Obstetrical management of cancer in pregnancy and risk of adverse pregnancy and neonatal outcomes: a nationwide cohort study

Objectives. To investigate the obstetrical management of cancer in pregnancy and to determine adverse pregnancy and neonatal outcomes. Design. A register-based nationwide historical prospective cohort study. Setting and population. We assessed all pregnancies (N = 4,071,848) in Denmark from 1 January 1973 to 31 December 2018. Methods. We linked data on maternal cancer, obstetrical, and neonatal outcomes. Exposure was defined as pregnancies exposed to maternal cancer (n = 1,068). The control group comprised pregnancies without cancer. The groups were compared using logistic regression analysis and adjusted for potential confounders. Main outcome Measures. The primary outcome was the iatrogenic termination of the pregnancy (induced abortions/labor induction or elective caesarean section). Secondary outcomes were adverse neonatal outcomes. Results. More women with cancer in pregnancy, as compared to the control group, experienced first-trimester induced abortion; adjusted odds ratio (aOR) 3.7 (95% CI 2.8─4.7), second-trimester abortion; aOR 9.0 (6.4─12.6), iatrogenic preterm delivery; aOR 10.9 (8.1─14.7), and iatrogenic delivery below 32 gestational weeks; aOR 16.5 (8.5─32.2). Neonates born to mothers with cancer in pregnancy had a higher risk of respiratory distress syndrome; aOR 1.5 (1.2─2.0), but not of low birth weight; aOR 0.6 (0.4─0.8), admission to neonatal intensive care unit more than seven days; aOR 1.4 (1.1─1.9), neonatal infection; aOR 0.9 (0.5─1.5) nor neonatal mortality; aOR1.3 (0.6─2.6). Conclusion. Cancer in pregnancy implies an increased risk of iatrogenic termination of pregnancy and iatrogenic premature birth. Neonates born to mothers with cancer in pregnancy had no increased risk of severe adverse neonatal outcomes.

Colorectal cancer during pregnancy or postpartum: Case series and literature review

Background Colorectal cancer in young adults is on the rise. This rise combined with delayed childbearing increases the likelihood of colorectal cancer diagnosed during pregnancy or in the postpartum period. Methods Electronic health records were used to identify individuals with colorectal cancer in pregnancy or the postpartum period from 1 August 2007 to 1 August 2019. Results Forty-two cases were identified. Median age at diagnosis was 33 years. Most (93%) were diagnosed in an advanced stage (III or IV) and had left-sided colorectal cancer tumors (81%). Molecular analysis was completed in 18 (43%) women with microsatellite status available in 40 (95%). The findings were similar to historical controls. Sixty percent were diagnosed in the postpartum period. Common presenting symptoms were rectal bleeding and abdominal pain. Conclusion Currently there is no consensus recommendation regarding how to manage colorectal cancer during pregnancy. Given the overlapping symptoms with pregnancy, patients often present with advanced disease. We encourage all health care professionals caring for pregnant women to fully evaluate women with persistent gastrointestinal symptoms to rule out colorectal cancer.

312Long-term survival of women diagnosed with cancer during pregnancy or postpartum

Background Cancer is the second leading cause of death in reproductive-aged women, and the incidence of pregnancy-associated cancer is rising. We assessed long-term survival of women diagnosed with cancer during pregnancy or postpartum. Methods A population-based retrospective cohort study included all reproductive-aged women (18-50 years) with a cancer diagnosis in Alberta, Canada, 2004 to 2016. Hazard ratios (HR) were calculated for all-cause and cancer-specific mortality, comparing 244 women who were diagnosed with cancer during pregnancy and 670 women diagnosed with cancer within one year postpartum, with 3,680 women diagnosed with cancer outside of these periods as the referent. Cox regression adjusted for age at cancer diagnosis, parity, cancer stage, and type of cancer. Results Rates of cancer in pregnancy and postpartum did not increase across the study period (trend p-value=0.49). Women diagnosed with cancer in pregnancy had an adjusted HR of 1.61 (95% CI 1.07-2.41) for all-cause mortality, 1.67 (95% CI 1.09-2.57) for cancer-specific mortality, relative to the referent. Those diagnosed with cancer postpartum did not have a greater risk of all-cause (HR = 1.10, 95% CI 0.80-1.50) or cancer-specific (HR = 1.15, 95% CI 0.82-1.60) mortality. Conclusions The risk of all-cause and cancer-specific mortality is increased in women diagnosed with cancer during pregnancy. Key messages Women diagnosed with cancer during pregnancy experience poorer survival than those diagnosed in postpartum or remote from a pregnancy. These findings should be used by physicians to guide care of women diagnosed with pregnancy-associated cancers.

Recent Advances in Personalized Treatment of Cancer in Pregnancy

Cancer that occurs inside the pregnant or during the first postpartum year (or throughout lactation time) is considered gestational. The diagnosis of this entity is intrinsically accompanied by ethical problems when making clinical decisions about the disease and the newborn future [1,2]. Nowadays a modern medical treatment achieves treat cancer with the same prognosis than no-pregnant population and childbirth without any sequela. Spanish consensus of different specializations (Surgery, gynecology, radiology and radiotherapy and medical oncology) on the last year have published recommendations that allow harmonization of management and review the last advances in cancer in pregnancy [3].

Cancer and Pregnancy: A Comprehensive Review

Cancer diagnosis and treatment in pregnant women is a challenging situation. A multidisciplinary network of specialists is required to guide both, the expecting mother and the unborn child through the diagnostic workup and the cytotoxic therapy, by balancing the respective risks and benefits. Tumor entity, stage, biology and gestational week at diagnosis determine the appropriate approach. As premature delivery emerged as one of the main risk factors for adverse long-term outcome of the progeny, it should be avoided, if reasonable from the oncological perspective. This article offers a comprehensive review with respect to the various aspects of cancer in pregnancy.