Sigmoid Colon Diagnosed in Pregnancy: A Case Report

Adenocarcinoma of Sigmoid Colon Diagnosed in Pregnancy: A Case Report

Challenges and Opportunities to Updating Prescribing Information for Longstanding Oncology Drugs

The Safety of Viscum Album L. in A Murine Model: A Reproductive Toxicity Study

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