Special Issues in Pregnancy
Summary of Key Points
• Cancer complicates 1 in 1000 pregnancies; the most common malignancies in pregnant women are breast, uterine, and cervical cancer, lymphoma, and melanoma.
• No evidence exists that pregnancy alters the clinical behavior of cancer, but cancer often is advanced at diagnosis because of the overlap of symptoms with those of a normal pregnancy.
• Important factors in management include assessment of gestational age, maternal staging with limited exposure to ionizing radiation, the urgency of therapy, and the impact of therapy on maternal prognosis and fetal outcome.
• Physiological changes in pregnancy affect the metabolism of chemotherapy drugs, but few practical guidelines exist about how dosing should be adjusted to take this factor into account.
• Alkylators and antimetabolites should be avoided in the first trimester, but these agents and other cytotoxic drugs are generally not contraindicated (with the possible exceptions of methotrexate and hydroxyurea) in the second and third trimesters.
• The scheduling of chemotherapy should be planned to minimize the risk of complications at the time of delivery.
• No evidence exists that exposure to chemotherapy results in long-term adverse effects on physical or intellectual development, and surviving children have no increased risk of malignancy.
• Therapeutic radiation jeopardizes fetal outcome and should be reserved for the postpartum period whenever possible.
• Subsequent pregnancy after cancer diagnosis and treatment is usually possible.
