Tumore e gravidanza. Diagnosi, trattamento e outcome, l'esperienza della clinica ostetrico ginecologica di Monza

BACKGROUND The exact incidence of cancer during gestation is yet to be determined but it is estimated that cancer occurs in 1 in 1000 pregnancies. The most common cancers in pregnancy are those with a peak incidence during the woman‘s reproductive period such as cancer of the breast and cervix, lymphoma, leukemia and melanoma. Cancer during pregnancy is a challenge about assistance and therapy, the aim of therapy in pregnancy is to give optimal treatment to the mother without harm to the fetus. After cancer diagnosis there are following problems such as the difficulty to stage it according usual criteria, the need to planner differentiated treatment, the need to delay or modify treatment in order to preserve the fetus, the risk of teratogenic effects of chemotherapy, the risk of fetal prematurity and so on. The aim of this study was to analyze the pregnancy outcome in a group of patients whit diagnosis of several malignancies during pregnancy. METHODS We retrospectively analyzed 34 patients who have been treated during pregnancy or after delivery because of several malignancies. Cancer was diagnosed at the moment of obstetric visit and all the patients were staged according to standard criteria pregnancy permitting. Serial visits were done by Oncologist and Obstetrician at the same time to take the relationship between pregnant state, cancer and therapeutic choices into account. Chemotherapy, when useful, was started in the second trimester. In all cases were done fetal monitoring and prematurity complications prophylaxis at viability age. Gestational age at delivery was established according to disease state and fetal risk of prematurity. Was avoided the neonatal spinal marrow aplasia attending two weeks from last chemotherapy course. Placental histology was studied in all cases about the presence of cancer cell or chemotherapy effect. RESULTS Surgery during pregnancy was performed in 27% of cases. Chemotherapy during pregnancy was given in 48% of cases. There were not cases of preeclampsia or stillbirth. 73% of patients delivered before 37 weeks of gestation, of them 42% delivered before 34 weeks of gestation in order to begin a therapy not indicated in pregnancy. The incidence of cesarean section was 73%. The incidence of neonates small for gestational age was 12%. There were not cases of congenital malformations. There were not cases of metastatic involvement of placenta. The neonatal outcome evaluated within 1 year from birth was good in all cases. The maternal mortality was 33% between 3-5 years after delivery. CONCLUSIONS Our data are in conformity with the Literature about the possibility to continue the pregnancy when cancer diagnosis. The possibility to receive in pregnancy chemotherapy in selected cases as standard of care is the assumption to have the same survival between the patients that interrupt the pregnancy and who not. According to advancement of perinatal care is possible to do delivery early, treating the patient with the therapy controindicated in pregnancy, without important complications after 32 weeks of gestation. All neonates had good outcome and follow-up, however the prematurity (69% advanced stage vs 25% early stage) was conditioned by cancer stage at the moment of diagnosis. In conclusion, the most important thing is to follow these patients into Specialized Hospital, taking care the cancer and the pregnancy at the same time.