Mamma- und gynäkologische Karzinome in der Schwangerschaft

Kernaussagen

Maligne Tumoren, welche während der Schwangerschaft diagnostiziert werden, sind selten. Da in den westlichen Ländern das Alter von Gebärenden stetig steigt, steigt auch die Inzidenz von schwangerschaftsassoziierten Malignomen.

Die Prognose von schwangeren Tumorpatientinnen ist bei gleichem Tumorstadium mit der Prognose von nicht schwangeren Patientinnen vergleichbar. Deshalb wird heute nicht a priori zum Schwangerschaftsabbruch geraten.

Die Betreuung einer schwangeren Karzinompatientin sollte unbedingt an einem Zentrum in interdisziplinärer Zusammenarbeit erfolgen.

Im Rahmen der normalen Schwangerschaftskontrollen sollten die Adnexe, die Cervix uteri und die Mammae routinemäßig beurteilt werden.

Eine notwendige operative Therapie kann in jedem Trimenon erfolgen. Im zweiten und dritten Trimester kann eine Chemotherapie mit vertretbarem Risiko für Mutter und Kind appliziert werden. Radiotherapien sollten postpartal durchgeführt werden, ebenso eine allfällige Hormon- oder Herceptintherapie beim Mammakarzinom.

Jede Frau, die während ihrer Schwangerschaft an einem Malignom erkrankt, muss als geburtshilfliche Risikopatientin angesehen werden.

Die Geburt des Kindes sollte möglichst nach der 37. Schwangerschaftswoche erfolgen, um Probleme der Frühgeburtlichkeit zu vermeiden. Ist die Entbindung aus onkologischer oder geburtshilflicher Sicht vor der 34. Schwangerschaftswoche indiziert, sollte eine Lungenreifungsinduktion mit Kortikosteroiden durchgeführt werden. Der Geburtsmodus muss individuell, unter Berücksichtigung der geburtshilflichen und onkologischen Situation, festgelegt werden. Vorzugsweise sollte das Kind in einem Perinatalzentrum zur Welt kommen.

Literatur

• 1 Pavlidis N A. Coexistence of pregnancy and malignancy.  Oncologist. 2002;  7 279-287
• 2 McDonald S D, Faught W, Gruslin A. Cervical cancer during pregnancy.  J Obstet Gynaecol Can. 2002;  24 491-498
• 3 Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy.  Lancet Oncol. 2004;  5 283-291
• 4 Weisz B, Schiff E, Lishner M. Cancer in pregnancy: maternal and fetal implications.  Hum Reprod Update. 2001;  7 384-393
• 5 Sankila R, Olsen J H, Anderson H et al. Risk of cancer among offspring of childhood-cancer survivors. Association of the Nordic Cancer Registries and the Nordic Society of Paediatric Haematology and Oncology.  N Engl J Med. 1998;  338 1339-1344
• 6 Berry D L, Theriault R L, Holmes F A et al. Management of breast cancer during pregnancy using a standardized protocol.  J Clin Oncol. 1999;  17 855-861
• 7 Pentheroudakis G, Pavlidis N. Cancer and pregnancy: poena magna, not anymore.  Eur J Cancer. 2006;  42 126-140
• 8 Leiserowitz G S, Xing G, Cress R et al. Adnexal masses in pregnancy: how often are they malignant?.  Gynecol Oncol. 2006;  101 315-321
• 9 Amant F, Van Calsteren K, Vergote I et al. Gynecologic oncology in pregnancy.  Crit Rev Oncol Hematol. 2008;  67 187-195
• 10 Lens M. Melanoma during pregnancy: epidemiology, diagnosis, staging, clinical picture.  Recent Results Cancer Res. 2008;  178 165-174
• 11 Pereg D, Koren G, Lishner M. The treatment of Hodgkin's and non-Hodgkin's lymphoma in pregnancy.  Haematologica. 2007;  92 1230-1237
• 12 Sood A K, Sorosky J I, Mayr N et al. Cervical cancer diagnosed shortly after pregnancy: prognostic variables and delivery routes.  Obstet Gynecol. 2000;  95 832-838
• 13 Oduncu F S, Kimmig R, Hepp H et al. Cancer in pregnancy: maternal-fetal conflict.  J Cancer Res Clin Oncol. 2003;  129 133-146
• 14 Zanetti-Dallenbach R, Wight E. Chemotherapy for gynecological malignancies – a contraindication during pregnancy?.  Ther Umsch. 2005;  62 53-60
• 15 Schmeler K M, Mayo-Smith W W, Peipert J F et al. Adnexal masses in pregnancy: surgery compared with observation.  Obstet Gynecol. 2005;  105 1098-1103
• 16 Wright Jr T C, Massad L S, Dunton C J et al. 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ.  Am J Obstet Gynecol. 2007;  197 340-345
• 17 Hunter M I, Monk B J, Tewari K S. Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease.  Am J Obstet Gynecol. 2008;  199 3-9
• 18 Hunter M I, Tewari K, Monk B J. Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease.  Am J Obstet Gynecol. 2008;  199 10-18
• 19 Ahn B Y, Kim H H, Moon W K et al. Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings.  J Ultrasound Med. 2003;  22 491-497 ,  quiz 498–499
• 20 Hahn K M, Johnson P H, Gordon N et al. Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero.  Cancer. 2006;  107 1219-1226
• 21 Barnes D M, Newman L A. Pregnancy-associated breast cancer: a literature review.  Surg Clin North Am. 2007;  87 417-430
• 22 Jones A L. Management of pregnancy-associated breast cancer.  Breast. 2006;  15 S47-S52
• 23 Liberman L, Giess C S, Dershaw D D et al. Imaging of pregnancy-associated breast cancer.  Radiology. 1994;  191 245-248
• 24 Rosenkranz K M, Lucci A. Surgical treatment of pregnancy associated breast cancer.  Breast Dis. 2005;  23 87-93
• 25 Mazze R I, Kallen B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5 405 cases.  Am J Obstet Gynecol. 1989;  161 1178-1185
• 26 Melnick D M, Wahl W L, Dalton V K. Management of general surgical problems in the pregnant patient.  Am J Surg. 2004;  187 170-180
• 27 Purnichescu V, Cheret-Benoist A, Von Theobald P et al. Laparoscopic management of pelvic mass in pregnancy.  J Gynecol Obstet Biol Reprod (Paris). 2006;  35 388-395
• 28 Palanivelu C, Rangarajan M, Senthilkumaran S et al. Safety and efficacy of laparoscopic surgery in pregnancy: experience of a single institution.  J Laparoendosc Adv Surg Tech A. 2007;  17 186-190
• 29 Duncan P G, Pope W D, Cohen M M et al. Fetal risk of anesthesia and surgery during pregnancy.  Anesthesiology. 1986;  64 790-794
• 30 Brodsky J B, Cohen E N, Brown Jr B W et al. Surgery during pregnancy and fetal outcome.  Am J Obstet Gynecol. 1980;  138 1165-1167
• 31 Nicklas A H, Baker M E. Imaging strategies in the pregnant cancer patient.  Semin Oncol. 2000;  27 623-632
• 32 Alexander A, Samlowski W E, Grossman D et al. Metastatic melanoma in pregnancy: risk of transplacental metastases in the infant.  J Clin Oncol. 2003;  21 2179-2186
• 33 Daryanani D, Plukker J T, De Hullu J A et al. Pregnancy and early-stage melanoma.  Cancer. 2003;  97 2248-2253
• 34 Alexander A, Harris R M, Grossman D et al. Vulvar melanoma: diffuse melanosis and metastasis to the placenta.  J Am Acad Dermatol. 2004;  50 293-298
• 35 Driscoll M S, Grant-Kels J M. Nevi and melanoma in pregnancy.  Dermatol Clin. 2006;  24 199-204
• 36 Behtash N, Karimi Zarchi M, Modares Gilani M et al. Ovarian carcinoma associated with pregnancy: a clinicopathologic analysis of 23 cases and review of the literature.  BMC Pregnancy Childbirth. 2008;  8 3
• 37 Ohara N, Teramoto K. Successful treatment of an advanced ovarian serous cystadenocarcinoma in pregnancy with cisplatin, adriamycin and cyclophosphamide (CAP) regimen. Case report.  Clin Exp Obstet Gynecol. 2000;  27 123-124
• 38 Tabata T, Nishiura K, Tanida K et al. Carboplatin chemotherapy in a pregnant patient with undifferentiated ovarian carcinoma: case report and review of the literature.  Int J Gynecol Cancer. 2008;  18 181-184
• 39 Picone O, Lhomme C, Tournaire M et al. Preservation of pregnancy in a patient with a stage III B ovarian epithelial carcinoma diagnosed at 22 weeks of gestation and treated with initial chemotherapy: case report and literature review.  Gynecol Oncol. 2004;  94 600-604
• 40 Otton G, Higgins S, Phillips K A et al. A case of early-stage epithelial ovarian cancer in pregnancy.  Int J Gynecol Cancer. 2001;  11 413-417
• 41 Mendez L E, Mueller A, Salom E et al. Paclitaxel and carboplatin chemotherapy administered during pregnancy for advanced epithelial ovarian cancer.  Obstet Gynecol. 2003;  102 1200-1202
• 42 Sood A K, Shahin M S, Sorosky J I. Paclitaxel and platinum chemotherapy for ovarian carcinoma during pregnancy.  Gynecol Oncol. 2001;  83 599-600
• 43 Marana H R, de Andrade J M, da Silva Mathes A C et al. Chemotherapy in the treatment of locally advanced cervical cancer and pregnancy.  Gynecol Oncol. 2001;  80 272-274
• 44 Gordon A N, Jensen R, Jones 3rd  H W. Squamous carcinoma of the cervix complicating pregnancy: recurrence in episiotomy after vaginal delivery.  Obstet Gynecol. 1989;  73 850-852
• 45 Norstrom A, Jansson I, Andersson H. Carcinoma of the uterine cervix in pregnancy. A study of the incidence and treatment in the western region of Sweden 1973 to 1992.  Acta Obstet Gynecol Scand. 1997;  76 583-589
• 46 Coppola A, Sorosky J, Casper R et al. The clinical course of cervical carcinoma in situ diagnosed during pregnancy.  Gynecol Oncol. 1997;  67 162-165
• 47 Tewari K, Cappuccini F, Gambino A et al. Neoadjuvant chemotherapy in the treatment of locally advanced cervical carcinoma in pregnancy: a report of two cases and review of issues specific to the management of cervical carcinoma in pregnancy including planned delay of therapy.  Cancer. 1998;  82 1529-1534
• 48 Palaia I, Pernice M, Graziano M et al. Neoadjuvant chemotherapy plus radical surgery in locally advanced cervical cancer during pregnancy: a case report.  Am J Obstet Gynecol. 2007;  197 5-6
• 49 Karam A, Feldman N, Holschneider C H. Neoadjuvant cisplatin and radical cesarean hysterectomy for cervical cancer in pregnancy.  Nat Clin Pract Oncol. 2007;  4 375-380
• 50 Hoopmann M, Valter M, Kurbacher C et al. Chemopersistent early recurrence in the perineal tear scar of an intrapartally diagnosed cervical cancer.  Gynecol Oncol. 2003;  91 272-274
• 51 Cliby W A, Dodson M K, Podratz K C. Cervical cancer complicated by pregnancy: episiotomy site recurrences following vaginal delivery.  Obstet Gynecol. 1994;  84 179-182
• 52 Sanders J E, Hawley J, Levy W et al. Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation.  Blood. 1996;  87 3045-3052
• 53 Blakely L J, Buzdar A U, Lozada J A et al. Effects of pregnancy after treatment for breast carcinoma on survival and risk of recurrence.  Cancer. 2004;  100 465-469
• 54 Loibl S, von Minckwitz G, Gwyn K et al. Breast carcinoma during pregnancy. International recommendations from an expert meeting.  Cancer. 2006;  106 237-246
• 55 Lethaby A E, O'Neill M A, Mason B H et al. Overall survival from breast cancer in women pregnant or lactating at or after diagnosis.  Int J Cancer. 1996;  67 751-755
• 56 Ishida T, Yokoe T, Kasumi F et al. Clinicopathologic characteristics and prognosis of breast cancer patients associated with pregnancy and lactation: analysis of case-control study in Japan.  Jpn J Cancer Res. 1992;  83 1143-1149
• 57 Woo J C, Yu T, Hurd T C. Breast cancer in pregnancy: a literature review.  Arch Surg. 2003;  138 91-98 ,  discussion 99
• 58 Krontiras H, Bland K I. When is sentinel node biopsy for breast cancer contraindicated?.  Surg Oncol. 2003;  12 207-210
• 59 Mazonakis M, Varveris H, Damilakis J et al. Radiation dose to conceptus resulting from tangential breast irradiation.  Int J Radiat Oncol Biol Phys. 2003;  55 386-391
• 60 Nettleton J, Long J, Kuban D et al. Breast cancer during pregnancy: quantifying the risk of treatment delay.  Obstet Gynecol. 1996;  87 414-418
• 61 Langagergaard V, Gislum M, Skriver M V et al. Birth outcome in women with breast cancer.  Br J Cancer. 2006;  94 142-146
• 62 Peccatori F, Martinelli G, Gentilini O et al. Chemotherapy during pregnancy: what is really safe?.  Lancet Oncol. 2004;  5 398
• 63 Cullins S L, Pridjian G, Sutherland C M. Goldenhar's syndrome associated with tamoxifen given to the mother during gestation.  Jama. 1994;  271 1905-1906
• 64 Barthelmes L, Gateley C A. Tamoxifen and pregnancy.  Breast. 2004;  13 446-451
• 65 Tewari K, Bonebrake R G, Asrat T et al. Ambiguous genitalia in infant exposed to tamoxifen in utero.  Lancet. 1997;  350 183
• 66 Sekar R, Stone P R. Trastuzumab use for metastatic breast cancer in pregnancy.  Obstet Gynecol. 2007;  110 507-510
• 67 Shrim A, Garcia-Bournissen F, Maxwell C et al. Favorable pregnancy outcome following Trastuzumab (Herceptin) use during pregnancy – Case report and updated literature review.  Reprod Toxicol. 2007;  23 611-613
• 68 Zanetti-Dallenbach R, Tschudin S, Lapaire O et al. Psychological management of pregnancy-related breast cancer.  The Breast. 2006;  15 S57-S63
• 69 Jones A L. Fertility and pregnancy after breast cancer.  The Breast. 2006;  15 S41-S46
• 70 Mulvihill J J, Myers M H, Connelly R R et al. Cancer in offspring of long-term survivors of childhood and adolescent cancer.  Lancet. 1987;  2 813-817
• 71 Green D M, Whitton J A, Stovall M et al. Pregnancy outcome of female survivors of childhood cancer: a report from the Childhood Cancer Survivor Study.  Am J Obstet Gynecol. 2002;  187 1070-1080
• 72 Robison L L, Green D M, Hudson M et al. Long-term outcomes of adult survivors of childhood cancer.  Cancer. 2005;  104 2557-2564
• 73 Nulman I, Laslo D, Fried S et al. Neurodevelopment of children exposed in utero to treatment of maternal malignancy.  Br J Cancer. 2001;  85 1611-1618