Pregnant cancer patients can be treated without harming fetus

By Paula Moyers

NEW YORK (Reuters Health) – Pregnant patients with cancer symptoms need to be diagnosed and treated promptly, without either terminating the pregnancy or waiting for delivery, according to Dr. Elyce Cardonick, speaking at the 22nd annual meeting of the Society for Maternal-Fetal Medicine in New Orleans.

In a prospective study that tracked maternal and neonatal outcomes after the mothers received cancer chemotherapy during pregnancy, Dr. Cardonick and her colleagues found no increase in preterm delivery or growth restriction.

In a second prospective study, they found that infants exposed to chemotherapy after the first trimester were not at risk of preterm delivery, low birth weight, neutropenia, alopecia, myocarditis, or rashes.

"The majority of cancers are not worsened by pregnancy, although the treatment is more complicated," Dr. Cardonick told Reuters Health. "Also, the majority of cancers are not improved by termination of pregnancy." Dr. Cardonick is an assistant professor of maternal-fetal medicine at Thomas Jefferson Medical College in Philadelphia.

"The problem with cancer in pregnancy is that the patient is afraid, and the physician is afraid, too," she said. "Therefore, diagnosis is delayed and the condition worsens. It's not the pregnancy that makes the cancer worse. It's the delay in diagnosis and treatment."

Another dilemma is that some of the common occurrences of pregnancy, such as constipation, fatigue, and anemia, would cause suspicion of cancer if the patient were not pregnant.

The first study included 42 pregnant cancer patients: 18 with breast cancer and 4 each with melanoma, and tumors of the thyroid and central nervous system, respectively. Other cancers included Hodgkin's lymphoma, leukemia, and cancers originating in the ovaries, lung, vulva, cervix, and bladder.

At diagnosis the mean gestational age was 17.2 weeks. Of the six women advised to terminate pregnancies, four did so. Among the remaining patients, four had preterm deliveries. Two women were induced at 31 and 32 weeks, respectively, to avoid fetal exposure to cancer treatment, one was induced at 35 weeks because of pre-eclampsia, and one spontaneously delivered twins at 29 weeks. The infants' mean birth weight was 2798 g, with two below the 10th percentile for gestational age.

The second study include 18 pregnant patients undergoing chemotherapy. The mean gestational age at cancer diagnosis was 15.8 weeks. All patients were treated after the first trimester; no patients underwent radiation therapy.

The only fetal malformation occurred in an infant who was born with syndactyly of the right hand. The child had been exposed to multi-agent chemotherapy regimen at 14.6 weeks gestation while the mother was being treated for Hodgkin's lymphoma.

The only pregnancy complication was uterine contractions due to dehydration; this complication did not result in delivery. The infants' mean gestation age at time of delivery was 36.9 weeks; the mean birth weight was 2742 g. One infant's birth weight was below the 10th percentile for gestational age.

"If the fetus is 12 weeks or older, you can give chemotherapy without an increased risk of birth defects, mental retardation, or compromise in immune function," Dr. Cardonick told Reuters Health. "There are several diagnostic procedures that are safe to perform at that point in pregnancy, such as mammography and biopsies of several types of tissue

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