Рак и беременность.
Cancer and pregnancy
There is nothing more beautiful than the birth of a new life and there is nothing more dangerous. than oncological disease during pregnancy. This combination will have consequences for the two: for the future mother and for the future child.
Pregnancy does not provoke the onset of the oncological process, it stimulates the process of an already existing tumor in an organism.
But because of the absence of clinical manifestations of any tumor in the early stages (especially breast cancer), its detection often occurs during pregnancy in its progressive development. Before that, the woman considered herself healthy.
Before planning a pregnancy, every woman, especially after 30 years of age, must necessarily be examined by a doctor, with an ultrasound examination of the pelvic organs, mammary glands, thyroid gland, etc. When detecting any background or precancerous disease, it is necessary to undergo treatment, only then to become pregnant.
Cancer is the second cause of death among women of reproductive age and in ~ 0.1% of cases is combined with pregnancy. According to statistics, cancer occurs during pregnancy - 1 case per 1000 pregnancies.
The most commonly encountered in combination with pregnancy are:
1st place cervical cancer -44.2%
2nd place of breast cancer - 17.8%
3rd place - sarcoma - 7,1%
4th place - lymphomas - 5.9%
5th place - ovarian cancer - 5.5%
6th place - thyroid cancer - 2.4% 7-emesto-melanoma - 1,9%
8th place - uterine body cancer, vulvar cancer and vagina. No situation in practical medicine is as
complex and emotional as finding a pregnant woman with a malignant tumor. The diagnosis of cancer puts a woman in a difficult choice. her family and doctors. Interaction of obstetric and oncological problems is unavoidable, since pregnancy may indicate an adverse effect on the tumor, and a tumor on development and onset of pregnancy.
Pregnancy may reduce the cancer's prediction, and the treatment of the tumor can harm the fetus or reduce pregnancy.
The gap between the joy of the birth of a new life and the horror of the diagnosis of a malignant tumor creates many psychological and ethical problems. The clinician faces a difficult task in informing about the prognosis of the disease and pregnancy, as well as in the immediate realization of treatment, assuming responsibility for 2 lives.
Any malignant tumor during pregnancy should be treated in the same way as in the absence of pregnancy. When choosing a treatment method, the mother's interests should be placed first. But despite the presence of a cancer process and the need for treatment (surgical, chemotherapy, radiation therapy, etc.), a pregnant woman is able to bear and give birth to an absolutely healthy child, because the course of the cancer process very rarely affects directly on the fetus itself. But there are other more sad cases when the cancer spreads to the placenta and can be metastasized into the fetus. In 1886, the first case of MTS in the liver's mother's liver was described, which died on the 6th day after childbirth.
Over the past 100 years, only 35 cases of placenta and fetal metastases have been reported. Of these 29 - MTS in the placenta without fetal damage and 6
cases of MTS in the fetus.
In cervical cancer, cases of MTS in the placenta and the fetus are not registered. The MTS affects not the proximity of the tumor to the uterus, but its potential for generalization.
Diagnosis, treatment and prognosis of the disease during pregnancy are very complicated. The treatment plan is developed strictly individually, taking into account the stage of the disease, the period of pregnancy, the age of the pregnant woman and taking into account the desire to preserve the child.
Distant results of treatment and prognosis in a number of cases are disappointing.
But there are many cases of happiness of motherhood with fully cured oncological disease.
Cancer and Breastfeeding: After lactation, as a rule, lactation should be stopped.
1st place among tumors associated with pregnancy is cervical cancer. It is detected according to various authors from 1 to 13 cases per 10,000 pregnancies and 1 per 1000 - 2,500 births. Cervical cancer detected within 6 months after the abortion and 12-18 months after delivery can be attributed to tumors associated with pregnancy, and the clinical and morphological manifestations of the tumor process are present during pregnancy.
Over the past 10 years in Ukraine, the amount of cervical cancer in pregnancy has increased by 2 times.
Among all patients with cervical cancer, the frequency of combination with pregnancy is 1-3%, i.e., every 50 cases. In Dnipropetrovsk region, 6-9 cases of cervical cancer (9 out of 372 in 2016) are associated with pregnancy annually.
The average age of patients with cervical cancer in combination with pregnancy is 30 years. Causes and risk factors for cervical cancer in pregnancy are the same as in non-pregnant women. In recent years, a proportional increase in the frequency of human papillomavirus (HPV) during pregnancy (28-30%) compared with non-pregnant women (12.5 - 18.6%) was noted. Scientists noted an increase in HPV-positive patients during pregnancy (in the 1st trimester from 20.9% to 46% in the 3rd trimester) and a significant decline after delivery (17.5%). During pregnancy, processes of metaplasia of the cervical epithelium, which are most sensitive to HPV infection, are activated. Another explanation for the high frequency of HPV pregnancy detection may be hormonal changes that play a role in stimulating the replication of HPV DNA and make the detection of the virus more readily available during pregnancy.
It is extremely difficult to predict the biological behavior of the tumor of the cervix with a large spread of the process during pregnancy. The choice of therapeutic tactics depends not only on the stage of the disease and on the duration of pregnancy, but also on the patient most with regard to pregnancy and the method of treatment.
The prognosis of the disease in the early stages (insitu, 1-A, 1-B) during pregnancy does not differ from non-pregnant women. Although RHM is rare in pregnancy, but in general it is found to be an unpredictable prediction.
At stage 1-A-1 organ-preservation surgery is possible even during pregnancy - electroconation of the cervix. And in stage 1-A-2 or stage 1-B, an organ-preserving operation is possible -traheletectomy, when a neck affected by a cancerous tumor is removed from the pregnant uterus and regional lymph nodes are removed. And so
At stage 1-B, depending on the period of pregnancy, delivery is also carried out by the operation of the Caesarean section and extended panthistorectomy of the 3rd type. At the 2nd and 3rd stages of the disease, the choice of treatment is even more difficult, is developed by the consilium individually; treatment starts depending on the duration of the pregnancy: (up to 16 weeks with radiotherapy, and after 16 weeks a small cesarean section and then radiotherapy)
2nd place is breast cancer (breast cancer). There are 1 case in 3,000 pregnancies. In recent years, cases of breast cancer have become more frequent, and even the underdeveloped forms during pregnancy. Treatment for breast cancer should be started without delay and does not differ from the treatment in non-pregnant women (surgery, chemotherapy, radiation therapy, etc.).
Ovarian cancer during pregnancy is a very rare disease and accounts for ~ 0.5% of the total number of pregnancies. The frequency of PP in pregnancy is 1 case in 9000 - 20 000 pregnancies. Diagnosis of RA during pregnancy is very complicated. Tumor markers (CA-125 and NE-4), which are used for diagnosis of RH, do not carry full information, since during pregnancy they are always elevated. Help in the diagnosis of ultrasound examination of pelvic organs and alertness of the doctor, especially if the woman has or had a cyst of the ovary.
When detecting ovarian cancer, sarcoma, lymphomas in pregnant women begin treatment immediately. The treatment scheme is developed by a consensus consisting of a oncologist, a chemotherapist and a radiologist. Chemotherapy, radiation therapy, surgical treatment on the fetus have no adverse effects. The child can be born alive and healthy.
Endometrial cancer and uterine tubes associated with pregnancy are also extremely rare diseases. Prognosis for endometrial cancer is favorable. In case of cancer of the fallopian tube, the treatment is prolonged, the disease can recur.
Gastric and intestinal cancer during pregnancy is extremely rare disease and manifests itself by the discovery of large size of metastases in the ovaries - the tumor of Krukkenberg. Nausea and vomiting, loss of appetite and weight in a pregnant woman are often interpreted as a manifestation of toxicosis and the woman does not pay attention to them, does not hurry to the doctor. And only a significant increase in the abdomen and the appearance of "cysts" of the ovary causes the woman to be examined in depth. Treatment is very complicated, it must be started immediately, taking into account the condition of the mother and the fetus.
Thyroid cancer during pregnancy is a rare disease, but requires treatment. As a rule, at early stages of the disease treatment is operational, but the choice of treatment depends on many factors. If the disease is detected in the first trimester and when puncture biopsy revealed highly differentiated cancer, surgical treatment can be performed in 15-16 weeks of pregnancy. When the disease is detected in 2-3 trimesters and at G-1, surgical treatment can be delayed until the end of pregnancy. And if G-3 is present, treatment should be performed without delay after 15-16 weeks of gestation.
Pregnancy after cured cancer: chances, risks, hopes and prognosis.
Until the beginning of cancer treatment in non-pregnant young women (with lymphoma, melanoma, sarcoma, genital cancer, etc.), for the purpose of preserving the genital function can be preserved eggs.
After the cancer is cured, a woman's reproductive function can be restored (using canned eggs, using donor eggs, IVF, surrogate motherhood).
The prognosis of any cancer associated with pregnancy depends on the stage of the disease, age, and the radicalness of the treatment.
Cancer is curable if you contact a doctor in a timely manner.
Dyakova Valentina Nikolaevna Physician-oncogynecologist chief freelance specialist
On the questions of oncognetology of the GOU of the Regional State Administration of the Dnieper