| Abstract: |
The occurrence of cancer in pregnant women is not a common phenomenon. The incidence ranges from 0.07% to 0.1% of all malignant tumors; although a variety of other benign neoplasms (i.e. desmoid tumors and pheochromocytoma) are also seen. The most common malignancies associated with pregnancy include cervical cancer, breast cancer, melanoma, lymphomas, and leukemias.Most reproductive-aged women who have cancer are capable of ovulating and, therefore, able to conceive at any time. When pregnancy is diagnosed, chemotherapy may be continued or begun and should not be unnecessarily withheld. In general, systemic therapy for cancer in pregnancy must be individualized and may be different if the patient is diagnosed during the first versus the second or third trimesters. Chemotherapy during the first trimester may cause more severe fetal effects, and in cases where a malignancy that requires chemotherapy is diagnosed during the first trimester, termination of pregnancy is a consideration.When cancer is diagnosed in a pregnant woman, life-saving chemotherapy for the mother poses life-threatening concerns for the developing fetus. Depending on the type of cancer and the stage at diagnosis, chemotherapy cannot necessarily be delayed until after delivery. Women diagnosed with acute lymphoblastic leukaemiawho decline both termination and chemotherapy often die with the previable fetus in utero. Safe use of chemotherapy, especially during the second and third trimester, has been reported, and pregnant women with cancer can accept therapy without definite neonatal harm. Here, we review the use of chemotherapy in pregnancy by trimester of exposure and summarize neonatal outcomes, including malformations, perinatal complications, and oldest age of neonatal follow-up. We will also discuss the modes of action of the drugs used and look at the multiagent regimens recommended for use during pregnancy.
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