Cancer occurs with relative infrequency during the reproductive years. Approximately 1 out of 1000 pregnant women will have cancer. These malignancies may be responsible for up to one third of maternal deaths. The most frequently occurring types are breast cancer, cervical cancer, melanomas, ovarian cancer, leukemia and lymphomas. Bone, colorectal, vulvar, uterine and vaginal cancers are rarely diagnosed during pregnancy.
When pregnancy and cancer coincide, therapeutic issues are complex, and intense reactions occur in the woman, her family and the health care team. Women are confronted with issues such as continuing or terminating the pregnancy. The selection and timing of therapies such as chemotherapy, radiation and surgery are all affected by the pregnancy. Add to this the conflicting feelings the woman has, like the joy of pregnancy versus the fear and anxiety associated with pregnancy.
Decisions about the type and timing of therapy for cancer in the pregnant woman evoke moral and philosophic dilemmas, as well as complex medical judgments and intense emotional responses. The fetus is at risk at either chemotherapy or radiation. The effect of cancer therapy to the fetus can include death, miscarriage, birth defects, alteration in growth and development and alteration in function. These detrimental effects to the baby must be weighed against the potential dangers to the mother if treatment is withheld. Surgery offers the least potential risk to the fetus; however, the risk of miscarriage and preterm labor may increase.
Chemotherapy is avoided during the first trimester if possible. There are isolated reports of fetal abnormalities with the use of chemotherapeutic drugs. The placenta may act as a barrier against the agents, although the risk still exist, the judicious use of chemotherapy agents after the first trimester can result in live births with few congenital abnormalities.
Radiation therapy presents its own set of issues. During the fetal development, the tissues are extremely radiosensitive. If cells are killed or altered during this time, the child will either fail to survive or will be deformed.
Pregnancy After Cancer Treatment
If cancer therapy has not included the removal of the uterus, ovaries or fallopian tubes, there is a possibility that the woman may still be able to become pregnant. Although, a woman’s menstrual cycle may have resumed, pregnancy may be difficult to achieve. Therapy that has affected the pituitary or thyroid gland (responsible for secreting reproductive hormones) may make conception difficult. Radiation appears to have the most deleterious effects on the endocrine system. The use of chemotherapy may result in temporary or permanent sterility, depending on the drug used, dose and length of treatment.
For recovery from cancer and treatment to be complete, a delay of at least 2 years from the end of therapy to conception is advised. An exception is a woman who had ovarian cancer, who is advised to complete her childbearing as soon as possible because of a high incidence of a second primary tumor.
Before conception, a woman who has had cancer should have a complete physical examination to rule out any complications that may put her and her baby in danger. The couple should be referred for reproductive and genetic counseling as well.
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