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The words cancer and reproduction conjure images of the human circle: death and the beginning of life itself. Both of these areas are very broad, encompassing the complexity of cancer and its varied biology, and the equally challenging areas of fertility, conception and pregnancy. While cancer afflicts primarily the elderly, it also occurs in younger age groups, with different implications specifically relating to reproduction. An even rarer situation is cancer occurring within pregnancy itself, although with more women delaying having a family this is becoming more common.
This book is derived from the 55th RCOG study group, which brought together acknowledged experts in cancer and human reproduction to address these issues. The sequelae of cancer and therapy in young women, the impact on fertility, and newer methods of fertility preservation through ovarian cryopreservation or adjusting standard surgical techniques are all included. The book also covers the incidence of cancer in pregnancy, how and when to intervene, how diagnostic tools are more limited or less accurate, and how therapies may affect the pregnant mother and fetus. Specific attention is focused on the more common cancers, the gynaecological cancers and placental tumours. As more recent evidence revealed the association between LLETZ and preterm labour, it seemed logical to include management of precancer cervical lesions pertaining to pregnancy.
While cancer affects primarily the elderly, it also occurs in younger age groups, with different implications specifically relating to reproduction. Cancer can also occur during pregnancy itself. This brings together two diverse areas of medicine, encompassing the complexity of cancer and its varied biology and the equally challenging areas of fertility, conception and pregnancy. The 55th RCOG Study Group brought together a range of experts to examine these issues. This book presents the findings of the Study Group, with sections covering:• epidemiology, genetics and basic principles of chemotherapy and radiotherapy• fertility issues and paediatric cancers• gynaecological cancers and precancer• diagnostic dilemmas• the placenta• non-gynaecological cancers• multidisciplinary care and service provision.
The widespread use of ultrasound in the first trimester for dating and for viability and nuchal fold assessment has increased the detection of ovarian masses. The use of high-frequency transvaginal probes has allowed the detailed imaging of cystic pelvic masses. Cervical and ovarian cancers are the gynaecological malignancies most frequently diagnosed in pregnancy. Most non-benign ovarian cysts found in pregnancy are borderline tumours or germ cell tumours. Ultrasound imaging of ovarian cysts or masses is helpful in identifying lesions that are of a suspicious nature. A significant proportion of germ cell tumours in pregnancy are dysgerminomas. Presentation and diagnosis at an early stage of pregnancy does not always warrant termination of pregnancy as there are several reports of uneventful term pregnancies despite administration of chemotherapy. If malignancy is suspected, a full staging laparotomy is needed either immediately or after delivery.
This chapter presents the consensus views arising from the 55th study group of cancer and reproductive health. A national cancer and pregnancy database should be developed to include data regarding the outcome of all cases of multiple pregnancies where there is a hydatidiform mole and a normal fetus. Further research into the pharmacokinetics of chemotherapeutic agents during pregnancy and lactation, and the effects on placenta, fetus and infant, is required. Guidelines should be developed for the use of frozen sections in pregnancy or otherwise. National standards of care and pathways should be produced to address the unique needs of cancer patients with regard to rapid access to fertility care. All cancer multidisciplinary teams should consider the possible consequences of cancer treatment for fertility and reproductive health. All molar pregnancies should be registered with the one of the three UK National Trophoblast Centres for follow-up.