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Malignant disease in pregnancy 

Malignant disease in pregnancy

Chapter:
Malignant disease in pregnancy
Author(s):

Robin A.F. Crawford

DOI:
10.1093/med/9780199204854.003.1417

February 27, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 27 April 2017

Cancer in pregnancy is rare, affecting less than 1 in 1000 live births. It may be specific to pregnancy (gestational trophoblastic disease) or incidental to it, the less infrequent conditions being melanoma, lymphoma, and cervical malignancy.

Malignant disease particular to pregnancy

Gestational trophoblastic disease—a group of conditions that arise in the fetal chorion during various types of pregnancy: histologically they are categorized as (1) partial or complete hydatidiform mole, (2) gestational choriocarcinoma, or (3) placental site trophoblastic tumour. The most common of these conditions is molar pregnancy, when villi are present in association with malignant trophoblast in gestational choriocarcinoma.

Any woman of reproductive age who has an undiagnosed tumour or unexplained bleeding from any organ other than the uterus should have a human chorionic gonadotrophin estimation to exclude highly treatable gestational trophoblastic disease.

General aspects of management during pregnancy

Consideration must be given both to the mother who is affected and the unborn fetus, with the balance of care favouring the mother’s well-being.

Anaesthesia and extra-abdominal surgery—these rarely carry any risks to the fetus, and intra-abdominal surgery may be safely carried out in the second trimester.

Exposure to ionizing radiation—during the first trimester this can increase the risk of fetal abnormalities and childhood cancers. The dose of radiation, the gestational age of the fetus, and the practicability of shielding the fetus from radiation must be balanced against potential benefits to the mother.

Chemotherapy—administration during the first trimester carries risks that include abortion or congenital abnormalities. Treatment after the first trimester, when structural development is largely complete, is reasonably safe in many diseases and more appropriate than postponement of treatment.

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