Having a tumor and, at the same time, carrying a child. It is an eventuality that occurs in about one in a thousand pregnant women. But if, up until a few years ago, the diagnosis of cancer during a pregnancy that had already begun most often represented an abortion sentence, now the perspective has changed and thanks to the advances in research, the majority of women are able to bring the pregnancy despite illness. The experts at the congress of the American Society of Clinical Oncology (ASCO) shine the light on this special category of cancer patients, and it is a message of hope for many women who find themselves experiencing this condition.
“Doctors – says Frederic Amant, of the Leuven Gasthuisberg campus in Belgium – must be prepared to support patients and their loved ones in this difficult moment.
Fortunately, management options for patients with cancer during pregnancy are expanding.” Already in a study published in the New England Journal of Medicine in 2015, Amant reported that prenatal exposure to maternal cancer, with or without treatment, it did not adversely affect the cognitive, cardiac or general development of the children in early childhood. Now, he explains, “a recent follow-up completed when the children were an average age of 9 years, revealed no long-term effects of exposure prenatal to maternal cancer on cognitive or behavioral functioning”. Green light also for many analyzes and procedures, while caution remains on some. pregnancy Surgery can also be performed and chemotherapy can be given safely after 12-14 weeks of gestation, i.e. after the first trimester. In fact, the effects of chemo are very different in the first trimester, when the fetal organs are forming, compared to the second and third trimesters, when the fetus is growing and may be able to tolerate the stress of chemotherapy. However, immunotherapeutics are contraindicated in pregnancy due to limited data. After delivery, breastfeeding should be discussed and the newborn should receive blood tests to assess acute toxicity with follow-up. Premature birth should instead be avoided whenever possible. A very different picture, despite some cautions, says Amant, “compared to a few years ago, when options were limited to abortion, treatment delay or premature birth”.
“The data – says Rossana Berardi, director of the AOU Oncological Clinic of the Marche-Polytechnic University of the Marches and Aiom national councilor – say that there are over 500 new cases of cancer incidence in pregnancy per year in Italy.
According to recent estimates, cancers in pregnancy account for about 2% of all cancers diagnosed during childbearing age. The change in reproductive habits, characterized by an increase in the age of the first pregnancy, and the overall increase in the incidence of tumors in the reproductive age are also elements that make us understand how these estimates are inevitably destined to grow”. Overall, he explains, “Tumors in pregnancy do not have a worse prognosis, although conclusive data are not yet available given the rarity of the condition. However, today there are concrete possibilities for treatment: the literature suggests that the termination of pregnancy is not necessary, at least in most cases, and above all that it is not necessary to subject either the mother to the risks caused by a delay in starting treatment or the unborn child at the risk of a premature birth”. The first trimester of gestation remains more problematic: “it is necessary to postpone the start of treatment due to potential damage to the fetus or proceed with the termination of the pregnancy. In any case – he concludes – it is always important to rely on a qualified center with extensive experience”.
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