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1 Professor of Surgery at Medical College of Wisconsin in Milwaukee, Wisconsin, and an American Cancer Society Professor of Clinical Oncology.
The weight of opinion is that poor results in the past from treatment of cancers during pregnancy may have largely resulted from late diagnosis and inadequate treatment. Symptoms of cancer are too often mistakenly attributed to the changes of pregnancy. Recent emphasis has concentrated on the need to appreciate that cancers occur during pregnancy and should be diagnosed aggressively. There is clear concern for the welfare of the patient, with emphasis on complete and optimal treatment without delay. Cesarean section or induced labor is appropriate if the fetus has reached viability or is at term, but any delay of treatment to reach these points is discouraged. For the common cancers, it is difficult to demonstrate that pregnancy materially influences their growth and spread or has a substantially adverse influence on their inherent curability independent of the patient's age or the stage of the cancer. Nor is it evident that there is any but negligible risk that a maternal cancer will metastasize to the fetus if a pregnancy is allowed to continue. Thus, abortion to avoid this eventuality or as a therapeutic measure against the cancer has little to support it. A decision for or against termination of a pregnancy is based principally on social and ethical issues as well as matters of disposition and convenience. In view of this, therapeutic decisions that must be made when cancers complicate the pregnancy of young women are best reached through frank discussions with the patient about the risks and potential benefits to her and her unborn child associated with various therapeutic strategies. Because future pregnancies have no obvious influence on recurrence, the decision for or against them is principally a psychosocial decision, influenced by the patient's predetermined chances of having been cured and the strength of her desire for a child.
Cancer and Pregnancy
William L. Donegan M.D.1
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