Nasopharyngeal carcinoma in pregnancy: A Case Report
Nasopharyngeal carcinoma (NPC) in pregnancy presents a dilemma in managing the patient with much consideration to both mother and the unborn child.
Aims: To present the treatment outcome of nasopharyngeal carcinoma in pregnancy. Methods/design: Case report.
Results: This is a case of a 33-year old female who presented with a gradually enlarging bilateral neck masses during her second trimester of pregnancy. Her neck CT Scan showed a nasopharyngeal mass which was more prominent at the right measuring 3.3 x 5.3 x 3.0 cm. There were inhomogenously enhancing lobulated densities in the lateral cervical areas with the largest measuring 11.6 x 5.8 x 7.0 cm. Inhomogenously enhancing densities were seen in the supraclavicular, posterior and anterior cervical and submandibular areas with the largest seen at the right supraclavicular area measuring 1.8 x 2.5 x 2.1 cm. Punch biopsy of the nasopharyngeal mass revealed it to be morphologically consistent with nasopharyngeal carcinoma, non keratinizing, differentiated type (T3N3M0). Metastatic work up was unremarkable. She consented to begin her treatment with Gemcitabine and Cisplatin every 21 days as induction chemotherapy. Since the neck masses continued to rapidly increase in size after three cycles of chemotherapy, she was shifted to Paclitaxel and Carboplatin. At 26 weeks of gestation, she delivered a male infant weighing 970 grams with APGAR scores of 8 and 8 at 1 and 5 minutes, respectively, via normal vaginal spontaneous delivery with complete breech extraction. She has completed 6 cycles of chemotherapy and 70 Gy in 35 fractions of intensity modulated radiation therapy. The infant showed no anatomical and organ malformations. The patient showed an almost complete response after six cycles of chemotherapy.
Conclusion: Systemic chemotherapy in a pregnant NPC patient can be administered initially as a means of a delaying measure to reach a certain period of gestation where it is safer to deliver the baby. Radiation therapy can follow after the delivery to spare the unborn child from the hazards of radiation. Guided and shared decision making between the patient, family, and her physicians is vital in directing the management of NPC in pregnancy.