Pregnancy after cancer: is there a chance for success. Cancer and pregnancy: effects on the fetus, diagnosis, treatment The danger of late pregnancy for a woman

There is nothing more beautiful than the birth of a new life, and there is little more dangerous than oncology. This combination will have consequences for two already: the expectant mother and the unborn child. We give the opinion of experts.

Pregnancy and oncology: warnings and complications

Pregnancy cannot provoke the onset of the development of an oncological disease - it stimulates the progress of a tumor already existing in the body. But due to the absence of pain in the early stages (especially with breast cancer), the detection of a tumor often occurs already against the background of pregnancy in its progressive development.
Pregnancy can complicate the detection of breast cancer due to breast engorgement. Usually in this case, the detection of breast cancer occurs with a delay of 5 to 15 months. This is a longer delay in the detection of the disease than usual. Perhaps it is the late detection of breast cancer due to pregnancy that causes the greatest mortality compared to non-pregnant patients.
Treatment of cancer can significantly affect the possibility of conception and the course of pregnancy. A comprehensive examination, including a gynecologist, is necessary. Chemotherapy can significantly reduce a woman's fertility.
High-dose chemotherapy can provoke the development of infertility in a man. But the damage to the spermatozoa themselves by chemotherapy does not last very long: within 72 days, the sperm is completely renewed. When planning to conceive a child after chemotherapy, it is necessary to consult with your doctor, do a spermogram, undergo a fertility test, and start pregnancy planning after 1 year.
Pregnancy and childbirth can provoke the recurrence of various types of tumors, including melanoma, breast cancer, colorectal cancer, etc. The reason is a hormonal surge during pregnancy, labor and hormonal changes after them.
In the 50s and 60s of the 20th century, when cancer was detected during pregnancy or pregnancy during cancer observation, termination of pregnancy was considered the best way out. Now abortion will be a necessity for surgical intervention due to oncology in the pelvic organs, if it is impossible to carry out the necessary chemotherapy, due to the developing stage of cervical cancer. But abortion itself does not have a positive effect on cancer.
Mammary cancer- one of the most common types of cancer detected in pregnant women and women in childbirth (approximately 1 case per 3000 pregnant women; average age is 32-38 years). Most, having learned this diagnosis, terminate the pregnancy because of the likelihood of a deterioration in the condition.
During pregnancy and lactation, a woman should not stop regular breast self-examination. If a neoplasm is detected, you should immediately consult a doctor. You may need to undergo a breast ultrasound or mammogram. When proper protective measures are followed, mammography will not have a significant harmful effect on the fetus. In 25% of cases, mammography may not detect an existing tumor during pregnancy, in which case a biopsy under local anesthesia will be required. It is still important to remember that radiation during research can adversely affect the development of the fetus, especially in the first trimester of pregnancy: there is a possibility of congenital malformations, mental retardation, and an increased risk of carcinogenesis. The effect of MRI on pregnancy has not yet been studied in humans. But there is evidence of penetration through the placenta with developmental anomalies in the fetuses of rats. If bone cancer is suspected, a bone scan is preferred. The liver can be examined with an ultrasound.
It is the surgical method of treatment for breast cancer that is most acceptable during pregnancy. Hormone therapy, chemotherapy will have great limitations during this period. Chemotherapy is best used after the first trimester. Radiation therapy after surgery to increase the chance of breast preservation. There is also a way to analyze the level of influence of radiation. But it should be remembered that radiation therapy can harm the fetus at any stage of development. With its implementation, it is often advised to wait until the birth of the child.
There is evidence that after bone marrow transplantation with hematological disorders in breast cancer, preterm birth occurs in 25% of cases and low birth weight is observed in children. So far, there are no large studies on the effects of bone marrow transplantation, high-dose chemotherapy, and whole-body radiation.
A woman (especially) and a man who has or has had a cancer diagnosis, or who has first-line relatives with similar diagnoses, should undergo a genetic test (preferably before pregnancy or already in the early stages) of the possibility of inheriting the risk of cancer in an unborn child. The high level of risk may make you consider egg or sperm donation.

Even at the end of pregnancy and childbirth, there are some precautions for a newborn baby in a woman with cancer. A woman undergoing chemotherapy should stop breastfeeding. The systemic administration of anticancer drugs adversely affects the infant to a high degree.

Pregnancy and Cancer: Opportunities and Improvements

Pregnancy, childbirth, and full breastfeeding are sometimes recommended as a means of protecting against cancer if there are already diseases stimulating its appearance (for example, breast adenomatosis).
It is better to start planning pregnancy 5 or more years after the absence of a recurrence of cancer. Some experts reduce this period to 2 years.
Today, operations are already being carried out to remove the tumor (except for the pelvic areas) and relatively safe chemotherapy courses are being selected during pregnancy without the unequivocal need to interrupt it.

If there is a suspicion of the presence of an oncological disease, if the patient is in remission, then before planning a pregnancy, you should undergo a complete examination - this is the unequivocal opinion of specialists. You should definitely undergo a thorough breast examination by a gynecologist or mammologist, especially when planning a pregnancy after 30 years. The decision on the possibility of carrying a pregnancy in some cases will have to be taken not only by a gynecologist, but also by an oncologist. Then these specialists will work together to monitor pregnancy.

Natalia Mazhirina
Center "ABC for parents"

Cancer during pregnancy is quite rare. Most often, cancer during pregnancy occurs in young women. Some cancer treatments are safe to use during pregnancy, while others may harm the fetus (unborn baby).

It is very important to consult with an experienced oncologist in time so that he can determine the risks and benefits of conducting specific diagnostic tests and cancer treatments if a pregnant woman is faced with oncology.

Leading clinics abroad

Cancer Diagnosis During Pregnancy

Pregnant women often delay timely diagnosis, for the simple reason that some of the symptoms of cancer, such as bloating, frequent headaches, rectal bleeding, are common to both cancer and pregnancy itself. For the same reason, these symptoms are not considered suspicious.

On the other hand, it is during pregnancy that one can detect an oncological disease that has not been noticed before. For example, a PAP test (early detection of changes in the cells of the cervix) is performed as part of a standard prenatal examination, the results of which can be used to diagnose cancer. According to the same principle, it is possible to detect ovarian cancer during an ultrasound examination of a pregnant woman.

Cancers that typically occur during pregnancy include cervical cancer, breast cancer, thyroid cancer, Hodgkin's lymphomas, melanomas, and gestational trophoblastic tumors (a particularly rare type of cancer that can occur in the reproductive woman's system).

The most common form of cancer in pregnant women is , which affects approximately one in 3,000 pregnancies. Everyone knows that pregnancy is associated with breast enlargement, so most women do not undergo routine mammography during this period, which can cause late detection of small breast tumors.

If there is a suspicion of cancer during pregnancy, doctors may also be concerned about doing x-ray examinations. However, numerous studies have shown that the level of radiation in diagnostic x-rays is too low to harm the fetus.

Computed tomography (CT), according to the principle of its effect on the human body, is similar to X-rays, as it produces ionizing radiation. However, CT is much more accurate than x-rays in showing the structure of internal organs, which plays a big role in making a diagnosis and determining the affected areas.

CT scans of the head or chest are also generally considered safe during pregnancy as there is no direct effect on the fetus.

A CT scan of the abdomen or pelvis should only be done if absolutely necessary and after discussion with the oncology team.

Other diagnostic tests and analyzes such as magnetic resonance imaging (MRI), ultrasound, and biopsies are considered safe during pregnancy because they do not use ionizing radiation.

Cancer treatment during pregnancy

When making decisions about cancer treatment during pregnancy, the doctor individually determines the best treatment options for the mother-to-be. Also, the possible risks for the developing child must be taken into account.

The type and method of treatment are selected depending on many factors, the main of which are:

gestational age of the fetus (stage of pregnancy);
type, location, size of the tumor;
cancer stage;
wishes of the future mother and her family.

Because some cancer treatments can harm the fetus, especially during the first trimester (the first three months of pregnancy), treatment may be delayed until the second or third trimester. When cancer is diagnosed late in pregnancy, doctors may wait and not take any treatment until after the baby is born. In some cases, such as early-stage (stage 0 or IA) cervical cancer, doctors monitor and do not start treatment until after delivery.

Some cancer treatments can be used during pregnancy, but only after careful consideration and treatment planning to optimize the safety of the mother and unborn child. These include surgery, chemotherapy, and rarely, radiation therapy.

Surgery

Surgery in our case is the removal of the tumor and surrounding tissues during surgery. It poses little risk to the developing baby and is considered the safest cancer treatment option during pregnancy. In some cases, more extensive surgery may be done to avoid the need for chemotherapy or radiation therapy.

Chemotherapy

Administering chemotherapy, if diagnosed cancer during pregnancy, involves the use of drugs to kill cancer cells, usually by stopping the ability of cancer cells to grow and divide. Chemotherapy can harm the fetus, especially if it is given during the first trimester of pregnancy, when the organs of the fetus are still developing. Chemotherapy during the first trimester can cause birth defects or even pregnancy loss (miscarriage).

During the second and third trimesters, some types of chemotherapy may be given. During this period, the placenta acts as a barrier between mother and child, under the influence of which certain drugs are not able to harm the baby.

While chemotherapy in late pregnancy may not directly harm the developing baby, it can still cause side effects such as anemia (low red blood cell count) in the mother, which can interfere with the blood flow between mother and fetus. In addition, chemotherapy given during the second and third trimesters sometimes causes preterm labor, low birth weight, and problems during lactation.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to kill cancer cells. Because radiation therapy can harm the fetus, especially during the first trimester of pregnancy, doctors generally avoid using this type of cancer treatment. Even in the second and third trimesters, the use of radiation therapy is uncommon.

Cancer during pregnancy: prognosis and what to expect?

Oncology and pregnancy- the phenomenon is quite rare, occurring approximately one in every 1000 pregnancies. It is for this reason that women often find themselves in a situation where even the most qualified doctors cannot decide how to fight cancer.

However, while most women who are suspected or diagnosed while carrying a child continue to discuss with their doctor when and how long to start cancer treatment during pregnancy, others may not even be aware that they have a malignant process.

But despite the foregoing, the most important thing is that a pregnant woman with cancer, even despite a terrible diagnosis, is able to endure and give birth to an absolutely healthy baby, because the course of the cancer process very rarely directly affects the fetus itself. But there are other, sadder cases as well. So, some types of cancer tend to spread to the placenta (the temporary organ that connects the fetus to the mother), but does not affect the child himself. In addition, the treatment and recovery of a pregnant woman is extremely difficult morally for the medical team itself. Therefore, it is very important to find a doctor who has experience in treating pregnant women with cancer.

Leading specialists of clinics abroad

Cancer and breastfeeding

Although cancer cells cannot reach an infant through breast milk, doctors strongly advise women undergoing cancer treatment not to breastfeed.

In addition, the consequences of chemotherapy performed the day before can be especially dangerous for the baby, since drugs can be passed to him through breast milk. Similarly, radioactive components that are taken by mouth for thyroid cancer treatment (such as doses of radioactive iodine) can pass into breast milk and harm the baby.

How pregnancy affects the course of cancer

The prognosis (chance of recovery) for a pregnant woman with cancer is often the same as for other women of the same age and with the same types and stages of cancer. However, if a woman's diagnosis or treatment during pregnancy is delayed, the extent of the cancer may progress.

In addition, due to the amount of hormones produced during pregnancy, it has the potential to influence the growth and spread of certain types of cancer. In this case, it is very important to talk to your doctor first about how pregnancy may affect your stage and form of cancer, as well as the healing process.

Questions to ask your oncologist!

If you are pregnant and have unfortunately recently been diagnosed with cancer, in order to protect your health and the life and health of your unborn child, you must know and operate with all the necessary information, which can be obtained by asking your oncologist the following questions (also , based on the answers of this doctor, you can be sure of his qualifications and experience).

How many years of experience do you have in treating pregnant women with cancer?
How will you interact with my obstetrician (a doctor who specializes in pregnancy and childbirth)?
Do I need to undergo any special tests and examinations?
What plan and method of treatment do you recommend? Why?
Do I need to start treatment right away, or do I have to wait until the end of the pregnancy?
Can delaying treatment worsen my condition and affect my prognosis?
What are the short and long term risks of treatment for me? For a baby?
Will I be able to breastfeed?
What social support is available to me and my child?
In addition to the oncologist, which doctors will additionally observe cancer and pregnancy?

The physiological process of pregnancy is aimed at the birth of a healthy child. Malignant tumors without special treatment lead to a rapid fatal outcome. With the combination of malignant tumors and pregnancy, an extremely acute and dynamic clinical situation develops. The interaction of obstetric and oncological problems is inevitable, since pregnancy can have an adverse effect on tumor growth, and the tumor on the development and outcome of pregnancy. At the same time, ethical problems also arise, since further continuation of pregnancy can worsen the already dubious prognosis of a malignant tumor, and its treatment can harm the unborn child or even terminate the pregnancy.

In most cases, pregnancy adversely affects the progress, growth, and spread of cancer. It must be emphasized that the first place should be put mother's interests. This position is shared by most clinicians. Pregnancy is characterized by a programmed violation of hemostasis: an increase in blood levels of glucose, insulin, fatty acids and cholesterol. Pregnancy is seen as an example of metabolic immunosuppression, which may predispose to cancer. However, in clinical oncology there is no evidence of an increase in the incidence of malignant tumors during pregnancy. It is possible that the immunosuppressive effect of pregnancy manifests itself in the long term.

Thus, In the clinic, two options are most likely: no effect of pregnancy on the tumor or worsening of the clinical course of the disease.

Malignant and benign tumors are observed in 0.27% of pregnant women. The combination of pregnancy and malignant tumors of various localizations occurs in 0.01-0.03% of cases. Most combinations with pregnancy are cervical and breast cancer (62%). The frequency of the combination of widespread cancer of the stomach and rectum (10.8%) is not much higher than that of rare sarcomas (7.1%). Next in decreasing frequency are ovarian cancer (5.5%), malignant lymphomas (4.9 %), thyroid cancer (2.4%), malignant melanomas (1.9%). All other malignant tumors are combined with pregnancy in 5.4% of cases.

The combination of malignant tumors and pregnancy raises many questions for specialists.

There is no shortage of specialist literature on the issue of "cancer and pregnancy". However, it remains much more controversial than clear, and many issues have not received sufficient coverage.

Cancer and pregnancy. What effect do malignant tumors have on the course of pregnancy?

The emergence, growth and spread of cancer is associated with various metabolic and immunological disorders that can adversely affect pregnancy.

As various studies have shown, there is an inverse relationship between the prognosis for the unborn child and for the health of the mother on the gestational age at which a malignant tumor is diagnosed.

The prognosis for the child is more favorable if the tumor appears late - in the III trimester.

If cancer detected in the third trimester, this indicates that the growing tumor does not significantly affect the carrying of the pregnancy and the growth of the fetus.

In oncological patients, the frequency of miscarriage and intrauterine fetal asphyxia increases. Infant mortality in the first year of life is 25%, which is significantly higher than the average.

Do not forget about the possible complications in childbirth and the postpartum period with the localization of the tumor in the pelvic area.

Large "injected" tumors can create mechanical obstacles for natural childbirth.

infected, decaying tumors of the cervix or rectum are a possible cause of purulent-septic complications.
At pheochromocytoma adrenal glands in childbirth, acute circulatory disorders, shock are possible.
In patients with primary and metastatic Liver cancer has been described as bleeding leading to death.
At brain tumors, especially when they are localized in the pituitary gland, during childbirth there is often an increase in intracerebral pressure with an outcome in severe neurological disorders.
In patients with acute leukemia there is a violation of the blood coagulation system with the development of severe postpartum hemorrhage, of which 10 % are the cause of deaths on the 1st day of the postpartum period. In the future, septic postpartum diseases develop. Thus, malignant tumors adversely affect the course of pregnancy and childbirth in advanced stages. With non-common forms of cancer, this effect is not observed.

Is it possible to metastasize to the placenta and fetus?

The question of metastasis was raised as early as 1866. A case of a malignant tumor of the liver in a pregnant woman is described. In a child who died 6 days after birth, an autopsy revealed metastases of an identical structure.

For more than 100 years, only 35 cases of metastasis to the placenta and fetus have been described. Currently, 29 cases of tumor metastasis to the placenta without fetal involvement and 6 metastases to the fetus (including 2 with documented placental involvement) have been published. Observations of malignant melanoma, ovarian cancer, liver cancer, kidney cancer are described.

It should be noted that in the literature there are no descriptions of cervical cancer metastasis to the placenta and fetus. It is believed that placental and transplacental metastasis is influenced not by the proximity of the tumor to the uterus, but by its potential for generalization.

When metastases were found in the placenta and (or) the fetus, all mothers died of cancer in the shortest possible time after delivery.

With metastases to the placenta during the 1st year, only 30% of children remained alive.

It must be said about the possible transmission of hemoblastoses from mother to fetus. In 1% of cases, children have the same disease as the mother with a fatal outcome.

Placental and transplacental metastasis is the most common and especially severe in malignant melanoma.

Clinical experience indicates that it is not advisable to maintain an early pregnancy when combined with malignant tumors, for the treatment of which radiation and (or) chemotherapy are supposed to be used.

Cervical cancer and pregnancy

Cervical cancer ranks first in the incidence of malignant tumors of the female genital organs. According to summary data, cervical cancer ranks first among malignant tumors in pregnant women: from 0.17 to 4.1 %.

Among the forms of cancer, exophytic and mixed forms of tumor growth predominate (in 74.3%), located in the ectocervix region (in 89.2%), and bleeding (in 68.2%).

In the first trimester pregnancy, a symptom of uterine bleeding is often regarded as a beginning miscarriage, in the II and III trimesters - as an obstetric pathology: placenta previa or premature detachment. In many cases, pregnant women do not make a thorough examination of the cervix with the help of mirrors; rarely used cytological examination and colposcopy. The situation is aggravated because of the unreasonable fear of a biopsy. The implementation of cytological screening provides information on the incidence of cervical cancer among pregnant women (0.34%). At the same time, the frequency of preinvasive cancer is 0.31%, invasive - 0.04%.

Currently, a two-stage diagnostic system is considered the basis for detecting early forms of cervical cancer:

cytological screening during gynecological examination;
in-depth comprehensive diagnostics in the detection of visual or cytological pathology.

According to many clinicians, long-term pregnancy and the postpartum period have an adverse effect on the clinical course of cervical cancer.

One of the leading manifestations of tumor progression is a decrease in the degree of its differentiation. Another unfavorable factor is the deep invasion of the tumor into the tissues of the cervix.

Reduced differentiation of the tumor and its deep invasion contribute to the rapid spread outside the body. During surgery for a combination of cervical cancer and pregnancy, metastases in the regional lymph nodes of the pelvis are 2 times more likely to be detected.

The results of the study of cellular immunity indicate the suppression of cellular immunity already in the first trimester of pregnancy in patients with stage I of the disease.

It is difficult to limit medical tactics in the treatment of pregnant women with cervical cancer within the rigid framework of a specific scheme. It is impossible to agree with the principle: treat cancer, taking into account the stage and ignore pregnancy. A strictly individual approach is needed, and the duration of pregnancy plays a significant role.

At cancer in situ cervix inI treatment consists of termination of pregnancy and cone-shaped excision of the cervix. InIIandIIItrimesters diagnostic colposcopic and cytological observation is carried out. 2-3 months after delivery, a cone-shaped excision of the cervix is performed.

At IA stage of the disease inI, II perform extirpation of the uterus with the upper third of the vagina.

At IB stages inI, IItrimesters of pregnancy and after childbirth extended extirpation of the uterus; in the postoperative period with deep invasion and regional metastases, remote irradiation is performed. ATIIItrimester of pregnancy produce a caesarean section followed by an extended extirpation of the uterus. In the postoperative period, remote radiation therapy is used.

At IIA stages inI, II, IIItrimesters of pregnancy produce an extended extirpation of the uterus, followed by remote irradiation. After childbirth treatment consists of preoperative irradiation; in performing extended extirpation of the uterus and in the postoperative period with deep invasion and regional metastases of remote irradiation.

At II In the disease stage inItrimester of pregnancy and after childbirth conduct combined radiation treatment (intracavitary and remote). One should not strive for artificial termination of pregnancy in the first trimester at stages II and III of the disease, since spontaneous miscarriages occur on the 10-14th day from the start of radiation therapy. If the PV stage of the disease is diagnosed inIIandIIItrimesters of pregnancy perform caesarean section and combined radiation treatment in the postoperative period.

At III stage of the disease inItrimester of pregnancy and after childbirth treatment begins with combined radiation therapy (intracavitary and remote irradiation). InIIandIIItrimesters of pregnancy treatment begins with a caesarean section followed by combined radiation therapy.

In women suffering from pre- and microinvasive cervical cancer and wishing to have children, it is possible to implement functionally sparing methods of treatment: electroconization, cryodestruction, knife and laser amputation of the cervix. In this case, pregnancy and childbirth do not adversely affect the course of the underlying disease. The recurrence rate after organ-preserving treatment of initial forms of cervical cancer is 3.9%; the frequency of relapses in the population is 1.6-5.0%.

The pregnancy rate after organ-sparing treatment of early forms of cervical cancer ranges from 20.0 to 48.4 %.

Prolongation of pregnancy is advisable not earlier than 2 years after functionally sparing treatment of cervical pathology. Conducting childbirth through the natural birth canal is not contraindicated. There was an increase in the frequency of miscarriage and premature birth compared with healthy women. There is a higher level of perinatal mortality (11.5%). An increase in the frequency of premature termination of pregnancy after organ-preserving treatment of cervical pathology indicates the need for preventive measures (antispasmodics, tocolytics, antiplatelet agents, bed rest). Delivery by caesarean section is carried out only according to obstetric indications. Dispensary observation after undergoing functionally sparing treatment of initial forms of cervical cancer includes examination in the 1st year at least 6 times; in the 2nd - 4 times; in the next - 2 times a year.

Uterine cancer and pregnancy

The combination of uterine cancer and pregnancy is rare for two main reasons: due to a significant decrease in the generative function in these patients and the strong effect of progesterone on the endometrium, which prevents the development of atypical hyperplasia and endometrial cancer. Probably, fertilization, implantation of the fetal egg and the development of pregnancy are possible only in the initial forms of endometrial cancer, when the tumor process in the uterus has not yet spread. In these cases, the prognosis after radical treatment is more favorable.

Malignant ovarian tumors and pregnancy

The frequency of combination of ovarian cancer with pregnancy does not exceed 1:25,000, and cancer of this localization is 3% of all ovarian tumors removed during pregnancy.

The question of the relationship between pregnancy and ovarian tumors is considered in several aspects:

about the possible influence of the state of childbearing function on the occurrence of ovarian tumors;
about the features of the course of an already existing tumor process against the background of pregnancy;
about the possibilities of preserving reproductive function after treatment for ovarian tumors.

Pain syndrome with a combination of ovarian tumors with pregnancy is observed in 48% of patients. During the examination in the early stages of pregnancy, tumors are found in 25% of patients. Twisting of the tumor stem is more often observed in pregnant women than in non-pregnant women and is 29%.

The frequency of miscarriages after surgery for an ovarian tumor in the first trimester of pregnancy is 35%, in the second - 20%.

The combination of arrhenoblastoma with pregnancy is very rare. There were no indications of relapse associated with a subsequent pregnancy. Therefore, saving operations are recommended in the absence of signs of the spread of the tumor process and subject to careful monitoring of patients, including determining the level of 17-KS excretion.

In patients with estrogen-producing granulosa cell tumors, infertility is often noted, and in case of pregnancy, miscarriages. In addition, childbirth is associated with bleeding from the tumor.

Based on the highest probability of recurrence in the first 2-3 years after tumor removal, pregnancy during this period is undesirable.

When a malignant tumor is localized in one ovary in young women who want to have children in the future, it is recommended to perform unilateral removal of the uterine appendages with resection of the second ovary and greater omentum, followed by chemotherapy. The recurrence rate with this treatment of initial forms of ovarian cancer is 9.1%; in the population - 23.4-27.0%.

The frequency of pregnancy after organ-preserving treatment in the specified volume reaches 72.7%.

Breast cancer and pregnancy

Among malignant neoplasms in women, breast cancer occupies one of the first places. In recent years, the frequency of the combination of pregnancy and cancer has increased.

There are two aspects to this problem: cancer among pregnant women and pregnancy with cancer. Breast cancer in pregnant women occurs in 0.03-0.3% of cases, pregnancy with breast cancer - in 0.78-3.8%, and in some reports this figure reaches 14%.

According to experimental data, changes in the body of rats associated with pregnancy generally inhibit the occurrence of neoplasms of the mammary glands, increase the differentiation of tumors and reduce the degree of malignancy.

In breast tumors diagnosed during pregnancy, deviations in hormonal homeostasis are characterized by hyperestrogenization, menstrual rhythm disturbance with the appearance of an unusual for the physiological norm peak of LH release in the follicular phase and low levels of FSH in patients after abortion, hyperestrogenization in combination with hyperprolactinemia in cancer patients mammary gland, diagnosed against the background of lactation, hypercortisolism in some patients.

Among the clinical forms of breast cancer, inflammatory ones predominate (in 15% of cases), rapidly metastasizing undifferentiated forms are common, less often differentiated. A characteristic feature of the combination of pregnancy and breast cancer is the detection of the latter in patients with many pregnancies and childbirth of the late reproductive period (35-44 years), with a significant (5 years or more) interval between pregnancies.

Another characteristic feature is the predominance of lobular forms among the morphological structures of the mammary gland and the severity of intracanalicular and myoepithelial proliferation in the tissues surrounding the tumor. There is a high frequency of previous hyperplastic and proliferative processes in the tissues of the gland, a high level of E 3 and progesterone.

If a malignant tumor of the mammary gland, confirmed morphologically, is detected, termination of pregnancy is indicated. After that, treatment is carried out according to the stage of the tumor.

Extragenital malignancies and pregnancy

Skin melanoma and pregnancy. It is well known that melanoma of the skin in the structure of oncological diseases ranges from 1 to 3%. Its combination with pregnancy is even less often observed. There is evidence of the effect of hormonal status altered by pregnancy on the pigment system, in some cases manifested in the activation of pigmented nevi. It has been established that in the cytoplasm of melanoma cells there are special estrogen receptors, and rapid tumor growth and metastases are reported when taking estrogens. This indicates an unfavorable tumor growth-stimulating effect of pregnancy on melanoma. Clinical observations show that the combination of pregnancy and melanoma in most cases worsens the prognosis.

The prognosis for skin melanoma largely depends on the location of the primary lesion. Unfavorable is the localization of the primary focus on the trunk, in the head and neck. Localization of melanoma in the area of the upper and lower extremities is prognostically more favorable. Survival of patients depends mainly on the stage of melanoma.

In the first clinical stage of melanoma, the 3-year survival rate for pregnant women is 65.2 ± 5.8%, for non-pregnant patients - 70.9 ± 2.2%; 5-year-old - 44.4 ± 6.7% and 53.6 + 2.6%; 10-year-old - 26 + 7.4% and 43 ± 2.8 % respectively. Therefore, when clinical stage I melanoma and pregnancy are combined, the long-term results of treatment worsen.

In the II and III clinical stages of the disease, the pregnancy factor does not significantly affect the prognosis of life.

Comparison of the survival of patients with stage I, in whom clinical manifestations of melanoma occurred in the first half of pregnancy, with those in whom they occurred in the second half and during lactation, showed that the course of the disease is significantly more complicated if melanoma occurs in the second half of pregnancy. Perhaps the high level of estrogen and growth hormone, which is observed precisely in this period of pregnancy, matters.

The main regularities of the combination of skin melanoma and pregnancy listed above make it possible to develop the following treatment tactics. In the first half of pregnancy in patients with I the stage of the disease with a favorable individual life prognosis abortion may not be performed. Under anesthesia (preferably neuroleptanalgesia), melanoma of the skin is widely excised according to the accepted method. The obtained data of the morphological study and their analysis allow us to make more informed judgments about the prognosis of the disease. The patient and relatives should be adjusted to maintain pregnancy.

With an unfavorable prognosis of life, established by a combination of clinical and morphological signs, the decision to maintain pregnancy is made individually. You should not insist on either maintaining the pregnancy or abortion. The decision must be made by the woman herself or her family. Information for relatives should not be dramatized, limited to the fact that the course of any oncological process is completely unpredictable, and the disease poses a certain danger to the life of the patient. By itself, pregnancy does not affect the course of the disease.

At II clinical stage melanoma in the first half of pregnancy at the first stage of treatment it is necessary to put medical indications to abortion, and then treat melanoma of the skin with metastases to the lymph nodes. This tactic is based on the fact that when a pregnancy is terminated, the result of treatment is somewhat better; in addition, there is an opportunity for additional treatment in the postoperative period.

At III clinical stage The first stage of treatment is medical abortion. It should be borne in mind that the preservation of pregnancy is the possibility of transplacental metastasis and the manifestation of the teratogenic effect of chemotherapy drugs.

In the second half of pregnancy, at any stage of the disease, based on the interests of the child, all measures should be taken to carry the fetus.

Surgical treatment in the generally accepted volume at stages I and II is carried out under anesthesia (neuroleptanalgesia). Additional treatment can be started in the postpartum period, provided that the child is artificially fed. In necessary cases, according to indications, a caesarean section is performed.

Currently, there are no direct data to establish the effect of pregnancy on the fate of patients after radical treatment for skin melanoma. Previous analysis has shown that there is no "protective" property in pregnancy, and therefore pregnancy after treatment should not be recommended.

After radical treatment in I stages of melanoma in patients with a favorable life prognosis abortion should not be recommended.

Sick with I stage with a poor prognosis and II stage of the disease you can be allowed to have a child after experiencing a "critical" period - 6 years. With a pregnancy that occurred at an earlier period, medical indications for termination of pregnancy can be established, and only a persistent desire to have a child and the second half of pregnancy serve as an obstacle. The patient and her relatives should be warned about all possible complications that may arise in this case.

Lymphogranulomatosis and pregnancy. Little studied in the literature is the question of the interaction of Hodgkin's disease and pregnancy. Pregnancy aggravates the prognosis of the disease even if it is interrupted.

In the case of complete clinical and hematological remission of lymphogranulomatosis for more than 2 years from the end of treatment, the issue of carrying a pregnancy can be resolved positively.

Among women with lymphogranulomatosis, pregnant women account for 24.7%. Lymphogranulomatosis more often affects women of childbearing age in 72%, and pregnancy occurs in 15-30% of patients.

Thus, there are two options for the combination of lymphogranulomatosis and pregnancy: a disease is possible during pregnancy or its onset in a woman with lymphogranulomatosis. Menstrual and reproductive functions in these patients may be impaired.

Irradiation of the para-aortic and inguinal-iliac lymph nodes results in loss of ovarian function and amenorrhea in almost all young women. To preserve ovarian function, young women and girls undergo ovarian transposition. In the future, during irradiation, the ovaries are protected with a lead block 10 cm thick. The use of this technique makes it possible to preserve ovarian function by 60%.

Lymphogranulomatosis during pregnancy is more often diagnosed in the II-III trimester.

Diagnosis of lymphogranulomatosis during pregnancy is difficult, since the subjective symptoms of the disease (skin itching, low-grade body temperature, increased fatigue) are interpreted by doctors as complications of pregnancy.

If malignant lymphoma is suspected, the volume of diagnostic procedures is determined depending on the gestational age. Needle biopsy of the lymph node can be performed at any stage of pregnancy. Removal of the lymph node is performed taking into account the duration of pregnancy and the condition of the patient. X-ray studies are contraindicated.

The opinion that pregnancy negatively affects the course of lymphogranulomatosis is currently not supported by most authors. The number of spontaneous abortions, stillbirths and pathological births observed with this combination is the same as among healthy women.

Medical tactics in relation to pregnancy in patients with lymphogranulomatosis needs strict individualization. When resolving this issue, it is necessary to take into account the duration of pregnancy, the nature of the course of the disease, prognostic factors and the desire of the patient. When pregnancy is detected in patients who have not yet undergone treatment, or the simultaneous development of the disease and pregnancy in the first trimester, it is advisable medical abortion, which will allow a full examination of the patient and start treatment.

In the acute course of the disease, including relapse, in the II and III trimesters of pregnancy, the beginning of treatment during pregnancy, termination of pregnancy by caesarean section or rhodostimulation at the 7-8th month are indicated. It should be taken into account the fact that intensive polychemotherapy or irradiation of the para-aortic and inguinal-iliac regions has an adverse effect on the fetus. Chemotherapy with cytostatics should be carried out with extreme caution.

In patients with I -II stage lymphogranulomatosis, in a state of complete clinical remission for 3 years or more, pregnancy can be saved.

Sick with III - IV stage of the disease preferably do not keep the pregnancy.

The active course of the disease in the first 2 years indicates a poor prognosis, so patients are advised to refrain from pregnancy or terminate it in a timely manner.

The adverse effect of lactation on the course of lymphogranulomatosis has not been established. However, given the great burden on the body of a nursing mother, especially in cases where she is to undergo specific treatment, it is advisable to refrain from breastfeeding.

Thyroid cancer and pregnancy. Currently, thyroid cancer accounts for about 6% of all human malignant diseases. The increase in the incidence of thyroid cancer occurred at the expense of women, and predominantly of a young age. According to the literature, thyroid hormones play an important role in the onset and maintenance of pregnancy. Any dysfunction of the thyroid gland has an adverse effect on pregnancy. In turn, it leads to significant changes in the thyroid gland: its volume increases, and the proliferation of thyroid hormones in the blood increases. Pregnancy can provoke the development of thyrotoxicosis and nodular goiter.

Thyroid cancer has a number of characteristics. Cancer of this localization, especially its highly differentiated form, is observed in women of childbearing age and is not accompanied by hormonal disorders. These forms of thyroid cancer are slow-moving. At the same time, women experience repeated pregnancies, childbirth, they breastfeed, and only later they recognize a malignant tumor of the thyroid gland.

The ten-year survival rate for papillary cancer is 90%, in young patients even more than 90%. Clinical experience also indicates a relatively benign course of thyroid cancer during pregnancy, due to the fact that papillary and follicular forms of thyroid cancer, even in the presence of regional metastases, proceed favorably. The five-year survival rate is 93.3%. In medullary squamous cell carcinoma, the prognosis is extremely poor.

If differentiated thyroid cancer is diagnosed during pregnancy and radical surgery is possible, then the pregnancy can be saved. At the same time, in the I and II trimesters, one should start with surgery, and in the III - to operate after delivery.

Malignant brain tumors and pregnancy. The combination of pregnancy and brain tumors is relatively rare. The frequency of this pathology ranges from 1:1000 to 1:17,500 births. There is also evidence that in approximately 75% of cases of brain tumors in women of reproductive age, the first symptoms of the disease appear during pregnancy. Most reports point to the negative impact of pregnancy on the course of brain tumors. The progression of the clinical manifestation of a brain tumor during pregnancy is explained by endocrine, electrolyte, hemodynamic and other changes that cause sodium and water retention in the body and an increase in intracranial pressure. There is also evidence that pregnancy can even stimulate the growth of meningiomas and glial tumors.

Tumors most prone to a rapid progressive course during pregnancy include vascular tumors.

Brain tumors are a contraindication to maintaining pregnancy. If the brain tumor is removed, then the issue of maintaining pregnancy is decided individually, depending on the morphological type of tumor and the woman's health status.

Leukemia and pregnancy. The combination of leukemia and pregnancy is relatively rare. Pregnancy is especially rare in patients with acute leukemia. The relative rarity of the combination of leukemia and pregnancy is explained by leukemic infiltration of the ovaries and tubes and functional amenorrhea.

The prevalence of the combination of pregnancy with chronic leukemia, mainly myeloid, is noted. According to most authors, pregnancy in patients with chronic leukemia does not adversely affect its course. There is also an opinion that pregnancy improves the course of leukemia due to the increased release of ACTH. Some authors draw attention to the fact that pregnancy in acute leukemia often ends in premature birth, less often - intrauterine fetal death, spontaneous abortion or death of patients before delivery.

In some cases, the course of pregnancy in acute leukemia is not disturbed, and it ends with urgent delivery. The reason for the uncomplicated course of acute leukemia during pregnancy and terminal exacerbation in the postpartum period is explained by the fact that the fetal bone marrow compensates for the mother's hematopoiesis, while others explain this by hyperfunction of the anterior pituitary gland and adrenal cortex in pregnant women.

In chronic leukemia, the prognosis for the mother is slightly better than in acute ones. Chronic leukemia should be treated in the same way as in the absence of pregnancy. The exception is the first trimester. The appointment of chemotherapy drugs in this period can cause significant disturbances in the development of the fetus. In this situation, it is better to terminate the pregnancy.

Malignant tumors of the urinary system and pregnancy. In women of childbearing age, tumors of the urinary system are extremely rare. The most common tumors of the kidneys, among which hypernephromas prevail.

The diagnosis is established equally often in the II, III trimesters of pregnancy and in the postpartum period (26, 29, 26%, respectively). The most common clinical symptoms are pain in the lumbar region (64%) and hematuria (36%). If the tumor process proceeds without significant complications, one should strive to bring the pregnancy to the time of delivery, when the fetus becomes viable, and perform a caesarean section and nephrectomy. If serious complications arise that require emergency interventions, the pregnancy is terminated and a nephrectomy is performed (the optimal time for the latter is the interval between the 12th and 36th weeks of pregnancy).

Malignant tumors of the adrenal glands and pregnancy. Malignant tumors of the adrenal glands are combined with pregnancy in a ratio of 1:12, which is 8.3% among women with malignant tumors of the adrenal glands. The histological type in half of the cases is represented by adenocarcinoma, and in the other half by malignant pheochromocytoma. Pheochromocytoma often manifests in early pregnancy with symptoms of high arterial hypertension.

Why do pregnant women develop cancer? Research studying malignant processes during pregnancy is not enough, not because cancer during pregnancy is rare, but also due to the moral and ethical characteristics of the problem. But, despite this, there are works that show that the processes of carcinogenesis (cancer development) and embryogenesis (fetal development and formation) are very similar, therefore, the immune and hormonal background of a woman, favorable for the fetus, becomes just as favorable for malignant processes.

The most common cancers during pregnancy are: cervical cancer (12 cases per 10,000 pregnancies), breast cancer (1 case per 3,000 pregnancies), ovarian cancer (1 case per 18,000 pregnancies), colon cancer (1 case per 50,000 pregnancies). ) and stomach, thyroid cancer and hematological diseases.

There are risk factors: late pregnancy (the incidence of cancer increases with age), hormonal disorders of a woman, the presence of bad habits (smoking, alcohol), heredity.

The presence of cancer in the mother's body is not an obstacle to the birth of a healthy child - cancer is not transmitted during pregnancy or childbirth

It is important to note that the presence of cancer in the mother's body is not an obstacle to the birth of a healthy child - cancer is not transmitted during pregnancy or childbirth! But you can find a description of isolated clinical cases of tumor metastasis to the placenta and fetus - mainly with melanoma (aggressive skin cancer), small cell lung cancer, non-Hodgkin's lymphoma and leukemia (in 1% of cases, leukemia can be transmitted to the child).

Cancer in the early stages is mostly asymptomatic, but non-specific complaints are still distinguished: weakness and fatigue, lack or decrease in appetite, nausea and vomiting, as well as the appearance of seals in the mammary glands and discharge from the genital tract - all this easily correlates with pregnancy including.

Safe diagnostic methods during pregnancy are endoscopic (gastroscopy and colonoscopy with sedation and biopsy), ultrasound and MRI, which do not have X-rays, and therefore do not have a teratogenic (damaging the fetus) effect. In some cases, the use of X-rays and computed tomography with the use of protective screens is allowed.

The impact of cancer on the course and prognosis of pregnancy, as well as on the life of the mother and fetus depends on the period of pregnancy and at what stage the cancer is diagnosed, which also determines the possibilities in therapy. Tactics is determined only individually and depends on the type and stage of cancer.

If the disease is diagnosed before 12 weeks (1st trimester), most of the specific treatments at this time are dangerous for the fetus, since there is a high probability of a violation of its development and / or a risk of the formation of anomalies of the internal organs. Therefore, at this stage, the patient is discussing the possibility of terminating the pregnancy in the interests of saving the life of the woman, or the possibility of delaying the start of therapy until the viable period of the fetus (28 weeks) for the purpose of delivery, or until the 2nd-3rd trimester of pregnancy, when the main processes of formation of the internal organs of the fetus are completed. But even in this case, it is impossible to completely exclude an anomaly in the development of the fetus during therapy. At the same time, an increase in the waiting period for treatment may be associated with a risk to the life of the mother.

Cancer treatment during pregnancy is complex. Surgery is considered the most common and safest method, especially after the 1st trimester of pregnancy, although here, each type of cancer has its own characteristics.

In case of breast cancer - at any time it is possible to perform both organ-preserving surgery and mastectomy (removal of the breast) with the possibility of performing a biopsy of the sentinel lymph node in both cases (with the help of a radiopharmaceutical, metastases in regional lymph nodes can be detected, but it is not recommended to use methylene for this procedure blue).
In case of intestinal cancer, surgical treatment is possible both before and after 20 weeks of pregnancy, provided that the uterus with the fetus is not involved in the pathological process and there is a possibility of its preservation; but in the case of colon cancer, it must be remembered that ovarian metastases during pregnancy occur in 25% of cases (against 3-8% in the absence of pregnancy), so it is advisable to perform a biopsy of both ovaries during surgery, and bilateral removal - only in the case of histological confirmation of their involvement in the pathological process and only after 12-14 weeks of pregnancy, but even in these terms there will be a high risk of miscarriage.
In case of ovarian cancer, the volume of surgery, depending on the situation, can be minimal - removal of only the affected ovary - or standard, which involves the removal of the uterus with both ovaries, in which case it is impossible to maintain pregnancy for up to 24 weeks, and later than 24 and closer to 36 weeks - caesarean section followed by a radical operation.
Cervical cancer in the early stages IA-IB1 (tumor up to 2 cm) - conization (resection of the cervix) and trachelectomy (amputation of the cervix) with removal of regional lymph nodes, in more advanced stages - the issue of preoperative chemotherapy and delivery is being decided to consider the possibility performing radiation therapy.

The decision for each individual case of pregnancy and cancer should be made only individually, after assessing the prevalence of the disease, the type of cancer and its dynamics, the condition of the woman

As for chemotherapy, the situation with it is quite simple: when it is indicated (recommendations and the purpose of its administration during pregnancy are similar to those in the absence of pregnancy), regardless of the type of cancer and its prevalence, preoperative or prophylactic (postoperative) is the main condition for its safe administration for the mother and the fetus is 2-3 trimesters of pregnancy.

But radiotherapy is contraindicated throughout pregnancy and is possible only after delivery. Breastfeeding is also prohibited during the entire period of specific cancer therapy.

If we are talking about, then many factors must be taken into account: the volume and timing of specific treatment, the chemotherapy drugs used in the regimen (for example, if a woman received targeted therapy in the postoperative period, then at least a year should pass before planning and pregnancy), the biology of the tumor - her hormonal status, because at the end of the main stage of treatment, antihormonal therapy is required for 5, and according to the latest recommendations - 10 years. In these cases, at least 2-3 years before pregnancy is recommended, and the resumption of antihormonal therapy after the birth of a child is recommended.

These are general recommendations. The decision for each individual case of pregnancy and cancer should be made only individually, after assessing the prevalence of the disease, the type of cancer and its dynamics, the condition of the woman. The decision should be made jointly (by the pregnant woman and a consultation of specialists), it is very important to explain to the woman that termination of pregnancy does not stop the development of cancer, but makes it possible to immediately start complex treatment.

Cancer prevention during pregnancy is, first of all, pregnancy planning with the necessary set of examinations before it occurs.

With the support of:

The occurrence of oncological diseases during pregnancy is in itself a rather rare phenomenon, but it still happens. Does pregnancy provoke the development of oncological neoplasms?

There is no exact answer to this question - on the one hand, during pregnancy, a woman's body undergoes tremendous changes, the hormonal background changes (the level of progesterone and estrogen increases), metabolic processes change, and this can provoke the growth of tumors.

At the same time, it takes a long time for the development of any oncological disease, so, most likely, the cancer begins to develop even before the onset of pregnancy, and during this period it simply actively progresses (see also pregnancy after cancer and pregnancy after chemotherapy).

Some experts consider the oncovirus to be the cause of oncological diseases, the heredity of the disease has also been proven, which means that the development of cancer during pregnancy is more of a coincidence, pregnancy itself does not provoke cancer, but contributes to its more rapid development.

Cancer Diagnosis During Pregnancy

In general, oncological diseases, unfortunately, are quite difficult to diagnose at the time of their onset. Most often, the diagnosis is made in the last stages of cancer. On the one hand, it is easier to detect a tumor during pregnancy, on the other hand, there are some difficulties in diagnosis.

It is easier to detect cancer during pregnancy due to the constant thorough examinations that a pregnant woman undergoes. Yes, the onset of pregnancy, women often neglect planned examinations, do not undergo medical examination, and for this reason, the onset of oncological disease most often goes unnoticed. During pregnancy, the situation changes, and the presence of the disease can be detected in a shorter time.

At the same time, the diagnosis of cancer during pregnancy is difficult due to the special condition of the body. So, for example, it is especially difficult to determine breast cancer during pregnancy, because a woman’s breasts swell during this period. Thus, the presence of a malignant neoplasm in the breast is very difficult to recognize, since on palpation such a neoplasm is very similar to the engorged mammary gland.

The best option for the detection of oncological neoplasms is an ultrasound examination. If during such a study there is a suspicion of cancer, it is necessary to prescribe treatment, you should not think that after childbirth the neoplasm will disappear on its own.

Cancer treatment during pregnancy

The treatment of cancer during pregnancy, of course, presents a certain difficulty, because most anticancer and other drugs used in therapy are toxic and negatively affect not only the health of the pregnant woman, but also the development of the fetus.

The course of therapy is prescribed after a thorough examination of the pregnant woman, only a qualified specialist develops a set of measures. Often, full treatment can begin only after childbirth.

There is an opinion that artificial termination of pregnancy will help stop the growth of a malignant tumor. This statement is based on the fact that after an abortion, the hormonal background of the body will change, pregnancy hormones will no longer be released into the body, and tumor growth will slow down. Such a statement is fundamentally wrong, because even after an abortion, the hormonal background will change gradually, it will take several months.

In addition, abortion itself is a huge stress for a woman's body. Yes, the hormonal background begins to change, but this happens against physiology, the body experiences significant overload, which can provoke the development of all kinds of diseases, including accelerating the growth of a malignant neoplasm.

Do not forget also that abortion weakens the immune system, which is unacceptable in oncological diseases. An important point is also the fact that when a woman terminates a pregnancy, she experiences a lot of negative emotions, depression can begin, which weakens the state of health in general.

Thus, if cancer is detected during pregnancy, it is necessary to seek help from qualified specialists who will prescribe adequate treatment during pregnancy, and after successful delivery, continue the course of therapy.

After childbirth, the hormonal background of the body will change naturally, which will help slow down the growth of the tumor, in addition, it will be possible to receive all types of treatment - prescribe chemotherapy. radiation therapy, etc. and this will allow the patient to recover as quickly as possible.