Cancer in pregnancy: <scp>FIGO</scp> Best practice advice and narrative review
Surabhi Nanda, Melanie Nana, Long Nguyen‐Hoang, Sumaiya Adam, Fionnuala M. McAuliffe, Lina Bergman, Sarikapan Wilailak, Orla McNally, Cynthia Maxwell, Nikhil Purandare, Bo Jacobsson, Virna Patricia Medina-Palmezano, Anil Kapur, Titus Beyuo, Francisco Ruiloba, Ernesto Castelazo, Graeme N. Smith, Sharleen O’Reilly, Patrick O’Brien, Mark A. Hanson, Mary Rosser, Claudio Sosa, Valerie T. Guinto, Jonathan S. Berek, Catherine Nelson‐Piercy, Frédéric Amant, Liona C. Poon
Abstract
Cancer during pregnancy is relatively rare. The incidence is underestimated due to the lack of international registries covering both high-income and low- and middle-income countries, and is expected to rise with increasing maternal age and increasing global adoption of cell-free DNA testing for aneuploidy. Physiological changes during pregnancy often make the diagnosis challenging and delayed. Lack of experience and knowledge about this condition may also contribute to late diagnosis, suboptimal management, and occasionally inadvertent fetal and/or maternal harm. The principles of cancer management in pregnancy for most cancer types do not differ significantly from the non-pregnant population. The impact of investigations for diagnosis and staging, risks of surgery, systemic chemotherapy, and/or radiotherapy on fetal well-being and preterm birth need to be considered for treatment and management planning, in addition to maternal wishes. Working in a multidisciplinary setting, ideally with medical and radiation oncologists, surgeons, radiologists, cancer specialist nurses, geneticists, psychologists, teratologists, and clinical pharmacologists, obstetricians, obstetric physicians, neonatologists, and experienced nursing and midwifery staff helps provide optimal care for the woman. This best practice advice aims to provide recommendations on the diagnosis and management of cancer in pregnancy, which can be adopted in all resource settings.