ESMO E-Learning: Cancer Management During Pregnancy

Learning Objectives

  • To critically discuss the risks and benefits of different treatment modalities for cancer during pregnancy and postpartum periods
  • To distinguish the mechanism of action, recognize potential side effects of various medical treatments and monitor for their impacts on foetal growth, baby and mother outcomes
  • To outline management strategies for the various stages of different cancer types during pregnancy according to the currently available evidence
Title Duration Content CME Points CME Test
Cancer Management During Pregnancy 109 min. 79 slides 1 Take Test
Nicholas Pavlidis
Nicholas Pavlidis
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Stergios Boussios
Stergios Boussios
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George Pentheroudakis
George Pentheroudakis
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This module has been produced by a renowned European group in the field of cancer management during pregnancy. The authors are also involved in the production of the ESMO Clinical Practice Guidelines on the subject of cancer, pregnancy and fertility. It is a necessary topic that involves two people, the mother and the foetus.

The module provides important messages that medical professionals should consider for optimal maternal treatment whilst safeguarding the foetal well-being, when the two are compatible.

It is an increasingly significant medical problem due to the observed trend toward delaying pregnancy into the later reproductive years. Therefore, more cases of cancer complicated pregnancies are expected to be seen. The condition raises considerable medical, ethical, psychological and religious issues.

Cancer is the second most common cause of death during the reproductive years. However, the occurrence of cancer in a pregnant woman is relatively rare, 0.07-0.1% of all malignant tumours. In this module, the authors emphasize optimal good standards: to try to benefit the mother’s life, to try to treat curable malignant disease of pregnant women, to try to protect foetus and newborn from harmful effects of cancer treatment, and to try to retain the mother’s reproductive system for future gestations.

When a drug is administered to the mother, placental transfer of the drug could be hazardous to the foetus. However, in most cases toxic effects were reported when treatment was given during embryogenesis in the first trimester. Chemotherapy agents have a molecular weight of 250-400 kDa and it is well known that most drugs with molecular weight of less than 600 KDa are able to cross the placenta. Still, most of the available data on the teratogenic risks of chemotherapy are based on case reports and retrospective series. Therefore, more data is needed.

This E-learning module provides more detailed explanation on current evidence of effects of chemotherapy by gestational stage, including miscarriage, foetal malformations, premature birth, low birth rate, effects on physical and neurocognitive functions, effects on gonads, a risk for second tumours, susceptibility for side effects from cancer-related treatment in the maternal body, etc.

In addition to covering the principles of systemic anticancer treatment (chemotherapy, hormonal therapy, targeted agents) for cancer during pregnancy and the potential for abortion/malformations by specific drug type, this module also covers the adverse effects of supportive care, and also the adverse effects of radiation in relation to gestational status. It provides recommendations for staging imaging tests in pregnant women with cancer and radiotherapy doses. Furthermore the module specifically discusses breast cancer associated with pregnancy and pregnancy safety after breast cancer, cervical cancer, ovarian cancer, melanoma, gastrointestinal cancers, and lymphoma and leukaemia associated with pregnancy.

The authors provide facts on placental involvement by tumour type and recommendations to clinicians for sending the placenta for microscopic and histopathological examinations, cytologic examination in both maternal and umbilical cord blood and clinical examination of neonates. Additionally, it has breastfeeding advice for such a situation. Furthermore, it summarises follow-up recommendations for people exposed to chemotherapy in utero.

Facing a pregnant woman with cancer in the clinic always imposes a difficult medical situation. Given the relative rarity of the topic, there is a lack of data from large randomised trials. Hence, the facts presented in this module are the authors’ best effort to summarise currently available evidence on the topic. Besides giving general principles, this material provides state of the art information regarding different cancer types in pregnant women.  

Last update: 12 November 2013

The authors have reported no conflicts of interest