Malignancies in Pregnancy Explored in Lancet Series
(ChemotherapyAdvisor) – Treatment of women diagnosed with cervical, ovarian, breast, and hematologic cancers in pregnancy is the focus of three articles published in The Lancet February 10. Up to 1 in 1,000 pregnancies is affected by cancer, and this number is expected to rise as women postpone pregnancy. The current trend is to preserve pregnancy wherever possible.
The first article explores issues around gynecological cancer, of which cervical and ovarian are the most common. Management of patients with cervical cancer is controversial and complex, the authors note, and should be discussed on a case-by-case basis “according to the tumor size, radiological findings, the term of pregnancy, and the patient's wishes.” For ovarian cancer, use of chemotherapy is possible in the second or third trimester.
The second article notes that breast cancer during pregnancy is not an emergency; therefore, time should be taken to determine a multidisciplinary approach. Both surgery and chemotherapy are possible, although radiation therapy is not generally advised. Termination of the pregnancy does not improve outcome for the mother and a normal-length pregnancy to avoid harm caused by premature birth should be the goal. The placenta should be examined for metastases; breastfeeding in the first few weeks after chemotherapy is not recommended.
Lymphoma is the fourth most common cancer in pregnancy, affecting one in 6,000 pregnancies, according to the third article. Non-Hodgkin lymphoma, acute leukemia, and other hematologic malignancies can also occur in pregnancy; all pose diagnostic and therapeutic challenges. This article emphasizes management should focus on survival of the mother and concludes that the scarcity of data underscores the need for extensive collaborative efforts to expand basic and clinical research.