Pregnancy should not delay treatment of cancer. Treatment is similar to that in nonpregnant women except for rectal and gynecologic cancers Introduction to Gynecologic Tumors Gynecologic cancers often involve the uterus, ovaries, cervix, vulva, vagina, fallopian tubes, or the peritoneum. Gestational trophoblastic disease is a group of proliferative disorders originating... read more .
Because embryonic tissues grow rapidly and have a high DNA turnover rate, they resemble cancer tissues and are thus very vulnerable to antineoplastic drugs. Many antimetabolites and alkylating drugs (eg, busulfan, chlorambucil, cyclophosphamide, 6-mercaptopurine, methotrexate) can cause fetal abnormalities. Methotrexate is particularly problematic; use during the 1st trimester increases risk of spontaneous abortion and, if the pregnancy continues, multiple congenital malformations. Although pregnancy often concludes successfully despite cancer treatment, risk of fetal injury due to treatment leads some women to choose abortion.
Rectal cancers Colorectal Cancer Colorectal cancer is extremely common. Symptoms include blood in the stool and change in bowel habits. Screening using one of several methods is recommended for appropriate populations. Diagnosis... read more may require hysterectomy to ensure complete tumor removal. Cesarean delivery may be done as early as 28 weeks, followed by hysterectomy so that aggressive cancer treatment can be started.
Pregnancy does not appear to worsen cervical cancer Cervical Cancer Cervical cancer is usually a squamous cell carcinoma; less often, it is an adenocarcinoma. The cause of most cervical cancers is human papillomavirus infection. Cervical neoplasia is often asymptomatic... read more .
Cervical cancer can develop during pregnancy, and an abnormal Papanicolaou (Pap) test should not be attributed to pregnancy. Abnormal Pap tests are followed by colposcopy and directed biopsies when indicated. Colposcopy does not increase risk of an adverse pregnancy outcome. Expert colposcopic evaluation and consultation with the pathologist are recommended before doing a cervical biopsy because the biopsy may cause hemorrhage and preterm labor. If the examination suggests that lesions are low-grade, a biopsy may not be done, particularly if cervical cytology also suggests that lesions are low-grade.
For carcinoma in situ (Federation of Gynecology and Obstetrics [FIGO] stage 0—see table FIGO Clinical Staging of Cervical Cancer Carcinoma FIGO Clinical Staging of Cervical Carcinoma* ) and microinvasive cancer (stage IA1), treatment is often deferred until after delivery because at these stages, cancer progresses very slowly and pregnancy can be completed safely without affecting the woman's prognosis.
If invasive cancer (FIGO stage IA2 or higher) is diagnosed, pregnancy should be managed in consultation with a gynecologic oncologist. If invasive cancer is diagnosed during early pregnancy, immediate therapy appropriate for the cancer is traditionally recommended. If invasive cancer is diagnosed after 20 weeks and if the woman accepts the unquantified increase in risk, treatment can be deferred until into the 3rd trimester (eg, 32 weeks) to maximize fetal maturity but not delay treatment too long. For patients with invasive cancer, cesarean delivery with radical hysterectomy is done; vaginal delivery is avoided.
Other gynecologic cancers
After 12 weeks gestation, ovarian cancer Ovarian, Fallopian Tube, and Peritoneal Cancer Ovarian cancer is often fatal because it is usually advanced when diagnosed. The most common histology—high-grade serous epithelial ovarian cancer—is considered as a single clinical entity along... read more is easily missed; then, the ovaries, with the uterus, rise out of the pelvis and are no longer easily palpable. If very advanced, ovarian cancer during pregnancy may be fatal before completion of the pregnancy. Affected women require bilateral oophorectomy as soon as possible.
Endometrial cancer Endometrial Cancer Endometrial cancer is usually endometrioid adenocarcinoma. Typically, it manifests as postmenopausal uterine bleeding. Diagnosis is by biopsy. Staging is surgical. Treatment requires hysterectomy... read more and fallopian tube cancer Ovarian, Fallopian Tube, and Peritoneal Cancer Ovarian cancer is often fatal because it is usually advanced when diagnosed. The most common histology—high-grade serous epithelial ovarian cancer—is considered as a single clinical entity along... read more rarely occur during pregnancy.
Leukemia and Hodgkin lymphoma
Leukemia Overview of Leukemia Leukemia is a malignant condition involving the excess production of immature or abnormal leukocytes, which eventually suppresses the production of normal blood cells and results in symptoms... read more and Hodgkin lymphoma Hodgkin Lymphoma Hodgkin lymphoma is a localized or disseminated malignant proliferation of cells of the lymphoreticular system, primarily involving lymph node tissue, spleen, liver, and bone marrow. Symptoms... read more are uncommon during pregnancy.
Antineoplastic drugs typically used to treat lymphoma increase risk of fetal loss and congenital malformations.
Because leukemias can become fatal rapidly, treatment is given as soon as possible, without any significant delay to allow the fetus to mature.
If Hodgkin lymphoma is confined to above the diaphragm, radiation therapy may be used; the abdomen must be shielded. If lymphoma is below the diaphragm, abortion may be recommended.
Breast engorgement during pregnancy may make recognizing breast cancer Breast Cancer Breast cancers are most often epithelial tumors involving the ducts or lobules. Most patients present with an asymptomatic mass discovered during examination or screening mammography. Diagnosis... read more difficult. Any solid or cystic breast mass Evaluation The term breast mass (lump) may be discovered by patients incidentally or during breast self-examination or by the clinician during routine physical examination. Masses may be painless or painful... read more should be evaluated. Usually, breast cancer should be treated immediately.
Drugs Mentioned In This Article
|Drug Name||Select Trade|
|Cyclophosphamide, Cytoxan, Neosar|
|Otrexup, Rasuvo, RediTrex, Rheumatrex, Trexall, Xatmep|