Onkologie. 2015:9(4):195-198

Malignant diseases in pregnancy

Aleš Roztočil

Gynekologicko &ndash, porodnické oddělení, Nemocnice Jihlava

The coincidence of malignant disease and pregnangy is not a current situation, but is not rare. These cases are no more casuistic, but at present,

there are groups of these patients published. The frequency of malignit diseases in pregnancy depends of the quality of data collections in

a defined population. Only very approximatively we can state, that in our euroatlantic conditions and medical care, one malignat disease is

diagnosed in 1 000 pregnants. Because of such a low frequency and the fact, that the symptoms of a malignant disease are often attribuated

to pregnancy changes, or are covered by them, the diagnosis is done in pregnants later than in non pregnant women. The mean age of pregnant

women becomes higher. Tumor growth is characteristic for higher age. Thus we can suppose in the future the rise of the coincidence ot these

two states. The most frequent tumors in pregnancy are malignant melanoma, breast, cervical and ovarian cancers, lymphomas and leukemia.

There is only one screening method in pregnancy: the cervical cancer by means of PAP smears and colposcopy. The diagnostics of other

tumors depends on autodiagnosis of the women or on the diagnostic skills of the obstetrician. The oncologic diagnosis in pregnancy doesn´t

differ from non pregnant wonem. In some organs and tumors it is more difficult in pregnancy. Tumor markers are elevated in pregnancy, the

breast density is increased and the pregnancy induces cervical canges similar to neoplasia. The oncologic treatment of pregnant poses a lot

of problems, but must be as efficace as in non pregnant state. The treatment must be tailored for each patient. We must take in an account the

type and the stage of the tumor, the desire of the women to continue the pregnancy, the risks and the modification of the treatment and the

posibility of it´s postponing after the delivery or at least the viability of the fetus. The surgery is diagnostic, staging and curative. If it doesn´t

touch reproductive organs of the patient, it is well tolerated by the woman as by the foetus. The surgery may take place even in the first trimester.

Diagnostic ionisation doses are minimal and have no negative impact on foetal developpment. Newertheless we prefer US and MRI to rtg and

CT. Radiotherapy may cause severe foetal dammage. This is influenced by the dosis, type of the tissue and the magnitude of the field influenced

by the ionisation. It may cause the cellular death, cancerogenesis and genetic influence, foetal hypotrophia, microcephalia and mental

retardation. Abdominal radiotherapy in pregnancy is contraindicated. In pregnancy only adiuvant chemotherapy is used. Due to it´s negative

side effects on the foetus like intrauterine death, malformations, growth retardation, the malignant growth in the future, there is a tendency

if possible to eliminate chemotherapy during the pregnancy or at least to apply it after the first trimester. Because of the high concentration

of chemotherapeutics in maternal milk, the breastfeeding is contraindicated during the chemotherapy

Keywords: malignant tumors, oncology, pregnancy, surgery, chemotherapy, radiotherapy

Published: September 18, 2015  Show citation