Urologic Malignancies in Pregnancy

Cancer is the second leading cause of death in women during reproductive years. Urological tumors occur with an incidence of 1 in 1000 pregnancies. Urologic malignancies are rare during pregnancy; therefore, diagnosis and management are problematic. Treatment of tumors of the adrenal gland, kidney, ureter, bladder, and urethra are reviewed. Testing during pregnancy can uncover incidental tumors, but confounding symptoms during pregnancy can delay the diagnosis of cancer. Urological tumor symptoms, such as pain, hematuria, and hypertension may be mistaken for other, more common conditions such as urinary infection, pyelonephritis, threatened abortion or preeclampsia [1]. Such symptoms warrant a thorough urologic evaluation. Evaluation for urologic tumors relies upon radiographic testing. In the pregnant patient, the risk to the mother and the fetus must be taken into consideration when diagnostic testing is considered. This issue of the Urologic Clinics of North America also includes an article on urologic radiology in pregnancy, which discusses the issue of fetal radiation risk in detail. There is no proven safe dose of radiation exposure to the fetus [2]. A review article by Loughlin described a relative risk of 1.6 for leukemia and of 3.2 for solid organ cancers in fetuses exposed to 1.6 to 40 mGy radiation dose before delivery [3]. Radiation exposure should be avoided, unless the study will have a major impact on the care of the mother, and the relevant information cannot be obtained in any other way. With modern technology, an accurate diagnosis usually can be established with ultrasound or MRI. After establishing a diagnosis, the tumor type and duration of pregnancy determine the treatment options and the timing of therapy. Depending upon the tumor type and stage, therapy may include chemotherapy or surgery. Timing of treatment must be discussed with the patient. Discussion must include the risks of immediate treatment to the health of the fetus and risks of delayed treatment to the mother, such as tumor progression.