Ethical Challenges in Treating Mother and Fetus When Cancer Complicates Pregnancy

Unusual cause of itching in a pregnancy (cholangiocarcinoma)

“…Diagnosis is often delayed as the presenting symptoms of malignancy may be confused with the common symptoms of pregnancy (Iseminger and Lewis 1998).…”

Ethical dilemmas in the management of tumor-stage mycosis fungoides in a pregnant patient

“…3,4 Treatment options in a pregnant patient diagnosed with a malignancy pose unique ethical issues because of competing obligations between mother and fetus. 5 The patient's consideration and ultimate decision on whether or not to continue or terminate the pregnancy is complicated because of these competing interests. Respect for autonomy recognizes the woman's independent right to base decisions upon her own world view and value system.…”

Acute lymphoblastic leukemia during gestation

“…It is critical that multiagent chemotherapy is started as soon as possible after the diagnosis. It has been shown that survival is significantly longer in patients whose induction therapy is started before delivery, than in those treated after delivery [3]. Standard antileukemic chemotherapy can be administrated safely during the second and third trimesters [10,11].…”

“…Fluorescent in situ hybridization (FISH) in peripheral blood sample for hybrid gene TEL/AML1 in chromosome regions 12p13 and 21q22, for hybrid gene BCR/ABL in regions 9q34 and 22q11 or anomaly in region 11q23, was negative. A joint decision between consultant hematologist and obstetrician was taken and the patient started aggressive chemotherapy at once for the benefit of the mother, since the fetus was at lesser risk for teratogenic effects, it being in the third trimester [3]. The interval between admission, diagnosis of ALL and the onset of chemotherapy was 2 days.…”