Cancer and Pregnancy 2012

Difficulties in treating pregnant patients

Dr Vesna Kesic – University of Serbia, Belgrade

It is a very important meeting, it gathered a group of people who are managing cancer during pregnancy. Oncology is difficult by itself but when you then have a pregnant woman with the baby with the oncological problem, this is really complicated and delicate and requires a lot of knowledge and, most important, a multidisciplinary approach. So this meeting gathered specialists from different areas, not only gynaecologists or medical oncologists but also neonatologists, psychiatrists, so a complete team which should think about these diseases. The problem is that there is no central registration of these cases and in fact we don’t know exactly how many pregnant patients with cancer we have. No single centre has enough data and enough numbers so the numbers and series are small. As a result no one of us can give any evidence-based recommendations but that’s what we are together trying to do. ESGO also recognised the importance of this field, pregnancy and cancer, and two years ago started a task force which is also called pregnancy and cancer. Through this task force we thought that it would be interesting to see how much people know, doctors know, about this subject, what are their attitudes, their behaviour, what do they do during pregnancy? Because not all of us are working in big university centres so it’s not a problem for a big, organised, comprehensive cancer centre to treat pregnant patients with cancer, the question is how the others do that.

So we did a survey and I must say that some data are worrying because in many cases we got the answer that doctors would prefer to terminate the pregnancy rather than continuing it and treating it. Also they rush to finish the pregnancy, much before the term, and the consequence is a premature baby which on its side can have many neonatalogical problems and even fatal outcome. So this survey shows a general picture of what people are doing; there are still places, almost 20%, where a not disciplinary team is managing the patient, it’s just the decision of the gynaecologist or the decision of the medical oncologist. So this is why this survey serves now as a basis for our future plans, what to do and how to improve the field.

With the current data, should there be fewer terminations?

Very few cancers that would require termination, either small pregnancy or termination, very few aggressive types, metastatic cancer. Most of the cancers are not affected by the pregnancy, nor do they affect pregnancy as the disease itself, the treatment is what can be delicate but also we know, and this meeting shows it very clearly, that once when the first part of the pregnancy, embryogenesis, is finished or is over then applying the treatment carries some risks but in fact it’s possible to treat by chemotherapy. It’s even possible to treat some locations distant from the baby and pregnant uterus by radiotherapy to a less extent, but mostly we were talking about chemotherapy as the therapy which is possible to provide during pregnancy.

Are current trials trying to find the most effective chemotherapy?

Which chemotherapy, what are the consequences? Also, what is the outcome of children born from a mother treated during chemotherapy? It would be interesting to see these children who were exposed to chemotherapy, how they develop later neurologically, psychosocially. So it seems to be a small field when you say cancer in pregnancy, a small number of patients, but there are so many different aspects of this field that really it requires, I repeat, a multidisciplinary approach and meetings and events like this one.