The number of pregnant women and 1 year postpartum newly diagnosed with a malignant disease annually in the U.S. is approximately 1 per 1000 pregnancies.
About 70,000 US women of reproductive age are diagnosed with cancer, and survival rates for this population exceed 80%.
Transmission of maternal cancer to offspring is extremely rare, estimated to occur in approximately one infant per every 500,000 mothers with cancer.
Melanoma, breast cancer, cervical cancer, leukemia and lymphoma are the most common malignancies that occur during pregnancy.
The incidence of simultaneous cancer and pregnancy is 0.1 – 0.2%.
Approximately 1 in 3000 pregnancies is associated with concurrent breast cancer.
The incidence of cancer during pregnancy or lactation is increasing, as the age of childbearing is increasing.
The increased incidence of pregnancy associated cancer may also be attributed to improvements in diagnostic testing, awareness of genetic factors and subsequent screening, and expansion of population based screening programs.
Pregnancy associated cancers are overwhelmingly diagnosed in the postpartum period: only 25% are diagnosed during pregnancy.
The time of diagnosis can be attributable to increased healthcare encounters in the ante-natal and post natal periods, and possibly due to hesitancy to perform diagnostic tests that might be harmful during pregnancy.
Cancer is the second most common cause of death for women of childbearing age.
As the maternal child bearing age increases, the number of cancers diagnosed during pregnancy is expected to rise.
The most common cancers affecting pregnant women are: breast cancer, cervical cancer, lymphoma, ovarian cancer, leukemia, colorectal cancer, and melanoma.
The prognosis of breast, melanoma, and vulvar cancer are worse when diagnosed during pregnancy.
Medical decision making during pregnancy is complex involving ethical and emotional issues, and they need to weigh the potential benefits to the mother against the risks of the fetus.
The gestational age of the fetus is a critical factor in treatment planning in general, chemotherapy should be avoided during the first trimester, but many types of oncologic therapies can be administered safely during the second or third trimester.
Surgery is possible during pregnancy ideally during the second trimester.
Radiation therapy is generally avoided during pregnancy except in rare scenarios where potential benefits exceed the risks.
The diagnosis of cancer during pregnancy is often delayed because many signs and symptoms including fatigue, breast changes, anemia, nausea, and or rectal bleeding may mimic those of pregnancy.
Almost 2/3 of cancer cases associated with pregnancy are diagnosed after delivery.
Ultrasound is the preferred imaging modality during pregnancy.
MRI contrast medium gadolinium crosses the placenta should not be used during pregnancy.
Radiation exposure above safe levels has been associated with fetal demise, malformations, mental retardation, and secondary cancers with higher risk at earlier gestational age.
Most diagnostic imaging modalities with appropriate shielding techniques expose the fetus to doses of radiation far below safe levels.
Pet scan/CT scan imaging going confers higher doses of radiation and should be postponed until after pregnancy, whenever possible.
Cancer treatment modalities including chemotherapy, radiation, hormone therapy come and surgery all have possible adverse effects on a fetus.
It is recommended that chemotherapy be prescribed in pregnant patients with cancer based on weight, and gestational pharmacokinetic changes and should not be adapted because of maternal survival seems to be unaffected when this dosing strategy is used.
Pregnant patients with cancer who receive multi-drug chemotherapy in the first trimester have an increased risk of spontaneous abortion, fetal demise and fetal malformations (Pereg D).