Obstetrical Outcomes of Head and Neck (Nonthyroid) Cancers: A 27-Year Retrospective Series and Literature Review

Abstract

Objective To describe the clinical presentation and obstetrical outcomes of nonthyroid head and neck cancers (HNCs), and to review literature on this rare condition in pregnancy. Study Design Pregnant women with nonthyroid HNC were identified retrospectively from 1990 to 2017. Maternal, neonatal, pregnancy, and demographic data were collected. A review of the literature from January 1980 to May 2018 was performed. Results Over the 27-year time period, 16 women with history of nonthyroid HNC were identified (9 diagnosed during and 7 diagnosed before current pregnancy). The cases were analyzed in detail and the most updated review of management of each type of HNC was provided. Conclusions HNCs are rare with diagnosis and management challenges during pregnancy. In this series, the cases diagnosed and managed previously to pregnancy presented better perinatal outcomes than the cases presented during pregnancy. The maternal outcomes appeared similar for HNC diagnosed before or after pregnancy.

Otolaryngology and the Pregnant Patient

“…Head and neck cancer (HNC) diagnosed during pregnancy is uncommon. A literature review identified 9 new patients with nonthyroid HNC during a 27-year period . Nevertheless, pregnancy should not delay thorough evaluation of concerning symptoms or suspicious lesions or masses.…”

“…The literature identifies 4 pregnant patients with HNC who underwent preterm pregnancy induction to expedite cancer treatment and 1 patient who elected for pregnancy termination. Three patients had antepartum surgery for treatment of HNC …”

Otolaryngologists and Reproductive Rights

“…Head and neck cancer treatment poses significant tradeoffs in terms of definitive oncologic management for the pregnant patient versus risks particularly to the fetus. Radiation risks during pregnancy include fetal growth restriction and intellectual disability 15 . Chemotherapy is typically postponed until the second/third trimester, if possible for patient survival, to avoid first‐trimester fetal exposure which may affect organogenesis 13‐15 .…”

“…Radiation risks during pregnancy include fetal growth restriction and intellectual disability 15 . Chemotherapy is typically postponed until the second/third trimester, if possible for patient survival, to avoid first‐trimester fetal exposure which may affect organogenesis 13‐15 . Surgical management during the second trimester of pregnancy given comparatively mild physiologic changes has been recommended 13 …”

“…15 Chemotherapy is typically postponed until the second/ third trimester, if possible for patient survival, to avoid first-trimester fetal exposure which may affect organogenesis. [13][14][15] Surgical management during the second trimester of pregnancy given comparatively mild physiologic changes has been recommended. 13 It is critical to provide complex, evidence-based multidisciplinary oncologic counseling and care for the pregnant patient with head and neck cancer.…”