Cancer in pregnancyIt is estimated that cancer in one of every 1,000 pregnant women is diagnosed. It is possible that this frequency will grow in the future as women delay the age at which get pregnant.
The occurrence of cancer in a pregnant woman is a process with unique characteristics, because the same person occurs in a controlled growth of the fetus and its placenta along with an uncontrolled growth of a malignancy that can influence the life of the mother and the fetus. In addition, usually in a pregnant cancer tends to be more advanced than in women of the same age who are not.
For the patient and the doctor presents a dilemma: If the treatment is delayed to not harm the fetus is likely to endanger the life of the mother; If it is just reaching the diagnosis the son's life risks. In addition, there are other problems, such as difficulties in diagnosis and in the study of the spread of cancer, the effect of the treatment on future pregnancies, or ethical problems in the mother or health professionals. Thus, the management of these patients is complicated and must be customized.
Most frequent types of cancer during pregnancy
Of all cancers that occur during pregnancy, one in four are breast cancers. Approximately at the same frequency is cancer of the cervix. The following two types of cancer most frequently are derived from blood cells and are leukemias (15% of cancer in pregnant women) and lymphomas (10%). 8% of cancers are melanomas, which is a type of cancer that begins in the skin, and 4% are thyroid cancers.
Diagnosis of cancer in pregnant women
The diagnostic and therapeutic management of cancer during pregnancy is especially difficult, because it involves two people: the mother and the child.
Many times the tumor is detected late in pregnancy. This is because the symptoms of cancer may be masked by symptoms of pregnancy, such as e.g. nausea, breast augmentation, genital bleeding in the first trimester, etc.
In addition, changes in the anatomy of women during pregnancy may confuse the doctor during the physical examination, for example when it carries out exploration of moms.
Finally, during the pregnancy are elevated in the blood, normal form, some markers that indicate inflammation and some tumor markers, which may delay the diagnosis of the enfermedad.cd
Some techniques that help the diagnosis are safe and do not involve damage to the fetus as a cervical cytology (for cervical cancer), mammography (for breast cancer), abdominal ultrasound (to ovarian cancer) or blood (for leukemias) analytics. However, there are other techniques such as computed tomography (CT), nuclear medicine studies, in which radioactive substances are used, iodinated contrast radiographs..., they can be harmful to embryo and try to not be performed.
Therefore, the diagnosis is difficult and often the treatment proposed is based on incomplete information on the disease.
How to treat cancer during pregnancy
Regarding the therapeutic management of cancer during pregnancy, obstetricians and oncologists are concentrated in offer optimal treatment for mother at the same time and hold the maximum time needed for fetal well-being, which may be essential for the mother may be, on the other hand, very harmful or even fatal to the fetus. For a woman with a diagnosis of cancer, wait 40 weeks can be a death sentence, especially if it is an aggressive cancer, or if there are metastases.
As well, several factors are valued in the handling of these cases:
- The type of cancer, their Stadium (extension of the tumor) and its prognosis.
- The weeks of gestation to diagnosis and fetal viability.
- Possible adverse effects of the treatment in the fetus.
- Risks to the mother of delayed therapy.
- Risk to the fetus if do need to induce a premature delivery.
- Delaying treatment until the child can be born safely. In this case would have to quantify the risk that this entails for the mother and also assume that the mother will have to take care of a premature infant, that he may also have sequels while she faces the side effects of his cancer treatment. This option is more feasible the more advanced pregnancy and earlier is cancer.
- Terminate the pregnancy to start treatment as soon as possible. It is the option safer for the mother, but also unacceptable for many of them. It is most dyed into account longer is early pregnancy.
- Treat cancer as effectively as possible while continues with the pregnancy, trying to minimize the risks to the fetus. It is the most accepted choice.
In addition to late diagnosis, chemotherapy and radiation are harmful to the fetus.
Breastfeeding is contraindicated in patients who are being subjected to chemotherapy
The effects of radiation on the fetus are varied depending on the weeks of gestation: before 10 weeks it may be lethal, until week 16 can cause mental retardation, retardation of growth, and from six months until the birth can cause sterility, malignant tumors or genetic alterations. Therefore, generally radiotherapy is contraindicated, although occasionally used above the diaphragm with abdominal protection, especially at the end of the pregnancy.
The problem with chemotherapy is almost all drugs that are used to cross the placenta and reach the fetus. These drugs they do is inhibit cell division so the tumor does not grow, and this is a risk for fetal development. A: associated chemotherapy during pregnancy, miscarriage, malformations, genetic mutations, tumors and delay development. If the pregnancy finally reach its term, breastfeeding is contraindicated for patients who are being subjected to chemotherapy.
If the treatment includes surgery, It is usually well-tolerated, provided it does not affect the genital tract.
Breast cancer and pregnancy
Within all cancers during gestation, we must make special mention to breast cancer, because it is the most frequent. It is estimated that breast cancer takes place in one of every 3,000-10,000 women pregnant or postpartum women. 10% of patients with breast cancer are under 40 years of age and pregnant to the diagnosis. 3% of breast cancers are associated with pregnancy. Its prevalence figures include cancers that appear during pregnancy and those that occur up to one year after childbirth.
As we have seen, diagnosis is often delayed, because the physiological changes that occur in the breast can hide small tumors. To help the diagnosis, suspected breast cancer, a mammogram and an ultrasound can be done. A suspicious lesion thick needle biopsy may also be done. MRI is contraindicated during pregnancy, although it may be done in the postnatal period.
When you start the treatment, fetal development should be evaluated to decide when to end the pregnancy. After the birth, could not be breastfeeding while mother is in treatment with radiotherapy or chemotherapy. Yes it is possible by the healthy breast lactation when the treatment is completed.
Following pregnancy not should be planned until after at least two years after treatment of breast cancer, as a new pregnancy could increase the risk of relapse (reappearance of the tumor).
Overall survival at 5 years is 70%, although it depends on the spread of the disease. It is important to know that pregnancy does not alter the prognosis of breast cancer.
Preservation of fertility after cancer
One of the problems that arise in the management of cancer in women in fertile age is that many of the treatments of the disease may prevent future pregnancies by natural.
You should not be maintained intact reproductive system of the mother, there are various techniques to preserve their fertility. Different techniques depends on the type of tumor and the time available until the oncologist to start cancer treatment.
There are several options to achieve the preservation of fertility after cancer:
- They vitrification oocytes of the woman or, in case of a couple, can can vitrify embryos. Vitrification is a special form of freezing allowing the pregnancy of women through the implementation of the oocytes or fertilized embryos when the disease has passed. The problem is that they need 2-3 weeks to stimulate the ovaries with hormones before collecting the oocytes. This can delay the start of chemotherapy. In addition, this technique is contraindicated when the tumors are sensitive to the hormones that are given to stimulate the ovaries.
- It can Remove and woven to cryopreserve ovarian. After the cure of the disease this tissue may placement instead of origin, what can get the ovaries to recover its natural functions.
- With surgery change the location of the ovaries can be so radiation therapy do not damage them.
- Administer a drug to inactive ovaries can also be during the treatment and thus damage as little as possible.