Obstetrics and Gynaecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
Best Pract Res Clin Obstet Gynaecol. 2010 Feb;24(1):61-79. doi: 10.1016/j.bpobgyn.2009.08.001. Epub 2009 Sep 8.
Cancer complicating pregnancy endangers two lives. Any approach should look at both maternal and foetal safety. Maternal prognosis will not improve by terminating the pregnancy. Imaging for staging purposes is possible, and sonar and magnetic resonance imaging are the preferred examinations. Abdominopelvic computed tomography exposes the foetus to the highest doses radiation and should be avoided. Provided a thorough maternal monitoring to ensure a stable uteroplacental blood flow and foetal oxygenation, surgical techniques that are used in non-pregnant patients are also safe for pregnant patients. Radiotherapy of the upper part of the body is possible during pregnancy, but during the third trimester the close distance may put the foetus at risk. Chemotherapy during the second or third trimester can be administered without increasing the incidence of congenital malformations. A systematic analysis, especially on the long-term outcome of the offspring after cancer treatment during pregnancy is still lacking. Here, we present a summary of issues related to the diagnosis and treatment of gynaecological malignancies during pregnancy. Firstly, we describe general diagnostic and cancer-treatment-related problems. In the second part, organ pathology including breast, cervical, ovarian, endometrial and vulvar cancer is discussed.
癌症合并妊娠危及两条生命。任何方法都应同时考虑母婴安全。终止妊娠并不能改善母体预后。为了分期目的进行影像学检查是可行的，超声和磁共振成像则是首选的检查方法。腹盆腔 CT 会使胎儿暴露于最高剂量的辐射下，因此应避免使用。只要能进行彻底的母体监测以确保胎盘血流和胎儿氧合稳定，用于非妊娠患者的手术技术对妊娠患者也是安全的。上半身的放疗在妊娠期间是可行的，但在孕晚期，由于接近胎儿，可能会使胎儿处于风险之中。在妊娠第 2 或第 3 期进行化疗不会增加先天畸形的发生率。目前仍缺乏有关妊娠期间癌症治疗对胎儿长期影响的系统分析。在这里，我们总结了与妊娠期间妇科恶性肿瘤的诊断和治疗相关的问题。首先，我们描述了一般的诊断和癌症治疗相关问题。在第二部分，我们讨论了包括乳腺癌、宫颈癌、卵巢癌、子宫内膜癌和外阴癌在内的器官病理学。
