Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 17 , ISSUE 2 ( April-June, 2023 ) > List of Articles


Carcinoma in Pregnancy: What is the Impact on Fetus?

Snezana Crnogorac, Aleksandra Vuksanovic Bozaric

Keywords : Pregnancy, Malignant disease, Treatment

Citation Information : Crnogorac S, Bozaric AV. Carcinoma in Pregnancy: What is the Impact on Fetus?. Donald School J Ultrasound Obstet Gynecol 2023; 17 (2):136-142.

DOI: 10.5005/jp-journals-10009-1972

License: CC BY-NC 4.0

Published Online: 05-07-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Cancer association with pregnancy (CAP) is defined as cancer diagnosed from the 1st day of childbearing to 1 year postpartum. Malignant disease in pregnancy is rare, 1:1000 pregnancies, but it represents an important therapeutic and ethical problem for both, the patient and the physician. The most important goals in curing are—treating the patient with the optimal anticancer regimen as soon as possible in order to preserve the mother's health, without harming the developing fetus. Until recently, the pregnancy had to be either terminated or cancer treatment delayed until after the birth. Nowadays, state-of-art treatment should be provided for this vulnerable population to preserve maternal and fetal prognosis. When suspicion of malignant disease in pregnancy is grounded, it is necessary to prove the same. It is recommended to apply standard methods, if possible. With some malignant tumors, some protocols for establishing diagnosis are changing sensitivity and specificity in pregnancy. Ultrasound examination is a method of choice for the breast, abdomen, and pelvis. If necessary, chest X-ray and mammography can be done safely with abdominal shielding. Magnetic resonance imaging (MRI) may be conducted if there is any unclarity in the analysis or suspicion of brain or bone metastasis. The main challenge in managing cancer in pregnancy is treating the patient with an optimal anticancer regimen without harming the developing fetus. Cancer during pregnancy is associated with a significantly increased risk of planned preterm birth, induction of labor, and a cesarean section. Women with CAP need psychological support during the pregnancy and after delivery.

  1. Zagouri F, Dimitrakakis C, Marinopoulos S, et al. Cancer in pregnancy: disentangling treatment modalities. ESMO Open 2016;1(3):e000016. DOI: 10.1136/esmoopen-2015-000016
  2. Chervenak FA, McCullough LB, Knapp RC, et al. A clinically comprehensive ethical framework for offering and recommending cancer treatment before and during pregnancy. Cancer 2004;100(2):215–222. DOI: 10.1002/cncr.11564
  3. Nicholas A. Pavlidis. Coexistence of Pregnancy and Malignancy. The Oncologist 2002;7(4):279–287. DOI: 10.1634/theoncologist.2002-0279
  4. Pentheroudakis G, Pavlidis N. Cancer and pregnancy: poena magna, not anymore. Eur J Cancer 2006;42(2):126–140. DOI: 10.1016/j.ejca.2005.10.014
  5. Smith LH, Danielsen B, Allen ME, et al. Cancer associated with obstetric delivery: Results of linkage with the California cancer registry. Am J Obstet Gynecol 2003;189(4):1128–1135. DOI: 10.1067/s0002-9378(03)00537-4
  6. Lee YY, Roberts CL, Dobbins T, et al. Incidence and outcomes of pregnancy-associated cancer in Australia,1994–2008: a population-based linkage study. BJOG 2012;119(13):1572–1582. DOI: 10.1111/j.1471-0528.2012.03475.x
  7. Peccatori FA, Azim HA, Orecchia R, et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24(6):160–170. DOI: 10.1093/annonc/mdt199
  8. Weisz B, Schiff E, Lishner M. Cancer in pregnancy: maternal and fetal implications. Hum Reprod Update 2001;7(4):384–393. DOI: 10.1093/humupd/7.4.384
  9. Gungorduk K, Sahbaz A, Ozdemir A, et al. Management of cervical cancer during pregnancy. J Obstet Gynaecol 2016;36(3):366–371. DOI: 10.3109/01443615.2015.1065235
  10. Seki N, Kodama J, Kusumoto T, et al. Complications and obstetric outcomes after laser conization during pregnancy. Eur J Gynaecol Oncol 2010;31(4):399–401. PMID: 20882881.
  11. Woitek R, Prayer D, Hojereh A, et al. Radiological staging in pregnant patients with cancer. ESMO Open 2016;1(1):e000017. DOI: 10.1136/esmoopen-2015-000017
  12. Ray JG, Vermeulen MJ, Bharatha A, et al. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA 2016;316(9):952–961. DOI: 10.1001/jama.2016.12126
  13. American College of Radiology. ACR committee on drugs and contrast media. ACR manual on contrast media v 10.3. Available from: American College of Radiology. ACR committee on drugs and contrast media. ACR manual on contrast media v 10.3. Available from: 2017;98–102.
  14. Gomes M, Matias A, Macedo F. Risks to the fetus from diagnostic imaging during pregnancy: review and proposal of a clinical protocol. Pediatr Radiol 2015;45(13):1916–1929. DOI: 10.1007/s00247-015-3403-z
  15. ACOG Committee on Obstetric Practice. Guidelines for diagnostic imaging during pregnancy and lactation. ACOG Committee Opinion No. 723. Obstet Gynecol 2017;130:e210–e216.
  16. Tremblay E, Thérasse E, Thomassin-Naggara I, et al. Quality initiatives: guidelines for use of medical imaging during pregnancy and lactation. Radiographics 2012;32(3):897–911. DOI: 10.1148/rg.323115120
  17. McCollough CH, Schueler BA, Atwell TD, et al. Radiation exposure and pregnancy: when should we be concerned? Radiographics 2007;27(4):909–917. DOI: 10.1148/rg.274065149
  18. SOGC Clinical Practice Guideline. The Use of Magnetic Resonance Imaging in the Obstetric Patient. JOGC 2014;306:349–355.
  19. Boussios S, Pentheroudakis G, Pavlidis N. Cancer managment during pregnancy. ESMO E-Learning. Available from: 2013.
  20. Van De Velde M, De Buck F. Anesthesia for non-obstetric surgery in the pregnant patient. Minerva Anestesiol 2007;73(4):235–240. PMID: 17473818.
  21. Basta P, Bak A, Roszkowski K. Cancer treatment in pregnant women. Contemp Oncol (Pozn) 2015;19(5):354–360. DOI: 10.5114/wo.2014.46236
  22. Balinskaite V, Bottle A, Sodhi V, et al. The risk of adverse pregnancy outcomes following nonobstetric surgery during pregnancy: estimates from a retrospective cohort study of 6.5 million pregnancies. Ann Surg 2017;266(2):260–266. DOI: 10.1097/SLA.0000000000001976
  23. Voulgaris E, Pentheroudakis G, Pavlidis N. Cancer and pregnancy: a comprehensive review. Surg Oncol 2011;20(4):e175–e185. DOI: 10.1016/j.suronc.2011.06.002
  24. Amant F, Halaska MJ, Fumagalli M, et al. Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting. Int J Gynecol Cancer 2014;24(3):394–403. DOI: 10.1097/IGC.0000000000000062
  25. Berveiller P, Carbonne B, Mir O. Cancer and pregnancy: an overview for obstetricians and gynecologists. Am J Obstet Gynecol 2014;211(1):82. DOI: 10.1016/j.ajog.2014.02.007
  26. Esposito S, Tenconi R, Preti V, et al. Chemotherapy against cancer during pregnancy. A systematic review on neonatal outcomes. Medicine (Baltimore) 2016;95(38):e4899. DOI: 10.1097/MD.000000000000489
  27. Boere I, Lok C, Vandenbroucke T, et al. Cancer in pregnancy: safety and efficacy of systemic therapies. Curr Opin Oncol 2017;29(5):328–334. DOI: 10.1097/CCO.0000000000000386
  28. Weisz B, Meirow D, Schiff E, et al. Impact and treatment of cancer during pregnancy. Expert Rev Anticancer Ther 2004;4(5):889–902. DOI: 10.1586/14737140.4.5.889
  29. Milojkovic D, Apperley JF. How I treat leukemia during pregnancy. Blood 2014;123(7):974–984. DOI: 10.1182/blood-2013-08-283580
  30. Cardonick EH, Gringlas MB, Hunter K, et al. Development of children born to mothers with cancer during pregnancy: comparing in utero chemotherapy-exposed children with nonexposed controls. Am J Obstet Gynecol 2015;212(5):658.e1–658.e8. DOI: 10.1016/j.ajog.2014.11.032
  31. Amant F, Vandenbroucke T, Verheecke M, et al. Pediatric outcome after maternal cancer diagnosed during pregnancy. New Engl J Med 2015;373(19):1824–1834. DOI: 10.1056/NEJMoa1508913
  32. Gziri MM, Debiève F, DE Catte L, et al. Chemotherapy during pregnancy: effect of anthracyclines on fetal and maternal cardiac function. Acta Obstet Gynecol Scand 2012;91(12):1465–1468. DOI: 10.1111/j.1600-0412.2012.01524.x
  33. Azim HA Jr, Azim H, Peccatori FA. Treatment of cancer during pregnancy with monoclonal antibodies: a real challenge. Expert Rev Clin Immunol 2010;6(6):821–826. DOI: 10.1586/eci.10.77
  34. Hudis CA. Trastuzumab—mechanism of action and use in clinical practice. N Engl J Med 2007;357(1):39–51. DOI: 10.1056/NEJMra043186
  35. Mitrou S, Zarkavelis G, Fotopoulos G, et al. A mini review on pregnant mothers with cancer: a paradoxical coexistence. J Adv Res 2016;7(4):559–563. DOI: 10.1016/j.jare.2016.01.004
  36. Lu D, Ludvigsson JF, Smedby KE, et al. Maternal cancer during pregnancy and risks of stillbirth and infant mortality. J Clin Oncol 2017;35(14):1522–1529. DOI: 10.1200/JCO.2016.69.9439
  37. Harpold TL, Wang MY, McComb JG, et al. Maternal lung adenocarcinoma metastatic to the scalp of a fetus. Case report. Pediatr Neurosurg 2001;35(1):39–42. DOI: 10.1159/000050384
  38. Wielowieyska-Szybińska DK, Spałkowska M, Wojas-Pelc A. Melanoma in pregnancy: a case report and review of the literature. Postep Derm Alergol 2015;32(6):483–487. DOI: 10.5114/pdia.2014.44006
  39. Yang HT, Chao KC. Foetal defence against cancer: a hypothesis. J Cell Mol Med 2013;17(9):1096–1098. DOI: 10.1111/jcmm.12095
  40. Alexander A, Samlowski WE, Grossman D, et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant. J Clin Oncol 2003;21(11):2179–2186. DOI: 10.1200/JCO.2003.12.149
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