Management of the Pregnant Cancer Patient

One in every 1,000 pregnant women will be diagnosed with cancer.1 Despite this fact, the level of evidencebased medicine available in the field of cancer during pregnancy is low. Randomized controlled trials in this area do not exist. Instead, retrospective collections of patients treated with varying treatment regimens and strategies, collected case reports, studies based on events, such as the Japanese atomic bomb experience, and, for rare malignancies, isolated case reports generally constitute the medical literature on pregnancy and cancer. Nonetheless, this chapter may guide oncologists facing patients in this relatively uncommon, but serious position. We discuss the use of the major diagnostic and treatment modalities in oncology during pregnancy: surgery, diagnostic imaging and therapeutic radiation, and antineoplastic agents. Therapeutic strategies for malignancies seen most frequently during pregnancy are addressed: these include breast cancer, cancer of the uterine cervix, Hodgkin’s disease, and non-Hodgkin’s lymphoma. Medical management of symptoms of malignancy and its treatment that are unique to the pregnant patient are discussed.