Cancer in pregnancy: To treat or not?

e12533 Background: Cancer in pregnancy accounts for ~1 in 1,000 pregnancies. Studies show that cytotoxic agents are safe from the second trimester. Long-term follow up has not shown increased malformations or malignancies in children exposed to chemotherapy in utero. There is no evidence of worse outcomes among women diagnosed in pregnancy. Methods: We retrospectively identified women diagnosed with cancer in pregnancy over a 25-year period. Medical records were reviewed for demographics, diagnosis, gestation, timing of treatment and outcomes. We assessed if all cancers need to be treated in pregnancy or if treatment could be safely deferred to allow normal delivery. Results: Twenty-five women were diagnosed with cancer in pregnancy and referred to medical oncology. Of 25 women, 16 (64%) received chemotherapy during pregnancy. These included 13 cases of breast cancer, one Ewing’s sarcoma, one ovarian cancer, and one small cell of cervix. All 16 women received doxorubicin and cyclophosphamide. There were 15 live births and no abnormalities seen in children who received chemotherapy in utero. At a median follow-up of 6 years 11 mothers (69%) are disease free and 4 (25%) have recurrent disease. Of nine mothers who did not receive chemotherapy in pregnancy, seven received chemotherapy immediately post-partum. Six (86%) were diagnosed in early pregnancy (median gestation 13 weeks). There were three cases of Hodgkin lymphoma, two breast cancers, and one ovarian cancer. At a median follow-up of 12 years, all mothers remain disease free. There were no abnormalities seen in these children. Conclusions: We did not identify any adverse outcomes in mothers or infants exposed to chemotherapy during pregnancy. We identified a cohort of patients that do not need immediate treatment during pregnancy. In selected cases, it is safe and appropriate to delay chemotherapy until delivery of the baby. There were no adverse outcomes to mothers due to delayed treatment and no adverse outcomes to babies not exposed to chemotherapy in utero. A multi-disciplinary team is essential to individualize treatment planning. [Table: see text]

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HYPOTHYROIDISM IN PREGNANCY -SIGNIFICANCE OF ADEQUATE TREATMENT: A STUDY OF 100 CASES IN NORTH BIHAR

10.36106/ijsr/7509847 ◽

2021 ◽

pp. 40-41

Author(s):

Vasudha Rani ◽

Punam Kumari

Keyword(s):

Post Partum ◽

Adverse Outcomes ◽

Endocrine Disorders ◽

Potential Threat ◽

Adequate Treatment ◽

Antibody Positivity ◽

Prompt Diagnosis ◽

In Pregnancy

Pregnancy is a nature's gift of humanity for procreation and continuation of its race. This gift is however fraught with several complications and has potential threat to the mother and the foetus. When pregnancy is compounded by endocrine disorders such as hypothyroidism, the potential for maternal and foetal adverse outcomes can be immense. While a lot of attention has been focused on the adverse foetal outcomes consequent to hypothyroidism, attention is also being gradually directed towards the adverse maternal outcomes of this disorder. Role of antibody positivity in inuencing outcomes in a euthyroid woman, also needs further clarication. Prompt diagnosis and treatment of hypothyroidism in pregnancy is very essential. Subclinical hypothyroidism also needs to be detected and treated to prevent adverse outcomes, especially maternal. Since women with hypothyroidism during pregnancy, especially of the autoimmune variety might have a are up of the disorder post-partum, or might continue to require thyroxine replacement post-partum, adequate follow-up is mandatory. While targeted case nding is generally practised, recent evidence seems to indicate that universal screening might be a better option. In conclusion, routine screening, early conrmation of diagnosis and prompt treatment allied with regular post-partum follow up, is required to ensure favourable maternal and foetal outcomes.

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Spontaneous rupture of malignant ovarian cyst in 8-gestation-week pregnancy: A case report and literature review

Archive of oncology ◽

10.2298/aoo1102039m ◽

2011 ◽

Vol 19 (1-2) ◽

pp. 39-41 ◽

Cited By ~ 1

Author(s):

Ljiljana Mladenovic-Segedi ◽

Aljosa Mandic ◽

Dimitrije Segedi ◽

Tatjana Kozarcic

Keyword(s):

Ovarian Cancer ◽

Histopathological Examination ◽

Post Partum ◽

Cystic Tumor ◽

Medical Observation ◽

Healthy Female ◽

Good General Condition ◽

Cancer In Pregnancy ◽

Gestational Week ◽

In Pregnancy

Ovarian cancer takes the second place in the incidence of all genital carcinomas occurring in pregnancy. In spite of a low overall incidence of ovarian cancer in pregnancy and, in most cases, asymptomatic clinical picture, the routine use of ultrasonographic examination in early pregnancy has led to a more frequent detection of adnexal masses in pregnant women. The authors presented a case of a 35-years-old patient with the diagnosis of unilocular cyst in the left ovary detected by ultrasonography at gestational week 8, with the subsequent sinistral adnexectomy administered for the rupture of the cystic tumor. Based on the histopathological examination we established the diagnosis of a serous cystadenocarcinoma stage I. The patient refused any proposed modality of oncologic diagnostics and therapy, and delivered a healthy female newborn of 3630g/49 cm, 10 days after the probable term of delivery. The control MRI, 8 months post partum did not confirm the presence of any pathological changes of either genital organs or any other organ of the small pelvis. The patient is in good general condition, under continual medical observation.

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Abstract 15193: Pulmonary Hypertension in Pregnancy: WHO Group 1 Outcomes Improved, Time to Focus on WHO Group 2

Circulation ◽

10.1161/circ.142.suppl_3.15193 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

William H Marshall ◽

Stephen Gee ◽

Woobeen Lim ◽

Elisa A Bradley ◽

Lauren Lastinger ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Post Partum ◽

Systolic Pressure ◽

Adverse Outcomes ◽

Cardiac Events ◽

Ventricular Systolic Pressure ◽

Group 5 ◽

Group 2 ◽

In Pregnancy ◽

Group 1

Introduction: Pregnancy is contraindicated in women with pulmonary hypertension (PH), yet many still decide to pursue pregnancy. Hypothesis: We hypothesized improved maternal mortality with PH at our center’s cardio-obstetrics program and sought to identify factors to estimate the risk of major adverse cardiac events (MACE). Methods: Pregnant women with right ventricular systolic pressure (RVSP) ≥35 mmHg or tricuspid regurgitant velocity > 2.8 m/s on transthoracic echocardiogram (TTE) were identified. Women with intermediate to high probability PH by ESC criteria (TTE or catheterization, n = 70) were classified using the 6 th World Society of PH definitions. Results: In 70 women with PH (30 ± 6 years-old, RVSP 52 ± 16 mmHg) there were 12 (17%) with WHO Group 1 PH, 45 (64%) with Group 2 PH, 4 (6%) with Group 3 PH and 9 (13%) with Group 5 PH (Figure A). Baseline characteristics were similar except: Group 1 PH had 83% on prostacyclin (PC) therapy, higher RVSP (78 ± 20 mmHg vs. Groups 2 (46 ± 9), 3 (44 ± 2 mmHg) and 5 PH (48 ± 10mmHg), p<0.01), and compared to Group 2 PH, more Group 1 PH women were diagnosed pre-pregnancy (9 (75%) vs. 12 (27%), p = 0.01) and had cardio-obstetrics care (10 (83%) vs. 16 (36%), p < 0.01) (Figure B - E). There were no peripartum deaths, however 3 (4.3%) women with Group 2 PH had late mortality (7 ± 4 months post-partum). MACE occurred in 24 (34%) women and was more likely in those with: NYHA FC ≥ 2 (95% CI 4.7-57, p < 0.01), pre-eclampsia (95% CI 1.2-13, p = 0.03), RVSP >50 mmHg (95% CI 1.3-10, p = 0.02) and LVEF <50% (95% CI 1.1-8.8, p = 0.04) (Figure F). Preterm birth occurred in 32 (49%) pregnancies, with no neonatal mortality. Conclusion: To conclude, in a large single center cohort we report 100% 1-year survival in Groups 1, 3, and 5 PH, with most Group 1 PH patients on PC therapy and under cardio-obstetrics care. We identify Group 2 PH as an under-recognized group for adverse outcomes in pregnancy, with NYHA FC, pre-eclampsia, RVSP >50 mmHg and LVEF <50% associated with increased MACE.

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Salvage radiation therapy for localized recurrent ovarian cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000247 ◽

2019 ◽

Vol 29 (5) ◽

pp. 916-921

Author(s):

Alicia Smart ◽

Yu-Hui Chen ◽

Teresa Cheng ◽

Martin King ◽

Larissa Lee

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Clear Cell ◽

Recurrent Ovarian Cancer ◽

Salvage Radiotherapy ◽

Platinum Sensitive ◽

Long Term Survivors ◽

Disease Free

IntroductionTo evaluate clinical outcomes for patients with localized recurrent ovarian cancer treated with salvage radiotherapy.MethodsIn a retrospective single institutional analysis, we identified 40 patients who received salvage radiotherapy for localized ovarian cancer recurrence from January 1995 to June 2011. Recurrent disease was categorized as: pelvic peritoneal (45%, 18), extraperitoneal/nodal (35%, 14), or vaginal (20%, eight). Actuarial disease-free and overall survival estimates were calculated by Kaplan–Meier and prognostic factors evaluated by the Cox proportional hazards model.ResultsMedian follow-up was 42 months. Median patient age was 54 years (range, 27–78). Histologic subtypes were: serous (58%, 23), endometrioid (15%, six), clear cell (13%, five), mucinous (8%, three), and other (8%, three). At the time of salvage radiotherapy, surgical cytoreduction was performed in 60% (24) and 68% (27) had platinum-sensitive disease. Most patients (63%, 25) received salvage radiotherapy at the time of first recurrence. Relapse after salvage radiotherapy occurred in 29 patients at a median time of 16 months and was outside the radiotherapy field in 62%. 18 At 3 years, disease-free and overall survival rates were 18% and 80%, respectively. On multivariate analysis, non-serous histology (hazards ratio 0.3, 95% CI 0.1–0.7) and platinum-sensitivity (hazards ratio 0.2, 95% CI 0.1–0.5) were associated with lower relapse risk. Platinum-sensitivity was also associated with overall survival (hazards ratio 0.4, 95% CI 0.1–1.0). Four patients (10%) were long-term survivors without recurrence 5 years after salvage radiotherapy. Of the five patients with clear cell histology, none experienced relapse at the time of last follow-up.DiscussionPatients with non-serous and/or platinum-sensitive ovarian cancer had the greatest benefit from salvage radiotherapy for localized recurrent disease. Although relapse was common, radiotherapy prolonged recurrence for > 1 year in most patients and four were long-term survivors.

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P11.09: A case of mature teratoma with strumal foci mimicking borderline ovarian cancer in pregnancy

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.18109 ◽

2017 ◽

Vol 50 ◽

pp. 189-190

Author(s):

R. Heremans ◽

W. Froyman ◽

C. Landolfo ◽

S. Han ◽

P. Moerman ◽

...

Keyword(s):

Ovarian Cancer ◽

Mature Teratoma ◽

Cancer In Pregnancy ◽

Borderline Ovarian Cancer ◽

In Pregnancy

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A case of early-stage epithelial ovarian cancer in pregnancy

International Journal of Gynecological Cancer ◽

10.1046/j.1525-1438.2001.01047.x ◽

2001 ◽

Vol 11 (5) ◽

pp. 413-417 ◽

Cited By ~ 33

Author(s):

G. Otton ◽

S. Higgins ◽

K. A. Phillips ◽

M. Quinn

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Early Stage ◽

Cancer In Pregnancy ◽

In Pregnancy

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Management of differentiated thyroid cancer diagnosed during pregnancy

Acta Endocrinologica ◽

10.1530/eje.0.1400404 ◽

1999 ◽

pp. 404-406 ◽

Cited By ~ 42

Author(s):

L Vini ◽

S Hyer ◽

B Pratt ◽

C Harmer

Keyword(s):

Thyroid Cancer ◽

Bone Metastases ◽

Differentiated Thyroid Cancer ◽

Subtotal Thyroidectomy ◽

Second Trimester ◽

Original Cohort ◽

Well Differentiated ◽

Disease Free ◽

In Pregnancy

OBJECTIVE: To assess the outcome of thyroid cancer diagnosed during pregnancy. DESIGN: Retrospective analysis of patients diagnosed between 1949 and 1997 with thyroid cancer presenting during pregnancy. RESULTS: Nine women with a median age of 28 years were identified. A thyroid nodule was discovered by the clinician during routine antenatal examination in four cases, the remainder had noted a lump in the neck. In all patients, the nodule was reported to almost double in size during the pregnancy. One patient underwent subtotal thyroidectomy during the second trimester; eight were operated on within 3 to 10 months from delivery. Total thyroidectomy was performed in five and subtotal thyroidectomy in four. All tumours were well differentiated and ranged in size from 1 to 6 cm. OUTCOME: The median follow-up was 14 years (5-31 years). One patient relapsed locally requiring further surgery. One patient developed bone metastases dying 7 years after presentation; her planned treatment had been delayed because of an intervening pregnancy. Eight of the original cohort of patients are currently disease free. CONCLUSIONS: Differentiated thyroid cancer presenting in pregnancy generally has an excellent prognosis. When the disease is discovered early in pregnancy, surgery should be considered in the second trimester but radioiodine scans and treatment can be safely delayed until after delivery. In all cases, treatment should not be delayed for more than a year.

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