BACKGROUND

• Counseling must balance risk to fetus of Rx & prematurity against the risk to mother of delaying Rx

• Most common malignancies of young: breast, lymphoma, leukemia, melanoma, colon, ovary, thyroid

DIAGNOSIS

History

• Sx specific to malignancy

Physical examination

• Note possible metastases (including lymph nodes)

Diagnostic tests

• Laboratory tests: check baseline hepatic, renal function

• Specific diagnostic tests: if indicated, check tumor marker

• Imaging tests: as indicated

DIFFERENTIAL DIAGNOSIS

• Specific for malignancy under Rx

COMPLICATIONS

• Maternal complications: depend on specific malignancy

• Fetal complications: iatrogenic prematurity, metastases to fetus (rare, only w/ melanoma)

PROGNOSIS

• Pregnancy does not appear to worsen outcome or disease progression

MANAGEMENT

General measures

• Multidisciplinary approach

• If a realistic chance of cure or significant prolongation of survival of mother, pregnancy should not delay Rx; if cure unrealistic, Rx should minimize effects to fetus

Specific treatment

• Consider pregnancy termination if excessive exposure to chemotherapeutic agents or radiation anticipated in early pregnancy

Side effects & complications of treatment

• Effects of chemotherapy depend on drug, dose/duration of Rx, gestational age: (1) in 1st trimester, teratogenicity ∼6% w/ single agent, 90–100% w/ folate antagonists; (2) in 2nd/3rd trimesters, no evidence of structural injury or developmental delay, but data limited

• Effects of radiation depend on type, dose/duration, gestational age: (1) in 1st trimester, 0.5–1 Gy (5–10 rad) may cause abortion; (2) at 3–10 wk, >50% of fetuses exposed to >2.5 Gy have mental retardation, microcephaly, retinal degeneration, cataracts, skeletal abnormalities, intrauterine growth restriction; (3) at 12–20 wk, may cause intrauterine growth restriction, microcephaly, mental retardation; (4) >20 wk, no anomalies

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