Maternal neoplasms are rarely, if ever, transmitted to the fetus. The three most common cancers in pregnant women are cervical cancer (~1 case per 1000 pregnancies, depending on the country), breast cancer (~2 cases per 10,000 pregnancies), and lymphomas (Hodgkin’s disease or non-Hodgkin’s lymphomas). Cervical cancer may be missed when its early sign, vaginal bleeding, is attributed to the pregnancy. Pregnant women with vaginal bleeding should be examined, and suspicious cervical lesions biopsied. Conization is generally performed only after the first trimester because of the abortion risk.
Breast lumps may also be attributed to change associated with pregnancy. However, women with a dominant mass should undergo diagnostic evaluation (mammogram, ultrasound, biopsy). Resection of the primary lesion is safe, but radiation therapy is unsafe at any time during pregnancy. The fetus cannot be shielded from internal scattering of radiation; therapeutic doses are associated with spontaneous abortion, increased perinatal death, and defects in central nervous system and/or cognitive function. Tamoxifen is not safe for pregnant women.
Lymphoma is usually diagnosed on the basis of adenopathy or constitutional symptoms (fever, sweats, or weight loss). Staging evaluation is not undertaken during the first trimester; women in the first trimester should be counseled about termination of the pregnancy. Single-agent chemotherapy can be used in the second or third trimester as a temporizing measure. Vinblastine or doxorubicin have been used most commonly. Early induction of labor may permit the physician to maximize the survival chances of both the fetus and the mother. Survival rates for 28-week-old fetuses are about 75% and about 90% for 32-week-old fetuses.
Cancer survivors of reproductive age may desire children. Pregnancy may increase the risk of melanoma recurrence but does not influence breast cancer recurrence. Cancer treatment may deplete oocytes. Oocyte retrieval and storage of fertilized or nonfertilized eggs before cancer treatment may permit conception after the cancer has been treated successfully.