Hepatocellular carcinoma during pregnancy and its comparison with other pregnancy-associated malignancies

Abstract

Background. Cancer in pregnancy is rare and hepatocellular carcinoma (HCC) in pregnancy even rarer. The impact of pregnancy on the prognosis of patients with different types of cancer remains controversial. Reported cases of HCC in pregnancy are largely isolated and highly scattered. Thus, the effect of pregnancy on the prognosis of patients with HCC and the risk factors of developing HCC in pregnancy are not well documented. Methods. A series of five patients with HCC in pregnancy seen at two different centers is reported. A Medlar search for articles between 1957 and 1993 with the key words“Hepatocellular Carcinoma” and “Pregnancy” was conducted. All reported cases were combined and analyzed in terms of race, age, parity, hepatitis B surface antigen status, cirrhosis, serum alpha‐fetoprotein (AFP) levels at presentation, history of taking oral contraceptive pills and fetal and maternal outcome. The impact of pregnancy on 12 other malignancies as reported in the medical literature also was reviewed. Results. To the authors' knowledge, The five cases reported here constitute the largest series of HCC in pregnancy. A literature search revealed 23 additional cases. Analysis of the 28 cases suggests that the rarity of HCC in pregnancy results from a combination of three factors: the male predominance of HCC, the late age at which the tumor usually presents in women, and decreased fertility in women with advanced cirrhosis (hepatitis is a predisposing factor for HCC development). Long term use of oral contraceptives and high parity enhance the risk. Elevated AFP level is useful for diagnosis. The median survival is shorter than for patients who are not pregnant. There is no significant difference in survival between pregnant and not pregnant women matched by tumor stage, age, and other clinical parameters in most malignancies except in some tumors like lymphoma, thyroid cancer, and nasopharyngeal carcinoma. Conclusion. Pregnancy has an adverse effect on the prognosis of patients with HCC, lymphoma, thyroid cancer, and nasopharyngeal carcinoma but not of most other malignancies. Measurement of AFP level is recommended for screening HCC in pregnant women at high risk. Cancer 1995;75:2669–76.

Anesthetic management during labor and delivery: a 21-year review of women with cancer in a tertiary care center

“…The risk of HCC rises with increasing parity [27]. Involvement of the liver may affect coagulation function, which should be assessed before regional anesthesia is administered.…”

Aggressive hepatocellular carcinoma complicating pregnancy after autologous bone marrow transplantation for non-Hodgkin's lymphoma

“…The incidence of HCC is low in young women (3/100 000 per year at age below 40, Hong Kong Cancer Registry 1996) and less than 40 cases of HCC complicating pregnancy have been reported worldwide, including 12 cases in Chinese. 8 The outcome is invariably poor, with few maternal survivals. This is attributed to delayed diagnosis, estrogen stimulation of HCC growth and preg- nancy-related immunotolerance.…”

“…This is attributed to delayed diagnosis, estrogen stimulation of HCC growth and preg- nancy-related immunotolerance. 8 Abdominal distension and raised AFP levels during pregnancy can cause diagnostic difficulty. 9 Estrogen stimulation of HCC growth is probably not a factor in our case with negative receptor staining.…”

Gastrointestinal, Pancreatic, and Hepatic Cancer During Pregnancy

“…By 1995 there were approximately 30 reported cases of HCC during pregnancy [101], whereas a more recent review of liver masses in pregnancy reported three additional cases of HCC [102].…”

“…Aflatoxin in the diet may also be a risk factor for HCC [104]. In 1995, Lau and coworkers [101] reported five cases of HCC during pregnancy and reviewed case reports of 23 additional cases. Among the 25 patients with known racial origin, 8 were Chinese and 6 were Nigerian.…”