Pregnancy and Cancer
99 slide(s) – 00:36:24 – English – 2008-10-27
After viewing this presentation the participant will be able to discuss:
- General aspects of cancer in pregnancy
- Difficulties in diagnostics and treatment of cancer in pregnancy
- Risks of radiotherapy and chemotherapy in pregnancy
- Management of precancer and cancer of the cervix in pregnancy
- Ovarian tumors in pregnancy
- Breast cancer and pregnancy
The management of pregnant women with cancer is influenced by different factors, such as the stage of the cancer and its prognosis; the gestational age; possible adverse effects of treatment on the fetus; risk to the mother from the delay of therapy; risk for the fetus of premature delivery; and the potential need to terminate the pregnancy.
With the lack of an ideal way to manage cancer in pregnancy, different options are considered depending on the clinical situation. Waiting till the end of pregnancy to deliver the cancer treatment, for example, is more viable the lower the risk posed by the cancer, and the more advanced the pregnancy, says Prof. Kesic. In early pregnancy it is more likely to terminate the pregnancy and allow the normal treatment to proceed. A third option is to give the cancer treatment during the pregnancy while minimizing risk for the fetus.
The diagnosis of cancer is often delayed in pregnancy, because its presentation may be masked by physiological body changes of pregnancy. The diagnosis and staging are compromised, since some techniques would be unreliable in pregnancy, and some would be dangerous. Radiotherapy is contraindicated in pregnancy; however it is sometimes used above the diaphragm with shielding particularly in advanced pregnancy. Chemotherapeutic drugs, which act to inhibit cell division, pose a risk to the developing fetus. Prof. Kesic talks about the risks of surgery, radiotherapy and chemotherapy in the first, second and third trimesters.
Cervical cancer and ovarian tumors are the most common cancers seen in pregnancy. The incidence of cervical pre-cancer and invasive cancer in pregnant women is similar to that in the general population. Screening for invasive cervical cancer should be performed during the first antenatal examination, to improve the chances of detection. Prof. Kesic discusses the management of an abnormal cervical smear in pregnancy, indications for colposcopy, the use of conization, management after the histological finding in pregnancy; and the management of cervical cancer, ovarian tumors and breast cancer in pregnant women.
Treatment of cancer in pregnancy requires evidence-based medicine, a multidisciplinary approach, the art of communication with the patient, and a high dose of humanity, says Prof. Kesic. The optimal gold standards for cancer in pregnancy would be to try to benefit the mother’s life, to try to treat the curable malignant disease of pregnant women, to try to protect the fetus and newborn from harmful effects of cancer treatment, and to try to retain intact the mother’s reproductive system.
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