Madrid, 11 September 2023-. Diagnosis of cancer during pregnancy is a rare occurrence, but it can happen. In Spain, it is estimated that around one in every 1,000 pregnant women receives a tumour diagnosis1. This particularly delicate and complex situation does not need to involve the termination of pregnancy but does require a combination of multidisciplinary professional teams and individualised treatments.
This is the opinion of Dr. Javier de Santiago, head of the Oncological Gynecology Service at MD Anderson Cancer Center Madrid – Hospiten, who underlines that the general consensus is that, if a woman is pregnant in the first trimester, the gestation process should be terminated. According to Dr. De Santiago, this idea “can be discarded". "Having a cancer during pregnancy does not necessarily mean having to interrupt it," says the specialist, who stresses that it is essential to individualise “completely” the treatment in this process.
On this issue, Dr. De Santiago explains that there are certain types of cancer diagnosis that are more frequent during pregnancy and that, among these, breast cancer2 stands out. This, he points out, is due to the advancement of age, which has been identified as a risk factor for this type of cancer, as well as an increased incidence, with breast cancer now positioned as the most commonly diagnosed form3. Evidence for this appears in the SEOM report Cancer figures in Spain 2023, which indicates that more than 35,000 breast cancers will be detected in Spain in 20233.
Multidisciplinary and individualised treatment for the patient
During pregnancy, due to potential risks to the foetus, some cancer treatments carry clear contraindications. These include radiation therapy, targeted therapies and immunotherapy3. The approach to this type of cancer, therefore, must both provide the mother with the appropriate treatment while guaranteeing the safety of the fetus.
According to Dr. De Santiago, cancer in pregnancy poses two major questions. On the one hand, how do we conduct diagnostic tests to detect the cancer? ”These we can safely perform because we have a series of tools that will not affect pregnancy, such as MRIs. Radiology tests can also be performed with adequate protection.” He said.
The second question is what treatment to apply. In the case of breast cancer, the specialist explains that we can evaluate various therapeutic scenarios without this involving a worse prognosis. "The possibility of using surgical treatment will depend on the location of the tumour and, in the case of breast cancer, can be a perfectly safe option," he continues.
Concerning complementary treatments, the specialist confirms that many of the available chemotherapy drugs can still be safe to use in the treatment of cancer during pregnancy, providing we take precautions and ensure far more regular checks than in a normal pregnancy to monitor the effect that the treatment may have on the growth of the fetus. However, Doctor De Santiago points out that we need to take into account the week of gestation and rule out their administration during the first trimester.
"It needs to be an absolutely personalised and multidisciplinary treatment, with follow-up by the perinatologist in conjunction with the gynaecologist including regular fetus surveillance. These patients will follow a complex course of treatment that requires a joint approach like that of any type of cancer. However, in such cases we must also add an obstetrics specialist, who will monitor the condition of the fetus at all times, and the presence of a psycho-oncologist,” concludes the head of the Oncological Gynecology Department at MD Anderson Cancer Center Madrid – Hospiten, who maintains that treating a tumour and carrying the pregnancy to term is fully possible.
References
- National Cancer Institute Cancer Treatment during Pregnancy: Questions about New Drugs. Available at: https://www.cancer.gov/espanol/noticias/temas-y-relatos-blog/2022/nuevos-medicamentos-tratamiento-cancer-durante-embarazo. Last accessed: July 2023.
- US National Library of Medicine. Tumours during pregnancy. Available at: https://medlineplus.gov/spanish/tumoursandpregnancy.html#:~:text=Los%20c %C3%A1nceres%20m%C3%A1s%20comunes%20en,m%C3%A9dico%20buscar%C3%A1n%20el%20mejor%. Last accessed: July 2023.
- Spanish Society of Medical Oncology (SEOM). Cancer figures in Spain 2023. https://seom.org/images/Las_cifras_del_Cancer_en_Espana_2023.pdf
- American Cancer Society. Treatment of breast cancer during pregnancy. Available at: https://www.cancer.org/es/cancer/tipos/cancer-de-seno/tratamiento/tratamiento-del-cancer-de-seno-durante-el-embarazo.html. Last accessed: July 2023.