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  1. Home
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  3. Cancer in Pregnancy and Lactation
  • Cited by 2
Publisher:
Cambridge University Press
Online publication date:
December 2011
Print publication year:
2011
Online ISBN:
9780511794995
DOI:
https://doi.org/10.1017/CBO9780511794995
Subjects:
Oncology, Obstetrics and Gynecology, Reproductive Medicine, Medicine
Information

Book description

Cancer in pregnancy presents physicians with a serious and ethical challenge, yet the sources of concise data and guidance for the management of this disease are scarce. The Motherisk program, based at the Hospital for Sick Children, Toronto, is dedicated to addressing this problem. Cancer in Pregnancy and Lactation: The Motherisk Guide tackles this subject by providing evidence-based information needed to address the complex issues of maternal diagnosis, management, treatment, prognosis and long-term impact on the unborn child. Based on the research by members of the international Consortium of Cancer in Pregnancy Evidence (CCoPE) this book provides physicians with the core knowledge required to make sound clinical decisions in the face of sometimes conflicting interests. Co-edited by recognized experts in the field with over 25 years' experience, this comprehensive volume is essential reading for all maternal-fetal medicine physicians, obstetricians, neonatologists, oncologists and pharmacologists.

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Contents

Page 2 of 2

Contents
  • Chapter 20 - Long-term neurodevelopment of children exposedin uteroto treatment for maternal cancer
    pp 157-175
  • View abstract

    Summary

    This chapter describes the diagnosis, treatment, prognosis, and lactation for thyroid cancer in pregnancy. A few studies suggest that thyroid stimulation during both pregnancy and lactation may result in transient increase in risk of papillary thyroid cancer especially among women diagnosed with thyroid cancer at a younger age. Ultrasound may be used to characterize the nodule, detect other nodules missed on physical examination, measure nodule growth during pregnancy, and to guide the fine needle aspiration. Radioiodine therapy is contra-indicated during pregnancy as it can cross the placenta and cause fetal hypothyroidism and cretinism. The risk of malformations when chemotherapy is administered in the first trimester has been estimated to be around 7.5-17% for single agent chemotherapy and 25% for combination chemotherapy. Current information based on follow-up studies of women having subsequent pregnancies after radioiodine treatment have failed to show statistically significant effects on chromosomal abnormalities, congenital malformation, and childhood malignancies.
  • Chapter 21 - Fertility of children exposedin uteroto chemotherapy
    pp 176-178
  • View abstract

    Summary

    This chapter discusses the risk of embryo-fetal irradiation during pregnancy. In pregnant patients undergoing radionuclide examinations, radiation may reach the embryo-fetus by means of the penetrating gamma rays and X-rays emitted by radionuclides concentrated in maternal organs or the placenta, or by radionuclides taken up by the fetus after they cross the placenta. Physicians faced with a pregnant woman who requires radiation therapy for cancer may be inclined to advocate abortion for fear of possible injury to the fetus. The chapter also discusses specific cancers complicating pregnancy that may require radiation therapy. These cancers are usually divided into extrapelvic and pelvic. The chapter describes the most common types: breast cancer, Hodgkin's disease (extrapelvic), and cervical cancer (pelvic). Radiation exposure has been shown to increase the risk of cancers in both adult and children.
  • Chapter 23 - Breast cancer and pregnancy: critical review of the effects of prior and subsequent pregnancy on the prognosis of young women with breast tumor
    pp 189-194
  • View abstract

    Summary

    This chapter reviews the current information and controversies regarding different aspects of the administration of chemotherapy during pregnancy. It also reviews the available experience with the most common anticancer regimens as well as each chemotherapeutic agent. Chemotherapy during the first trimester may increase the risk of spontaneous abortions, fetal death, and major congenital malformations. The teratogenic effects depend on the dosage, time of administration, and cumulative exposure to the chemotherapeutic agent. The choice of treatment for the pregnant patient with cancer has become even more complicated due to the increasing use of targeted anticancer therapies. J. I. Durodola reported that an infant that had received cyclophosphmide became neutropenic from breastfeeding. The chapter summarizes the important reports concerning different cytotoxic agents, and presents each medication according to its pharmacological group and time of publication. The chapter also provides a brief description of the study and the pregnancy outcome.
  • Chapter 24 - Effects of the placenta on metastatic breast cancer
    pp 195-205
  • View abstract

    Summary

    This chapter summarizes current data on the maternal and fetal effects of nonobstetrical surgeries during pregnancy, including anesthesia, diagnostic and therapeutic management, laparoscopy, and the common general surgical pathologies found in the pregnant patient. Changes in maternal physiology during pregnancy due to gestational hormones and mechanical effects of the increasingly gravid uterus have an impact on anesthesia during nonobstetrical surgery. The American College for Obstetrics and Gynecology (ACOG) concluded that although there are no data to support specific recommendations for nonobstetrical surgery and anesthesia in pregnancy, it is important for physicians to obtain obstetric consultation before surgery. The fetal loss rate is significantly greater for pregnant patients undergoing appendectomy when compared to other surgical procedures during pregnancy. Laparoscopic management of adnexal masses in pregnancy is a safe and effective procedure compared to traditional surgery.

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