Cancer and Pregnancy: The Clinician's Perspective

Although uncommon, the incidence of cancer complicating pregnancy is increasing. Managing these pregnancies creates many diagnostic, therapeutic, and ethical dilemmas for the patient, her family, and the medical care team. Despite concerns for fetal well-being, maternal survival should be the first priority. Although surgery and chemotherapy may be used during pregnancy, radiation is generally contraindicated. For most nongynecologic cancers, termination of pregnancy does not improve maternal outcome. Iatrogenic prematurity is the most common pregnancy complication associated with malignancy in pregnancy because many of these infants are delivered early to facilitate maternal treatment. Overall, maternal cancer survival is generally good and does not differ from that of nonpregnant patients. Target Audience: Obstetricians and gynecologists, hematologists/oncologists, family physicians, nurse midwives Learning Objectives: After completing this CME activity, physicians should be better able to describe differences in diagnostic imaging when treating pregnant patients with malignancy; explain basic principles of surgery, chemotherapy, and radiation therapy during pregnancy; identify cancers known to metastasize to the placenta and to the fetus; and choose the appropriate diagnostic and treatment considerations for pregnant women with certain nongynecologic malignancies.