Malignancy and pregnancy

doi:10.1017/CBO9780511544552.022

21 - Malignancy and pregnancy

from Section 5 - Other disorders

Published online by Cambridge University Press: 19 October 2009

Holly A. Muir ,

Michael Smith and

David R. Gambling

Edited by

David R. Gambling ,

M. Joanne Douglas and

Robert S. F. McKay

Show author details

Holly A. Muir: Affiliation:
Vice Chair, Clinical Operations Department of Anesthesiology, Duke University, Medical Center, Durham, North Carolina, USA; Chief, Division of Women's Anesthesia
Michael Smith: Affiliation:
Chief Resident in Anesthesiology, Department of Anaesthesiology, University of Kansas, School of Medicine – Wichita, Wichita, KS, USA
David R. Gambling: Affiliation:
Clinical Associate Professor, Department Anesthesiology, University of California, San Diego, CA USA; Staff Anesthesiologist, Sharp Mary Birch Hospital for Women
David R. Gambling: Affiliation:
University of California, San Diego
M. Joanne Douglas: Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay: Affiliation:
University of Kansas

Book contents

Get access

Summary

Introduction

Malignancy complicates between 0.02% and 0.10% of all pregnancies and in one study cancer diagnosis was associated with 1 in 1000 deliveries. Pregnancy does not affect the frequency of cancers seen in women of childbearing age. Melanoma may be the most frequent malignancy seen during pregnancy (1:350), followed by cervical cancer (1:2250), Hodgkin lymphoma (1:3000), breast cancer (1:7500), ovarian cancer (1:18,000), and leukemia (1:75,000). However, the National Cancer Institute maintains that breast cancer is the most common cancer seen in pregnant and postpartum women at 1:3000 pregnancies (www.cancer.gov/cancertopics/pdq/treatment/breast-cancer-and-pregnancy).

In general, the prognosis for pregnant women with malignant lesions is the same, stage for stage, as for nonpregnant women. However, for many reasons, diagnosis of cancer during pregnancy occurs at more advanced stages of the disease.

Typically, during pregnancy, what benefits the mother also benefits the fetus. However, that is not true in the case of the pregnant woman with cancer as treating the cancer often means compromising the pregnancy. Depending on the type of cancer and gestational age at diagnosis, treatment can sometimes be delayed until the fetus is either viable or mature. In some cases, protection of maternal and fetal health are congruent, but when care of the mother imposes iatrogenic risk to the fetus, the mother may decide to delay or alter her treatment for the good of the fetus, potentially to her own detriment.

Fetal monitoring

Fetal and uterine monitoring during cancer surgery is controversial.

Type: Chapter
Information: Obstetric Anesthesia and Uncommon Disorders , pp. 371 - 380

DOI: https://doi.org/10.1017/CBO9780511544552.022 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Smith, L. H., Danielsen, B., Allen, M. E. & Cress, R.Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am. J. Obstet. Gynecol. 2003; 189: 1128–35.Google Scholar

Cunningham, F. G., Hauth, J. C., Leveno, K. J.et al. (eds). Chapter 57: Neoplastic diseases. In Williams Obstetrics, 22nd ed. New York: McGraw Hill, 2005.

Rosen, M. A.Management of anesthesia for the pregnant surgical patient. Clinical concepts and commentary. Anesthesiology 1999; 91: 1159.Google Scholar

Berry, D. L., Theriault, R. L., Holmes, F. A.et al. Management of breast cancer during pregnancy using a standardized protocol. J. Clin. Oncol. 1999; 17: 855–61.Google Scholar

Weisz, B., Schiff, E. & Lishner, M.Cancer in pregnancy: maternal and fetal implications. Hum. Reprod. Update 2001; 7: 384–93.Google Scholar

Eedarapalli, P. & Jain, S.Breast cancer in pregnancy. J. Obstet. Gynaecol. 2006; 26: 1–4.Google Scholar

Nettleton, J., Long, J., Kuban, D.et al. Breast cancer during pregnancy: quantifying the risk of treatment delay. Obstet. Gynecol. 1996; 87: 414–18.Google Scholar

Gallenberg, M. M. & Loprinzi, C. L.Breast cancer and pregnancy. Semin. Oncol. 1989; 16: 369–76.Google Scholar

Carlson, R. W., Brown, E., Burstein, H. J.et al. for the National Comprehensive Cancer Network. NCCN Task Force Report: Adjuvant Therapy for Breast Cancer. J. Natl. Compr. Canc. Netw. 2006; 4: S1–26.Google Scholar

Marchant, D. J.Breast cancer in pregnancy. Clin. Obstet.Gynecol. 1994; 37: 993–7.Google Scholar

Hebl, J. R., Horlocker, T. T. & Pritchard, D. J.Diffuse brachial plexopathy after interscalene blockade in a patient receiving cisplatin chemotherapy: the pharmacologic double crush syndrome. Anesth. Analg. 2001; 92: 249–51.Google Scholar

Burrows, F. A., Hickey, P. R. & Colan, S.Perioperative complications in patients with anthracycline chemotherapeutic agents. Can. Anaesth. Soc. J. 1985; 32: 149–57.Google Scholar

Buvanendran, A., Mohajer, P., Pombar, X. & Tuman, K. J.Perioperative management with epidural anesthesia for a parturient with superior vena caval obstruction. Anesth. Analg. 2004; 98: 1160–3.Google Scholar

Stamatiou, G., Athanasiou, E., Simeoforidou, M., Bakos, P. & Michaloudis, D.Thoracic paravertebral block for breast surgery. Anaesthesia 2004; 59: 723–4.Google Scholar

Muller, C. Y. & Smith, H. O.Cervical neoplasia complicating pregnancy. Obstet. Gynecol. Clin. North Am. 2005; 32: 533–46.Google Scholar

Sood, A. K. & Sorosky, J. I.Invasive cervical cancer complicating pregnancy. How to manage the dilemma. Obstet. Gynecol. Clin. North Am. 1998; 25: 343–52.Google Scholar

Kyrgious, M., Koliopoulos, G., Martin-Hirsch, P.et al. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 2006; 367: 489–98.Google Scholar

Stan, C., Megevand, E., Irion, O.et al. Cervical cancer in pregnant women: laparoscopic evaluation before delaying treatment. Eur. J. Gynaecol. Oncol. 2005; 26: 649–50.Google Scholar

Duggan, B., Muderspach, L. I., Roman, L. D.et al. Cervical cancer in pregnancy: reporting on planned delay in therapy. Obstet. Gynecol. 1993; 82: 598–602.Google Scholar

Ungar, L., Smith, J. R., Palfalvi, L. & Del Priore, G.Abdominal radical trachelectomy during pregnancy to preserve pregnancy and fertility. Obstet. Gynecol. 2006; 108: 811–14.Google Scholar

Kay, T. A., Renninson, J. N., Shepherd, J. H. & Taylor, M. J.Successful pregnancy following radical trachelectomy and in vitro fertilization with ovum donation. Br. J. Obstet. Gynaecol. 2006; 113: 965–6.Google Scholar

Vange, N., Weverling, G. J., Ketting, B. W.et al. The prognosis of cervical cancer associated with pregnancy: a matched cohort study. Obstet. Gynecol. 1995; 85: 1022–6.Google Scholar

O'Rourke, N. & Kodali, B. S.Laparoscopic surgery during pregnancy. Curr. Opin. Anaesthesiol. 2006; 19: 254–9.Google Scholar

Leiserowitz, G. S., Xing, G., Cress, R.et al. Adnexal masses in pregnancy: how often are they malignant?Gynecol. Oncol. 2006; 101: 315–21.Google Scholar

Bandera, C. A.Advances in the understanding of risk factors for ovarian cancer. J. Reprod. Med. 2005; 50: 399–406.Google Scholar

Schmeler, K. M., Mayo-Smith, W. W., Peipert, J. F.et al. Adnexal masses in pregnancy: surgery compared with observation. Obstet. Gynecol. 2005; 105: 1098–103.Google Scholar

Giuntoli, R. L. 2nd, Vang, R. S. & Bristow, R. E.Evaluation and management of adnexal masses during pregnancy. Clin. Obstet. Gynecol. 2006; 49: 492–505.Google Scholar

Leiserowitz, G. S.Managing ovarian masses during pregnancy. Obstet. Gynecol. Surv. 2006; 61: 463–70.Google Scholar

Nishio, S., Ushijima, K., Fukui, A.et al. Fertility-preserving treatment for patients with malignant germ cell tumors of the ovary. J. Obstet. Gynaecol. Res. 2006; 32: 416–21.Google Scholar

Mantovani, G., Mais, V., Parodo, G.et al. Use of chemotherapy for ovarian cancer during human pregnancy: case report and literature review. Eur. J. Obstet. Gynecol. Reprod. Biol. 2007; 131: 238–9.Google Scholar

Han, J. Y., Nava-Ocampo, A. A., Kim, T. J., Shim, J. U. & Park, C. T.Pregnancy outcome after prenatal exposure to bleomycin, etoposide and cisplatin for malignant ovarian germ cell tumors: report of 2 cases. Reprod. Toxicol. 2005; 19: 557–61.Google Scholar

Patterson, D. M. & Rustin, G. J.Controversies in the management of germ cell tumors of the ovary. Curr. Opin. Oncol. 2006; 18: 500–6.Google Scholar

Mathevet, P., Nessah, K., Dargent, D. & Mellier, G.Laparoscopic management of adnexal masses in pregnancy: a case series. Eur. J. Obstet. Gynecol. Reprod. Biol. 2003; 108: 217–22.Google Scholar

Tanaka, H., Futamura, N., Takubo, S. & Toyoda, N.Gasless laparoscopy under epidural anesthesia for adnexal cysts during pregnancy. J. Reprod. Med. 1999; 44: 929–32.Google Scholar

Sivanesaratnam, V.Management of the pregnant mother with malignant conditions. Curr. Opin. Obstet. Gynecol. 2001; 13: 121–5.Google Scholar

Park, J. C., Cho, C. H. & Rhee, J. H.A successful live birth through in vitro fertilization program after conservative treatment of FIGO grade 1 endometrial cancer. J. Korean Med. Sci. 2006; 21: 567–71.Google Scholar

Sparac, V., Ujevic, B., Ujevic, M.et al. Successful pregnancy after hysteroscopic removal of grade 1 endometrial carcinoma in a young woman with Lynch syndrome. Int. J. Gynecol. Cancer 2006; 16: 442–5.Google Scholar

Ferrandina, G., Zannoni, G. F., Gallotta, V.et al. Progression of conservatively treated endometrial carcinoma after full term pregnancy: a case report. Gynecol. Oncol. 2005; 99: 215–17.Google Scholar

Ogunleye, D., Lewin, S. N., Huettner, P. & Herzog, T. J.Recurrent vulvar carcinoma in pregnancy. Gynecol. Oncol. 2004; 95: 400–1.Google Scholar

Gitsch, G., Eijkeren, M. & Hacker, N. F.Surgical therapy of vulvar cancer in pregnancy. Gynecol. Oncol. 1995; 56: 312–15.Google Scholar

Bradley, P. J. & Raghavan, U.Cancers presenting in the head and neck during pregnancy. Curr. Opin. Otolaryngol. Head Neck Surg. 2004; 12: 76–81.Google Scholar

Lao, T.Thyroid disorders in pregnancy. Clin. Opin. Obstet. Gynecol. 2005; 17: 123–7.Google Scholar

Layton, S. A., Rintoul, M. & Avery, B. S.Oral carcinoma in pregnancy. Br. J. Oral Maxillofac. Surg. 1992; 30: 161–4.Google Scholar

Ferlito, A., Devaney, S. L., Carbone, A.et al. Pregnancy and malignant neoplasms of the head and neck. Ann. Otol. Rhinol. Laryngol. 1998, 107: 991–8.Google Scholar

Yasmeen, S., Cress, R., Romano, P. S.et al. Thyroid cancer in pregnancy. Int. J. Gynaecol. Obstet. 2005; 91: 15–20.Google Scholar

Reddy, S. P., Mohideen, N., Marra, S. & Marks, J. E.Effect of tumor bulk on local control and survival of patients with T1 glottic cancer. Radiother. Oncol. 1998; 47: 161–6.Google Scholar

Tewari, K. S., Cappuccini, F., Asrat, T.et al. Obstetric emergencies precipitated by malignant brain tumors. Am. J. Obstet. Gynecol. 2000; 182: 1215–21.Google Scholar

Stevenson, C. B. & Thompson, R. C.The clinical management of intracranial neoplasms in pregnancy. Clin. Obstet. Gynecol. 2005; 48: 24–37.Google Scholar

Giannini, A. & Bricchi, M.Posterior fossa surgery in the sitting position in a pregnant patient with cerebellopontine angle meningioma. Br. J. Anaesth. 1999; 82: 941–4.Google Scholar

Balki, M. & Manninen, P. H.Craniotomy for suprasellar meningioma in a 28-week pregnant woman without fetal heart rate monitoring. Can. J. Anaesth. 2004; 51: 573–6.Google Scholar

Smith, I. F. & Skelton, V.An unusual intracranial tumour presenting in pregnancy. Int. J. Obstet. Anesth. 2007; 16: 82–5.Google Scholar

Smith, H. O., Kohorn, E. & Cole, L. A.Choriocarcinoma and gestational trophoblastic disease. Obstet. Gynecol. Clin. North Am. 2005; 32: 661–84.Google Scholar

Smith, H. O., Hilgers, R. D., Bedrick, E. J.et al. Ethnic differences in risk for gestational trophoblastic disease in New Mexico: a 25-year population-based study. Am. J. Obstet. Gynecol. 2003; 188: 357–66.Google Scholar

Bristow, R., Shumway, J., Khouzami, A. & Witter, F.Complete hydatidiform mole and surviving coexistent twin. Obstet. Gynecol. Surv. 1996; 51: 705–9.Google Scholar

Lewis, J. L. Jr. Diagnosis and management of gestational trophoblastic disease. Cancer 1993; 71: 1639–47.Google Scholar

Kendall, A., Gillmore, R. & Newlands, E.Chemotherapy for trophoblastic disease: current standards. Curr. Opinion Obstet. Gynecol. 2002; 14: 33–8.Google Scholar

Kohorn, E. I.The new FIGO 2000 staging and risk factor scoring system for gestational trophoblastic disease: description and critical assessment. Int. J. Gynecol. Cancer 2001; 11: 73–7.Google Scholar

Benedet, J. L., Bender, H., Jones, H. 3rd. Ngan, H. Y. S. & Pecorelli, S.Staging classifications and clinical practice guidelines of gynaecologic cancers. FIGO Committee on Gynecologic Oncology. Int. J. Gynecol. Obstet. 2000; 70: 207–312.Google Scholar

Xue, Y., Zhang, J., Wu, T. X. & An, R. F.Combination chemotherapy for high-risk gestational trophoblastic tumour. Cochrane Database Syst. Rev. 2006; 19: CD005196.Google Scholar

Seckl, M. J. & Newlands, E. S., Treatment of gestational trophoblastic disease. Gen. Diagn. Pathol. 1997; 143: 159–71.Google Scholar

Solak, M. & Akturk, G.Spinal anesthesia in a patient with hyperthyroidism due to hydatidiform mole. Anesth. Analg. 1993; 77: 851–2.Google Scholar

Soper, J.Gestational trophoblastic disease. Obstet. Gynecol. 2006; 108: 176–87.Google Scholar

Kvolik, S., Glavas-Obrovac, L., Sakic, K.et al. Anaesthetic implications of anticancer chemotherapy. Eur. J. Anaesthesiol. 2003; 20: 859–71.Google Scholar

Burlacu, C. L., Fitzpatrick, C. & Carey, M.Anaesthesia for caesarean section in a woman with lung cancer: case report and review. Int. J. Obstet. Anesth. 2007; 16: 50–62.Google Scholar

Jackisch, C., Louwen, F., Schwenkhagen, A.et al. Lung cancer during pregnancy involving the products of conception and a review of the literature. Arch. Gynecol. Obstet. 2003; 268: 69–77.Google Scholar

Bahador, A., Lowe, M. P., Cheng, J. & Roman L. D. Gynecologic cancer in pregnancy. In Gershenson, D. M., McGuire, W. P., Gore, M., Quinn, M. A. & Thomas, G. (eds.), Gynecologic Cancer. Livingstone, Philadelphia: Elsevier Churchill, 2004.