Coexistence of Pregnancy and Malignancy

The
Oncologist
Coexistence of Pregnancy and Malignancy

NICHOLAS A. PAVLIDIS
Department of Medical Oncology, Medical School, University of Ioannina, Ioannina, Greece
Key Words. Pregnancy Cancer Diagnosis Staging Treatment
A BSTRACT
cult because it involves two persons, the mother and
the fetus.
In this paper we review: A) the therapeutic and
diagnostic management of these patients; B) the safety
of diagnostic and therapeutic procedures; C) the
metastatic pattern of the maternal tumors to the placenta and fetus, and D) the potential recommendations for therapeutic abortion. The Oncologist
2002;7:279-287
INTRODUCTION
The occurrence of cancer in pregnant women is not a
common phenomenon. The incidence ranges from 0.07% to
0.1% of all malignant tumors, although a variety of other
benign neoplasms (i.e., desmoid tumors, pheochromocytoma)
are also seen. The most common malignancies associated
with pregnancy include cervical cancer, breast cancer,
melanoma, lymphomas, and leukemias (Tables 1 and 2) [1-4].
It is estimated that about 3,500 new cases of cancer are

diagnosed annually in pregnant women in the U.S., which
is equivalent to one case every 1,000 gestations [5]. As the
trend for delaying pregnancy into the later reproductive
years continues, physicians can probably expect to see more
cases of cancer complicating pregnancy.
Clear guidelines for the management of these women
are very important. Despite the absence of strict guidelines,
Table 1. Incidence of malignant tumors during gestation [1-4]
Table 2. Distribution of cancer in pregnant women
Tumor type
Incidence*
Site
n of cases
Breast cancer
1:3,000-10,000
Breast
298
26
Cervical cancer
1.2:10,000
Cervix
294
26
Hodgkins disease
1:1,000-6,000
Leukemia
174
15
Malignant melanoma
2.6:1,000
Lymphoma
119
10
Leukemias
1:75,000-100,000
Melanoma
93
Ovarian cancer
1:10,000-100,000
Colorectal cancer
1:13,000
Thyroid
45
111
11
1,134
100
*Malignant tumors per pregnancies or deliveries
Miscellaneous
Total
Correspondence: Nicholas A. Pavlidis, M.D., Department of Medical Oncology, Medical School, University of Ioannina, 45110
Greece. Telephone and Fax: 30-651-99394 and 30-651-97505; e-mail: npavlid@cc.uoi.gr Received December 5, 2001;
accepted for publication March 21, 2002. AlphaMed Press 1083-7159/2002/$5.00/0
The Oncologist 2002;7:279-287 www.TheOncologist.com
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Cancer complicating pregnancy is a rare coexistence.

The incidence is approximately 1 in 1,000 pregnancies. The
most common cancers are those more frequently seen during the reproductive age of a woman. Breast cancer, cervical cancer, Hodgkins disease, malignant melanoma, and
leukemias are the most frequently diagnosed malignancies
during gestation.
The diagnostic and therapeutic management of
the pregnant patient with cancer is especially diffi-
280
scans, and computerized tomography should be avoided. In

contrast, chest x-ray and abdominal ultrasound are indicated
as staging procedures.
In certain cases, i.e., brain tumors or pheochromocytomas, magnetic resonance imaging is recommended since
it has the benefit of avoiding ionizing radiation to the fetus.
SAFETY OF DIAGNOSTIC WORK-UP
SOLID TUMORS ARISING DURING GESTATION
Staging Radiodiagnostic Procedures

Ionizing radiation includes gamma rays, x-rays, and
particulate radiation. Epidemiological studies have established the potential of ionizing radiation to induce leukemia
and solid tumors in children and adults [6, 7].The radiation
effect on fetal life seems to be dose dependent (Table 3). In
addition, the adverse effects of radiation are directly related
to the stage of gestationthe earlier the stage, the more
detrimental the expected effects (Table 4).
It has been suggested that in utero exposure to radiodiagnostic procedures may cause leukemia or solid
tumors. This comes from the results of a number of studies mainly based on the Oxford Survey of Childhood
Cancer, which showed a greater risk (1.3-3.0) of leukemia
after exposure, especially when exposure was during the
first trimester [8].
In a large study on 32,000 twins, the relative risk for
leukemia and solid tumors was 1.6 and 3.2, respectively [9].
Despite numerous studies that correlate childhood leukemia
with prenatal radiation, there is still uncertainty whether it
plays a causative or an associative role.
In pregnant women with cancer, staging imaging tests
should be limited to those associated with the lowest exposure to ionizing radiation. Abdominal plain films, isotope
Breast Cancer
Table 3. Radiation dose effect on fetal life

Dose
Effect on fetus
<0.1 Gy (<10 rad)
No major effect
0.1-0.15 Gy (10-15 rad)
Increased risk
2.5 Gy (250 rad)
Malformations in most
>30 Gy (300 rad)
Abortion
Epidemiology
The incidence of breast cancer during pregnancy is
approximately 1 in 3,000 pregnancies [10]. It has been estimated that 0.2%-3.8% of all breast tumors are coincident
with pregnancy. Pregnancy-associated breast cancer is
defined as carcinoma that is diagnosed during pregnancy or
within 1 year postpartum. The median age of these women
is 33 years, ranging from 23 to 47 [11].
It is estimated that for an obstetrician managing
approximately 250 deliveries annually, he/she would
require at least 40 years of clinical practice to see two to
three cases of pregnancy-associated breast cancer.
Diagnosis
Pregnant women are at a higher risk of presenting with
more advanced disease than nonpregnant women since
small lumps cannot be easily detected due to the natural tenderness and engorgement of the breasts during pregnancy
and lactation. Average delays of 5 to 7 months are reported.
Most patients present with painless masses, 90% of
which are detected by self-examination. Diagnosis of breast
cancer should be made as early as possible. Breast examination must be a regular clinical practice to detect persisting and enlarging masses, nipple or skin retraction, other
skin changes, or axillary lymphadenopathy.
Due to a difference in radiographic density, the sensitivity of mammography in detecting cancerous changes in
breasts of pregnant women is about 68%, while that of
ultrasonography is around 93% [12]. Diagnosis may be
safely made with a fine-needle aspiration or excisional
biopsy under local anesthesia. Zemlickis et al. showed that
Table 4. Adverse effects of radiation in relation to gestation stage

Stage
Period
Adverse effect
Preimplantation/immediate postimplantation
From conception to day 9-10
Lethal
Early organogenesis
Weeks 2-6
Teratogenesis, growth retardation
Late organogenesis/early fetal period
Weeks 12-16
Mental and growth retardation, microcephaly
Late fetal stage
From weeks 20-25 to birth
Sterility, malignancies, genetic defects
the following optimal gold standards should always be followed: A) try to benefit the mothers life; B) try to treat curable malignant disease of pregnant women; C) try to protect
the fetus and newborn from harmful effects of cancer treatment, and D) try to retain the mothers reproductive system
intact for future gestations.
Pavlidis
281
after the first trimester of pregnancy. Berry et al. treated 24

pregnant patients suffering from primary or recurrent
breast cancer with CMF combination chemotherapy.
Chemotherapy was safely administered to all patients after
the first trimester [15].
Again, in the Petrek et al. study, the 5-year survival of
patients with positive axillary nodes was 47% for pregnant
and 59% for nonpregnant women, whereas 10-year survival
rates were 28% and 41%, respectively. Statistical analysis
showed no difference between pregnant and nonpregnant
women [16].
Treatment
The strategies for therapeutic management of pregnancy-associated breast cancer are mainly dependent on the
disease stage.
Fetal Outcome
Zemlickis et al. reported that radiation alone or in combination with systemic therapies was given to 73 of the 118
pregnant women, while 26 patients were treated with
chemotherapy alone. Concerning fetal outcome, 22 pregnancies were terminated by therapeutic abortion, 12 by
miscarriage, and there were 85 deliveries, 21 of which were
by cesarean section. Of the 85 deliveries, there were 83 live
births and two stillbirths [13] (Table 5).
Early Breast Cancer (Stages I and II)

Modified radical mastectomy is the treatment of choice
for stage I and stage II breast cancer. Radiotherapy should
be delayed until after delivery in order to avoid harmful
effects on the fetus. Adjuvant chemotherapyif indicatedshould not be administered during the first trimester
of gestation. In the studies of Zemlickis et al., and Berry et
al., 75% and 91% of pregnant women underwent modified
radical or segmental mastectomy, respectively [13, 15].
In the study of Petrek et al., the 5-year survival of
patients with negative axillary nodes was 82% in both pregnant and nonpregnant women, while the 10-year survival
was 77% for pregnant and 75% for nonpregnant women.
No statistically significant treatment effect was noted [16].
Advanced Breast Cancer (Stages III and IV)
Radiation therapy should be completely avoided for
the benefit of the fetus. Chemotherapy is still indicated
a pregnant woman has a 2.5-fold higher risk of presenting

with disseminated breast cancer than a nonpregnant woman,
and a lower chance of being diagnosed in stage I [13].
There are no differences in various histologic types of
breast cancer between pregnant and nonpregnant women
with cancer. Most of the benign tumors diagnosed during
pregnancy are similar to those seen in nonpregnant women,
e.g., fibroadenoma, lipomas, and papillomas. However,
almost 30% of benign breast lesions, such as lactating adenomas, galactoceles, mastitis, and infarcts, are unique to
pregnant or lactating women [14].
Therapeutic Abortion
In the 1950s and 1960s, therapeutic abortion was advocated due to concerns for hormonal stimulation of tumor
growth or to lack of effective systemic therapy. In the 1980s
and 1990s, therapeutic abortion failed to improve survival,
and it was found that pregnancy had no effect on the course
of the disease. In addition, it was observed that 80% of pregnancy-associated breast cancers were estrogen and progesterone receptor negative. Nowadays, oncologists should
consider therapeutic abortion during the first and second
trimesters only in aggressive primary breast cancer or in
patients with advanced disease, in which prompt treatment is
strongly recommended.
Table 5. Therapeutic management of pregnant women with breast cancer: literature review
Treatment (%)
Reference
Stage
(%)
Mothers outcome
Fetal outcome
RT
CX
Gestational age
at delivery
Delivery
method
Median
survival
Malformations
Birth
weight
Stillbirth
Follow-up
[13]
118
I-II = 85.5
III-IV = 14.5
75
62
22
38.3 weeks
65% vaginal
35% cesarean
At 7 years
Overall: 50%
0%
Low
2%
NM
[14]
24
I-II = 41.5
III-IV = 58.5
83
100
38.0 weeks
NM
At 3 years
Overall: 75%*
DFS: 70%
0%
Normal
0%
4.5 years
[15]
20
I-II = 50
III-IV = 50
55
100
34.7 weeks
75% cesarean
25% vaginal
NM
0%
Normal
15%
3.5 years
Abbreviations: S = surgery; RT = radiation; CX = chemotherapy; NM = not mentioned; DFS = disease-free survival

*for stages II + III
282
Pregnancy After Breast Carcinoma

The effect of pregnancy on survival after successful treatment of breast carcinoma is predominantly related to the stage
of the disease. Patients with early stages (stage I and II) show
no difference in overall and 5-year survival rates. Patients with
stage III disease should consider deferring pregnancy for at
least 5 years after treatment, whereas women with stage IV disease should not consider conception at all [17, 18] (Table 6).
Carcinoma of the Cervix
Diagnosis
Although the diagnosis of cervical cancer in pregnancy
can sometimes be delayed, there is adequate evidence that
pregnant women have a 3.1-fold higher chance of being
diagnosed with stage I disease because of frequent pelvic
examinations. [22]. The diagnosis can be safely performed
by colposcopy and colposcopy-directed biopsy.
Treatment and Outcome
Since most cases are diagnosed in an early stage, a
delay in treatment should be recommended in order to reach
fetal maturity and viability. With modern neonatal care,
newborn mortality has been dramatically decreased.
In order to avoid perinatal complications, it is preferable
to manage abnormal cytologic smears in a conservative way.
During the first trimester of pregnancy, it is generally safe to
delay cone biopsy since it can increase the overall abortion
rate by up to 17%. Conization should be left for the second
trimester and for cases where the diagnosis of invasive
cancer cannot be made otherwise. Conization in the first
trimester is associated with an abortion rate of 33%.
Following delivery, conization or hysterectomy should be
decided by the obstetrician [4, 23].
The overall therapeutic management of pregnancyassociated carcinoma of the cervix, according to the disease
stage, is as follows:
A) Stage I or carcinoma in situ. Treatment should be
delayed until the fetus has matured. If invasion is less than 3
mm without lymph-vascular space involvement, the pregnant
woman should be followed to term and delivered vaginally. If
invasion is 3-5 mm and lymph-vascular space is involved,
Year
n of patients
Study period
% 10-year survival (node /+)
1981
41
1940-1970
80/79
1986
57
1941-1980
64/26
1986
68
1940-1985
90/71
1989
46
1950-1980
75/56
1989
136
1931-1989
64
1994
91
1967-1989
93
these women may also be followed to term. Afterward, a

cesarean section should be performed followed by radical
hysterectomy and pelvic lymphadenectomy. If invasion is
more than 5 mm, the tumor should be treated as invasive cervical carcinoma while taking into consideration the stage of
gestation and the preference of the parents.
B) Stage IB (bulky), II, III, and IV. For all these stages,
radiotherapy is the treatment of choice. In the case of a viable
fetus, cesarean section is preoperatively recommended.
In general, cervical cancer does not adversely affect
pregnancy. Several retrospective studies have demonstrated
no difference in tumor grade or in 5-year survival between
pregnant and nonpregnant women with cervical cancer.
Also, some reports found no difference in maternal survival
between women who delivered vaginally and women who
underwent cesarean deliveries [19, 22].
Malignant Melanoma
Epidemiology
The real incidence of malignant melanoma during pregnancy is unknown. Smith and Randall, in 1969, reported an
incidence of 2.8 per 1,000 deliveries [24]. Generally, it is postulated that melanoma accounts for about 8% of all malignant
tumors arising during gestation. However, 30%-35% of
women with melanoma are of child-bearing age. From the
registry of the German Dermatological Society, it was found
that 1% of female melanoma patients were pregnant and 40%
were diagnosed during the premenopausal stage [25].
Diagnosis
The diagnosis of melanoma is always made by tumor
excision and pathological examination. Tumor thickness,
primarily, as well as tumor site remain important prognostic
factors for pregnant women with melanoma. The effect of
pregnancy on tumor location and thickness is still unclear [4].
Despite a long-term controversy on the prognosis of pregnancy-associated malignant melanoma, there is now strong
Epidemiology
Carcinoma of the cervix, being a tumor of the reproductive years, is one of the most common cancers diagnosed during gestation. Reports of the incidence vary between 0.02%
and 0.9%. The real incidence during the decade 1980-1990
was 1.2 in 10,000 pregnancies [19-21]. Recently, the incidence has seemed to decline due to better public awareness
for early detection.
Table 6. Survival of women with breast cancer who subsequently became pregnant [19]
Pavlidis
evidence that the clinical course of pregnant women with
melanoma is similar to that of nonpregnant women. Pregnant
patients with early primary lesions and adequate surgical
excision have a very good prognosis. In these cases, there
is no need for therapeutic abortion, whereas in advanced
disease, termination of the pregnancy may be useful [4].
Slingluff and Seigler published a series of 100 cases of
pregnancy-associated malignant melanoma. Although they
found a higher incidence of nodal involvement compared
with matched controls, overall mortality was not statistically
different [26].
HEMATOPOIETIC TUMORS ARISING DURING
GESTATION
Epidemiology
The incidence of Hodgkins disease ranges from 1 in 1,000
to 1 in 6,000 pregnancies [27, 28]. Among 775 women with
stage IA-IIA Hodgkins disease treated with radiotherapy,
3.2% were pregnant [29]. Non-Hodgkins lymphoma (NHL)
occurring in pregnancy is more rare. Up to 1985, 75 cases of
pregnancy-associated NHL were reported in the literature [30].
Diagnosis and Staging
To avoid teratogenicity, a limited staging work-up for
Hodgkins disease and NHL is mandatory during pregnancy. Staging should always include physical examination, blood tests, chest x-ray, bone marrow biopsy, and
abdominal ultrasound. Tomographic and isotope scans are
contraindicated.
It seems that pregnant women are not likely to be at a
higher stage of their disease when diagnosed than their
matched controls. From the 48 women with Hodgkins disease and pregnancy managed at the Princess Margaret
Hospital between 1958 and 1984, 34 (70.8%) had earlystage disease (stage I and II) and the rest (29.2%) had
advanced disease, stages III and IV [31].
Pregnancy in itself does not affect the course of the
lymphoma and survival, while therapeutic abortion does
not improve the course of the disease. From the Princes
Margaret Hospital experience, no significant difference in
the 20-year survival rate between 48 women with pregnancy-associated Hodgkins disease and 67 matched controls was found. Of the 50 pregnancies studied, there were
38 live births. No statistically significant differences in gestational age, birth weight, delivery method, malformations,
or stillbirth rate were observed [31].
There is also enough evidence from the literature to

show that no differences in maternal, pregnancy, or fetal
outcomes exist between pregnant women with Hodgkins
disease or NHL and matched controls [4].
There seems to be no evidence for teratogenic effect of
local treatment with supradiaphragmatic radiotherapy, especially in early trimesters, or chemotherapy, mainly given
during the second or third trimester of pregnancy [29].
Leukemias
Epidemiology
The real incidence of leukemia during gestation is not
well known. It is estimated to range from 1 in 75,000 to
100,000 pregnancies [32-34]. Acute leukemias are more frequent. Among them, acute myeloid leukemia is diagnosed
twice as often as lymphatic leukemia. Concerning chronic
leukemias, chronic myeloid leukemia (CML) accounts for
less than 10% of all cases. Chronic lymphocytic leukemia is
very rare since it is a malignancy most commonly detected
in the elderly.
From the existing data in the literature, it seems that
leukemia can affect both the pregnancy and the fetus. The
treatment of acute leukemia should be started immediately
after diagnosis. The therapeutic management of pregnant
women with acute leukemia is very difficult, and the final
decisions should be made by the hematologist/oncologist, the
patient, and the family. Abortion should be recommended
during the first trimester of pregnancy, however, if the patient
expresses the desire to keep the baby, then nonteratogenic
cytostatics should be used. Systemic chemotherapy during
later trimesters is not associated with teratogenic risk [35-37].
CML is usually treated conservatively. The successful
administration of hydroxyurea and interferon or even of
leukapheresis has been reported in single cases. If the
option for aggressive treatment (i.e., bone marrow transplantation) has been taken, then this should be delayed until
after delivery [38, 39].
OTHER MALIGNANT TUMORS ARISING DURING
GESTATION
Ovarian Cancer
The incidence of ovarian malignancies during pregnancy is estimated to be between 1 in 10,000 and 1 in
100,000 deliveries [40, 41]. Around 40% of these tumors are
germ-cell tumors. Epithelial ovarian tumors are usually of
low stage and low grade. The optimal management of pregnant patients with ovarian cancer is not well established,
Lymphomas
283
284
but several reports found good fetal outcomes with a

conservative surgical approach [4].
Endometrial Cancer
Endometrial cancer occurs very rarely during pregnancy.
Only 16 cases were reported up to 1996 [4].
Thyroid Cancer
Thyroid cancer seems to be rare during pregnancy. No
endocrine association between maternal hormonal changes
and thyroid cancer has been found. Therapeutically, lobectomy with cervical node dissection can be performed.
Radioactive iodine should be avoided, and chemotherapy is
not effective [45, 46].
Central Nervous System Tumors
Intracranial and spinal tumors are extremely rare in pregnancy. Thirty percent of tumors are gliomas, and another
30% are meningiomas. The most common spinal tumor is
vertebral hemangioma [47].
SAFETY OF CHEMOTHERAPY
The administration of chemotherapy during gestation
can induce harmful effects to the fetus, the newborn, and the
mother. For the fetus and the newborn, these detrimental
effects include malformations, teratogenesis, mutations, carcinogenesis, organ toxicity, and retarded development; for
the mother, they include spontaneous abortion and sterility.
Despite the fact that all chemotherapy drugs are capable of crossing the placenta, fetal toxicity is clearly dependent on the time of treatment. In most cases, toxic effects
were reported when treatment was given during embryogenesis in the first trimester and less often when administered
during later trimesters. The rate of chemotherapy-associated fetal malformation is 12.7%-17%, and that of low birth
weight is 40%. In contrast, the usual rate of malformations
in the general population is around 1%-3% [48-50].
Among the therapeutic drugs, antimetabolites (aminopterin, methotrexate, 5-fluorouracil, arabinosyl cytosine) and
alkylating agents (busulfan, cyclophosphamide, chlorambucil)
Drug
Risk
Chlorambucil
1:2
Nitrogen mustard
1:3
Aminopterin
1:3
5-fluorouracil
1:3
Methotrexate
1:4
Cyclophosphamide
1:6
Cytosine arabinoside
1:8
Busulfan
1:9
are the most common drugs reported to induce malformation or to exert teratogenic effects (Table 7). Vinca alkaloids and antibiotics seem to have no effect on the fetus;
however, cisplatin is implicated in growth restriction and
hearing loss, whereas etoposide is implicated in pancytopenia. No data are available on the effect of taxanes or of other
drugs on the fetus. The Toronto Leukemia Study Group data
demonstrated that about one-third of all infants exposed
in utero to chemotherapy experienced pancytopenia at birth
[51-52].
In addition, Doll et al. studied the effect of combination
chemotherapy on the rate of fetal malformation in 139 cases
treated in the first trimester of pregnancy. They found that
the rate was only slightly higher (25%) than that observed
with single agents (17%) [48].
It should be pointed out that most of the available data
on the teratogenic risks of chemotherapy are based on case
reports and small series. Long-term studies are needed to
evaluate the effects of chemotherapy on the mother, the
fetus, and the neonate.
In 1986, The Registry of Pregnancies Exposed to
Cancer Chemotherapy was established at the National
Cancer Institute by J.J. Mulvihill. The purpose of this computerized registry is to clarify the effects of cancer
chemotherapy on the developing fetus. It is a collection of
published and unpublished outcomes of pregnancies
exposed to drugs and radiation. To date, the registry
includes 277 pregnancies, 234 abstracted from the medical
literature, 40 personally reported cases, and three from
other sources. The 277 registered cases include 247 with
cancer (52% leukemia, 27% lymphoma, and 18% other
cancers) and 30 transplants, autoimmune disorders, or
attempted abortions. At present, the registry can provide
rapid access, via a Microsoft Access database, to specifically relevant cases from the literature as an aid to counseling. The Registry is now located at the University of
Oklahoma Medical Center Section of Genetics (940 NE
Colorectal Cancer
Up to 1985, almost 200 pregnant women with colorectal cancer were reported in the literature [42, 43]. Woods et
al. report an incidence of 1 in 13,000 deliveries [44]. More
than 60% of cases were rectal tumors. There is probably a
delay in diagnosis, resulting in the presentation of more
advanced stages and poorer prognoses than in nonpregnant
patients. This delay could be explained by attributing the
symptoms of colorectal cancer to the normal changes of
pregnancy [4].
Table 7. Treatment given during first trimester and estimated risk

of malformation
Pavlidis
285
Table 8. Maternal cancer metastatic to the products of conception (1866-1999) [4, 55-58]
Tumor type
n of cases to POC*
n of cases to placenta
n of cases to fetus
Malignant melanoma
17
13
Leukemia and lymphoma
11
Carcinoma of the breast
Lung carcinoma
Sarcoma
Gastric carcinoma
Hepatic carcinoma
Ethmoid carcinoma
Adrenal carcinoma
Ovarian carcinoma
Adenocarcinoma of rectum
Undifferentiated carcinoma
Pancreatic carcinoma
Squamous carcinoma
58
50
15
Total
*POC: products of conception
13th Street, Room B2418, Oklahoma City, OK 73104,

USA; telephone: 405-271-3663 or 866-654-3637; fax 405271-8697; e-mail: John-mulvihill@ouhsc.edu) [53-54].
METASTASES OF MATERNAL TUMORS TO THE
PLACENTA AND FETUS
Vertical transmission of cancer is exceptionally rare,
although maternal cells do reach the fetus. From 1866 to
1999, 58 cases of documented maternal malignancy metastatic to the placenta and fetus were reported in the western literature [4, 55-58]. The tumors most commonly seen
coexisting with pregnancy are not those most commonly
found involving the products of conception (placenta and
fetus). The most likely way for dissemination is through the
hematogenous route. The rarity of this dissemination is probably due to the placental barrier and the fetal immune system.
The most common tumor metastasizing to the placenta or
fetus is malignant melanoma, accounting for 30% of all pregnancy-associated tumors. The second most frequent malignancies are leukemia and lymphoma followed by carcinoma
of the breast and lung [56]. For more details see Table 8.
RECOMMENDED THERAPEUTIC ABORTION IN

PREGNANT WOMEN WITH CANCER
Although a final decision for therapeutic abortion is not
always easy, it becomes more important when the diagnosis of cancer is made during the first trimester of pregnancy.
Most of the time, the patient, her partner, and her physician
are required to make a difficult decision without a clear
answer. For the first trimester, the most important parameters for consideration are: A) the stage of the disease; B) the
need to provide chemotherapy, and C) the potential curability of this disease.
Despite the absence of guidelines, therapeutic abortion
during the first trimester of pregnancy could be recommended primarily for locally advanced-stage cervical carcinoma, advanced breast cancer or breast cancer necessitating
adjuvant systemic treatment, stage III-IV aggressive NHL
or Hodgkins disease, and acute leukemia. In addition, any
other chemosensitive or nonchemosensitive solid tumor
could be included under the same recommendations, provided that the decision follows a thorough discussion
among the pregnant patient, the doctor, and the family.
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Errata
An erratum has been published regarding this article. Please see next page or:
http://theoncologist.alphamedpress.org/content/7/6/573.full.pdf
The
Oncologist
Erratum
COEXISTENCE OF PREGNANCY AND MALIGNANCY
Nicholas A. Pavlidis
The Oncologist 2002;7:279-287
On page 281, in the first paragraph under Advanced Breast Cancer (Stages III and IV) the protocol used by Berry et al.
was identified as CMF combination chemotherapy, however, the correct protocol was cyclophosphamide, doxorubicin, and
fluorouracil (FAC).

Nicholas A. Pavlidis
The Oncologist 2002, 7:279-287.
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://theoncologist.alphamedpress.org/content/7/4/279

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