Pregnancy in cancer patients and survivors

Abstract

As the number of survivors of childhood and young adult cancers increases, it is becoming more common to manage the pregnancies of women who have a history of exposure to chemotherapies and radiation therapy. Similarly, these women want to know what the effect of their past cancer and cancer treatment will have on their ability to carry a pregnancy to term as well as on their future children's health. Chemotherapeutic agents and radiation exposure can have long-term effects on cardiovascular, pulmonary, and renal function; normal adaptations in these same systems occur during pregnancy to ensure fetal health. The patient should be counseled—preferably preconceptionally—about the potential fetal and maternal risk of previous cancer treatment. An understanding of the patient's cancer type and treatment history can help the obstetrician in planning prenatal care and monitoring during pregnancy. For women who are diagnosed with cancer during a pregnancy, care is multidisciplinary, provided by a team of obstetricians, maternal-fetal medicine specialists, surgeons, oncologists, neonatologists, nurses, and mental health professionals. Treatment must balance the risks to the mother in terms of her cancer treatment and prognosis against the risks posed to the fetus by treating the cancer. Treatment decisions take into consideration the age of the mother, the type and stage of cancer, and the length of the pregnancy. This information will be used to determine whether and how to treat the cancer, timing of treatment, and the type of surveillance that will be used during the pregnancy. Patients should be counseled on the impact of radiation and chemotherapy on the fetus, that certain chemotherapeutic agents can cross the placenta, and the ability of the fetus to metabolize these drugs.