Chemotherapie bei gynäkologischen Tumoren – kontraindiziert in der Schwangerschaft?

Abstract

Even though a malignant tumor during pregnancy is very rare it occurs in 0.02-0.1%. With the tendency in society to postpone childbirth to an older age, there will be more cancers diagnosed during pregnancy. The coincidence of malignant disease with pregnancy leads to an enormous emotional burden to the patient, the couple and the medical staff. Surgery for malignant tumors during pregnancy seems to be save. Radiotherapy on the other hand should be avoided. Chemotherapy is regarded to be save during the second and third trimester but it should not be applied during the first trimester because of its teratogenic effects. The most frequent malignant disorders during pregnancy are cervical cancer, breast cancer, melanoma and Hodgkin lymphoma. We discuss possible treatment options for breast cancer and gynecological tumors during pregnancy. Ovarian Cancer is a rare event during pregnancy. Because of frequent prenatal visits most of them are diagnosed at an early stage, with good prognosis. In case of advanced stage of ovarian cancer chemotherapy besides surgery is necessary. The former usually is preferred as monotherapy during pregnancy. To treat breast cancer during pregnancy a mastectomy with axillary lymphonodectomy is necessary to avoid radiotherapy. Indications for chemotherapy are the same as for not pregnant patients. Usually AC with and without 5-FU is used. For invasive cervical cancer surgery or radiotherapy +/- chemotherapy is indicated after induced abortion or cesarean section. Early termination of pregnancy is of no survival benefit to the mother in case of breast cancer and ovarian cancer. In these cases systemic therapy during pregnancy and delivery at 34 weeks is recommended.