Cordeiro Christina N, Gemignani Mary L
Resident Physician, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
Attending Surgeon, Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Obstet Gynecol Surv. 2017 Mar;72(3):184-193. doi: 10.1097/OGX.0000000000000407.
Cancer occurs in 0.05% to 0.1% of all pregnancies. Despite literature reporting good oncologic and fetal outcomes in women treated for cancer during pregnancy, as many as 44% of gynecologists would offer termination, and 37% would not administer chemotherapy or radiotherapy in pregnancy.
The aims of this study were to summarize current recommendations for the treatment of cervical and ovarian cancers in pregnancy and to review updates on existing knowledge regarding the safety of surgical and chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes.
A detailed literature review was performed on PubMed.
The treatment of gynecologic malignancies during pregnancy mirrors that outside pregnancy, with a balance between maternal versus fetal health. Fertility-sparing surgery can be offered to stage IA2 and low-risk IB1 cervical, stage I epithelial ovarian, germ cell ovarian, or sex-cord stromal ovarian tumors. Delayed treatment can be offered for stage IB1 cervical cancer. Neoadjuvant and/or adjuvant chemotherapy can be given for advanced gynecologic cancers with good disease-free survival without significant adverse neonatal outcomes.
A multidisciplinary approach and improved education of providers regarding the surgical and chemotherapeutic treatments in pregnancy are needed in order to fully inform patients regarding treatment options. Further research in women who are pregnant is needed to determine the safety of diagnostic and therapeutic procedures used in the nonpregnant woman.
This article reviews and supports treatment of gynecologic cancer during pregnancy, calls for additional study and long-term follow-up, and justifies improved education of patients and providers regarding treatment options.
Obstetricians and gynecologists, family physicians.
After completing this activity, the learner should be better able to (1) review general principles in the management and treatment of gynecologic cancers in pregnancy, (2) review the diagnosis and treatment of cervical cancer in pregnancy, and (3) review the diagnosis and treatment of ovarian cancer in pregnancy.
癌症在所有妊娠中发生率为0.05%至0.1%。尽管有文献报道孕期患癌女性的肿瘤学和胎儿结局良好，但多达44%的妇科医生会建议终止妊娠，37%的医生不会在孕期进行化疗或放疗。
本研究的目的是总结目前关于孕期宫颈癌和卵巢癌治疗的建议，并回顾关于孕期手术和化疗治疗安全性的现有知识更新，包括肿瘤学和胎儿结局。
在PubMed上进行了详细的文献综述。
孕期妇科恶性肿瘤的治疗与非孕期相似，需平衡母体与胎儿健康。对于IA2期和低风险IB1期宫颈癌、I期上皮性卵巢癌、卵巢生殖细胞肿瘤或性索间质卵巢肿瘤，可提供保留生育功能的手术。对于IB1期宫颈癌可延迟治疗。对于晚期妇科癌症，在无病生存期良好且无显著不良新生儿结局的情况下，可给予新辅助和/或辅助化疗。
需要采取多学科方法并加强医疗服务提供者对孕期手术和化疗治疗的教育，以便充分告知患者治疗选择。需要对孕妇进行进一步研究，以确定非孕妇使用的诊断和治疗程序的安全性。
本文回顾并支持孕期妇科癌症的治疗，呼吁进行更多研究和长期随访，并证明改善患者和医疗服务提供者对治疗选择的教育是合理的。
妇产科医生、家庭医生。
完成本活动后，学习者应能更好地（1）回顾孕期妇科癌症管理和治疗的一般原则，（2）回顾孕期宫颈癌的诊断和治疗，（3）回顾孕期卵巢癌的诊断和治疗。
