Oncology treatment during pregnancy is rare but not unheard of and the delay in pregnancy and rise in maternal age is found to be one of the major contributing factors. The treatment regimens of pregnant oncology patients don’t differ significantly from non-pregnant ones but the prolonged exposure to anticancer drugs and radiation is often seen as a cause of anxiety. The decision regarding the continuation of treatment is to be taken after thorough research and collective consultancy of a multidisciplinary team consisting of a surgeon, a clinical oncologist, a specialist in radiation therapy in oncological gynecology, an obstetrician, and a psychologist, with active involvement and support from the family of the pregnant patient. a multidisciplinary team consisting of a surgeon, a clinical oncologist, a specialist in radiation therapy in oncological gynecology, an obstetrician, and a psychologist, with active involvement and support from the family of the pregnant patient. The cancers that generally afflict pregnant women include breast and cervical cancer, as well as melanoma, lymphoma, thyroid, ovarian, colorectal and acute leukemia. Therapeutic options for oncology in pregnancy cases are surgery, chemotherapy and radiation therapy.
- Surgery is not antonym with pregnancy but it advisable to do conduct the operation after the first trimester (the first 12 to 14 weeks) so as not to increase the risk of miscarriage. Surgical treatment of non-neoplastic conditions in pregnant women includes cases of cholecystitis, appendicitis, and ovarian cysts. Most anesthetics during pregnancy are considered to be safe for the fetus and mother. Negative effects for the fetus are more correlated with maternal hypoxia, hypotension, hypothermia, or abnormal glucose metabolism than with anesthesia. The risk of pregnancy loss and congenital defects does not increase because of surgery. Laparoscopic surgery can be carried out during pregnancy by an experienced physician.
- On the other hand, dispensing of chemotherapy (CTH) in the first trimester of pregnancy can be justified with the damage to the fetus has been reported during embryogenesis and organogenesis (up to the 60thgestation day). After the administration of cytotoxic chemotherapy during pregnancy, especially during the first trimester, the occurrence of birth defects is about 20%, 40% of which regard low birth weight, and about 33% of which regard pancytopenia. According to research presented at the annual meeting of the Society for Maternal-Fetal Medicine (January 14–19 2002, New Orleans, LA, USA) there is no increased risk of preterm delivery and chemotherapy mostly produces the safest results if initiated after the first trimester as that is when chief fetus development take place. Most cytotoxic drugs have a relatively low molecular weight and can cross the placenta. Because of its teratogenic and mutagenic effect, chemotherapy is contraindicated during the first trimester of pregnancy. However, in some cases, chemotherapy is used after the period of organogenesis. Breastfeeding by pregnant women undergoing CTH is not recommended because the drugs are excreted with breast milk. In addition, the chemotherapy is not recommended too near the delivery date, the last dosage usually precedes eight weeks before the delivery date (32 to 33 weeks into the pregnancy). The reason behind this is the potential reduction of white blood cells counts (neutropenia) in the mother, leading to a risk of infection in the baby and mother around the time of delivery.
- Radiation is the least recommended form of treatment as its exposure to the pelvic area during pregnancy can cause defects in the children like microcephaly, mental retardation, stunted growth, microphthalmus, retinal degeneration, cataracts, and defective dentition. In principle, radiation therapy should be avoided during pregnancy, if possible. The neck and mediastinum can be considered as an area for irradiation, provided that the region of the pelvis is excluded.
In conclusion, the medicine for oncology while pregnant, method of diagnosis and treatment of oncology for pregnant patients have to be based on a very informed and minutely detailed research conducted whilst keeping the form of cancer, the stage of pregnancy and other various biological and psychological factors in mind.