Cancer and pregnancy
Cancer and pregnancy
Dr Elisa Ciurlia - Radiotherapist
How is the treatment against cancer in pregnant women? Is it possible to treat a pregnant woman safeguarding the child's health?
In a period as delicate as pregnancy, with already existing worries of the future mum as regards her baby, the diagnosis of a tumour is certainly shocking.
Even though this a rare event (one case in 1000-2000 pregnancies), we are witnessing an increase in the incidence of these cases in industrialised countries, since nowadays women decide to have a child at an older age.
Goods news come from Germany: analysing the register of breast tumours (one of the most frequent type of tumours during pregnancy), in most of the cases it is possible to guarantee the patient the same livelihood opportunities than a non-pregnant woman, without any harm to the unborn child.
Unfortunately, these results are not true for all the types of tumours, it should be considered the type of tumour, its stage and its aggressiveness. Equally important is the;gestational period in which the tumour appeared and last but not least, it has a paramount importance the decision of the patient to accept or not the proposed treatment.
To be able to answer all the questions that this case may bring about, it is essential for the patient to be accompanied by an interdisciplinary group in an experienced oncological centre.
Which are the therapeutic strategies to counteract the side effects of the therapy in the unborn child?
Oncological treatments during pregnancy, may be subject to risks which, however, can be minimised with the appropriate choices. For example, the tumour can be surgically removed without interrupting pregnancy, providing she is treated in a high level of expertise centre. There are some chemotherapy drugs that may be used after the first and the second quarter of pregnancy.
Conversely, there exists a contraindication related to hormone therapies and the new biological drugs, of which we still do not have enough safety data.
As a matter of principle, the radiotherapy will have to be postponed until after the child is born.; There are many pre-clinical studies that aim to evaluate the risks of a radiation treatment for the foetus and the risk-free threshold dose. Although they are only preliminary data, there is bibliography about the experience of ocular melanoma therapy treated with protons in pregnant women (the therapy with protons guarantees a very low exposure for the foetus).
In the case of gynaecological cancer,is it possible, after the treatment, to preserve fertility and allow the healed women to have a child?
In an early stage of cervix cancer there is a possibility to preserve women fertility through a conservative surgical approach. Unfortunately this cannot be guaranteed in cases of ovary or uterus cancer.
In any case, young women with the desire for pregnancy can conserve their oocytes before starting the treatments allowing them to fulfil the maternity desire through an assisted reproduction technique at the end of the treatment.
At CNAO we have many patients that have had a child after undergoing the therapies. I remember, for example, Franchesca, mother of a beautiful little one-year-old girl.