open access: Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

Obstetrics and Gynecology International
Volume 2012 (2012), Article ID 953937, 11 pages
doi:10.1155/2012/953937 Review Article Cancer, Fertility Preservation, and Future Pregnancy: A Comprehensive Review

• Abstract
• Introduction
• Methods and Materials
• Results and Discussion
• Options for Fertility Preservation
• Additional Considerations
• Pregnancy after Cancer

Conclusions 

Given the relatively high incidence of cancer in reproductive age women and improvements in 5-year survival, an increasing number of women are presenting for discussion of fertility preservation and pregnancy after cancer treatment. The ASCO published recommendations in 2006 on fertility preservation in cancer patients. These guidelines state that oncologists should address the possibility of infertility with cancer patients and be prepared to discuss possible fertility preservation options or refer the patient to a reproductive specialist. Part of the difficulty in counseling patients regarding the risk of infertility and/or subsequent pregnancy complications is that the risks are dependent on several factors. These risks include the dose and duration of treatment, other risk factors for infertility, the age of the patient, and the patient’s baseline ovarian reserve at the time of initiation of treatment.

abstract: Cancer during pregnancy: perinatal outcome after in utero exposure to chemotherapy.

Cancer during pregnancy: perinatal outcome after in utero exposure to chemotherapy

Cancer during pregnancy: perinatal outcome after in utero exposure to chemotherapy.

Abstract

OBJECTIVES:

To study the outcome of pregnancies complicated by malignant disease, in particular neonatal morbidity and mortality after in utero exposure to chemotherapy.

METHODS:

This prospective study included 118 patients diagnosed with malignant disease for the first time during pregnancy over an 8-year period (March 2003-March 2011). Outcome of neonates born to mothers who received chemotherapy during pregnancy was studied and compared with a control group.

RESULTS:

The commonest cancer type diagnosed during pregnancy (56/118 = 47.45 %) was breast carcinoma followed by lymphoma/leukemia (32 = 27.12 %). Gynecological tumors (all ovarian) represented 10.16 %, soft tissue tumors 5.08 %, colorectal 4.23 %, thyroid 2.54 % and others 3.38 %. Sixty-one (51.64 %) women received chemotherapy (average 3 ± 2 cycles) during the second and third trimesters. The incidence of neonatal survival, preterm birth, small for gestational age and congenital malformations was not significantly different between women who received chemotherapy during pregnancy and the control group. Five (4.23 %) women with advanced disease died during or shortly after termination of pregnancy.

CONCLUSION:

In utero exposure to chemotherapy during the second and third trimesters of pregnancy carries minimal morbidity to the unborn fetus.

abstract: Pregnant woman with an extremely small uterus due to pelvic irradiation in childhood (very sad)

Pregnant woman with an extremely small uterus due to pelvic irradiation in childhood:

Abstract

"A female cancer survivor, having suffered malignant lymphoma during childhood and received radio- and chemotherapy, became pregnant. Her uterus was extremely small and in the 22nd week of gestation, acute uterine contractions occurred, leading to preterm delivery and resulting in the death of the infant. Pelvic irradiation in childhood was considered to have caused a small uterus and thus brought on preterm delivery. The younger the patient, the more vulnerable the uterus is to irradiation. The exposure dose to the uterus in pediatric cancer patients should therefore be reduced, especially in younger patients. The cooperation of pediatric cancer specialists and obstetricians is necessary to preserve the future fertility of female cancer survivors."

open access: Managing pregnant women with cancer: personal considerations and a review of the literature

selected section: 

Gynecological tumours

Cervical and less commonly ovarian cancers have been diagnosed in women during their pregnancy course. Given their anatomical location, their treatment represents a major challenge. Pelvic surgery remains very challenging during pregnancy as the access is impaired and thus an optimum oncological resection is technically very difficult to achieve [19]. Thus, surgery should not be considered outside centres with experience dealing with pregnant cancer patients. Pelvic radiotherapy should be avoided during gestation, as the risk of foetal loss or malformations are significant [8]. Elective abortion should thus be considered during the first trimester, if the clinical situation mandates a prompt treatment.

A recent systematic review has identified 16, 18, and 20 patients treated with chemotherapy for cervical, non-epithelial and epithelial ovarian cancer, respectively [8]. Concomitant cisplatin and radiotherapy was frequently considered in cervical cancer patients, but spontaneous abortion was encountered in all patients exposed to radiotherapy; cases treated with weekly cisplatin alone had a normal pregnancy outcome. For non-epithelial ovarian cancer, 15/18 cases did not show any signs of pregnancy complications. In the remaining three cases, pregnancy complications were successfully managed with no foetal abnormalities documented. The most frequently used regimen was BEP (bleomycin, etoposide, and cisplatin), which is also considered as the gold standard treatment for non-pregnant women. The combination of paclitaxel and carboplatin was also frequently reported in managing epithelial ovarian cancer during pregnancy, with no serious complications reported.

abstract: Pregnancy after adolescent and adult cancer: A population-based matched cohort study

"In summary, fertility-preserving attempts have succeeded in patients with ovarian or testicular cancer and in males with Hodgkin lymphoma."

Outcomes after conservative treatment of advanced-stage serous borderline tumors of the ovary.

"Eighteen pregnancies (nine spontaneous) were observed in 14 patients."

Guidelines for the management of ovarian cancer during pregnancy.

"If chemotherapy is indicated, we recommend delaying administration, if possible, until after the delivery or at least after 20 weeks in order to minimize the potential fetal toxicity".