Multidisciplinary consensus on cancer management during pregnancy

Abstract

Cancer during pregnancy is a challenge for multi- and interdisciplinary collaboration due to the diagnostic, prognostic and therapeutic implications, the need for an integrated harmonization of medical action for the pregnant patient and the embryo or foetus and the characteristics of each gestational period, which will determine the protocol to be proposed and its limitations. For this reason, a group of experts appointed by participating scientific societies, which includes the Spanish Society of Medical Oncology (Sociedad Española de Oncología Médica—SEOM), the Spanish Association of Surgeons (Asociación Española de Cirujanos—AEC), the Spanish Society of Gynaecology and Obstetrics (Sociedad Española de Ginecología y Obstetricia—SEGO), the Spanish Society of Nuclear Medicine and Molecular Imaging (Sociedad Española de Medicina Nuclear e Imagen Molecular—SEMNIM), the Spanish Society of Oncological Radiotherapy (Sociedad Española de Oncología Radioterápica—SEOR) and the Spanish Society of Medical Radiology (Sociedad Española de Radiología Médica—SERAM), have worked together to establish consensus recommendations that allow the harmonization of management and ultimately the optimization of the healthcare of pregnant patients with cancer. When cancer is detected in a pregnant woman, the week of gestation in which the diagnosis is made must be considered, as well as the characteristics of the tumour. It is strongly recommended that a multidisciplinary team assesses the situation and guides the patient and her family during the informing, diagnosis and treatment process. Likewise, the foetus should be monitored and managed by specialized obstetricians who are part of a multidisciplinary cancer committee.

2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)

“…757 Chemotherapy is generally not applied during the first trimester due to the high risk of foetal congenital abnormalities (up to 20%) and cytotoxic chemotherapies have different risk profiles during the second or third trimesters. 758,759 Furthermore, chemotherapy administration is usually not given beyond week 34 of gestation to provide a 3-week window between the last cycle and delivery. 757 Supplementary data, Table S19 summarizes the chemotherapies for pregnant patients with cancer.…”

Hemoptysis during pregnancy: a comprehensive review of literature and an unprecedented case report of oropharyngeal carcinoma

“…The incidence of malignant neoplasms diagnosed during pregnancy is constantly rising with melanoma, breast and cervical cancer at the forefront [16][17][18] yet other types of malignancies cannot be excluded in pregnancy and have to be considered [19,20]. This includes a choriocarcinoma [21][22][23][24][25], which in our review proved to be the most common neoplastic process resulting in hemoptysis during pregnancy.…”

Sentinel lymph node biopsy for breast cancer during pregnancy: A comprehensive update

“…55 Additionally, the Chinese Society of Breast Surgery (CSBrS) 56 and the Spanish Society of Medical Oncology have published similar recommendations in 2021. 4 As a conclusion, there are six international societies' guidelines standing in favour of SLNB in PrBC, even if certain precautions for blue dye are expressed. 4.2.2 | Evidence against SLNB for PrBC Out of 63 articles included in the present critical review, only 10 evidence items were strongly against SLNB in PrBC patients.…”

“…Breast cancer represents the most frequent malignancy diagnosed during pregnancy (PrBC), accounting for onethird of all cases of gestational cancer. [1][2][3][4] It is estimated that 1 in every 3000-10,000 pregnancies is complicated by PrBC and this incidence is expected to rise due to the combination of delaying childbearing, increased incidence of early-onset BC and increasing usage of non-invasive prenatal testing (NIPT) during pregnancy that may add further diagnosed cases as well. 5,6 Patients with PrBC are usually diagnosed at an advanced stage.…”