Systemic lupus erythematosus, pregnancy and carcinoma of the tongue

Abstract

We present a case which describes a 29-year-old woman with systemic lupus erythematosus who was treated aggressively with cytotoxic immunosuppression. Five years later and approximately 12 weeks pregnant, she is confirmed as having carcinoma of the tongue. Not wishing to consider termination of her pregnancy, she underwent surgical resection, which included partial glossectomy with microvascular reconstruction. Good oral function (speech and swallowing) was restored within 2 weeks. The pregnancy proceeded relatively uneventfully to 37 weeks gestation when proteinuric hypertension necessitated induction of labour. She remains well with no evidence of recurrence. This case highlights the options available in the treatment of carcinoma of the tongue during pregnancy together with the ethical considerations required, balanced against optimising maternal outcomes.

Head and neck cancer during pregnancy

“…5,10,14 During pregnancy, chemotherapy treatment is dictated by tumor type, prognosis, and time of gestation. Each decision regarding treatment must be discussed with an interdisciplinary staff, including a pediatrician, an obstetrician, a surgeon, and an oncologist based on cancer aggressiveness and pregnancy term.…”

“…When surgery could be performed (for T1, T2 disease), it was most of the time during pregnancy. 5,10,14 During pregnancy, chemotherapy treatment is dictated by tumor type, prognosis, and time of gestation. Some systemic treatments may be performed during pregnancy, such as doxorubicin, cyclophosphamide, and 5-fluorouracil from the second trimester onwards.…”

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

“…5 38 39 This may be related to other factors such as marijuana use and viral infection. 40 41 Reviewing the available case reports, 4 14 15 24 40 42 43 44 45 46 47 48 49 50 51 we infer that pregnant women with tongue cancers are treated similarly to nonpregnant patients. Mhallem et al described five cases of tongue cancer during pregnancy.…”

“…24 Most recently, Tagliabue et al described six more cases of tongue cancer during pregnancy, which results in 31 cases described so far. 4 14 15 24 40 42 43 44 45 46 47 48 49 50 51 Yokoshima et al in reporting the surgical management of tongue cancer during pregnancy suggest that less than optimal management may result in a worse prognosis. 44…”

Post-glossectomy in lingual carcinomas: a scope for sign language in rehabilitation

“…in 2013 also mentioned that partial glossectomy with micro-vascular reconstruction procedure in tongue cancer patients helped with oral functions (i.e. speech and swallowing) in the early healing period [ 9 ]. Similarly, Tuhar et al .…”