Almost a thousand children are born in these circumstances and the numbers are on their side. Today, expectant patients can be treated effectively and the therapies do not harm the health of children
a relatively rare event: one in a thousand pregnancies sees the diagnosis of cancer intrude on the mother’s life. A nightmare for about 150 pregnant women who every year in Italy find themselves having to face cancer while expecting a child, but an event that experts have learned to face better and better to save the life of the fetus and that of the mother. So much so that, in the world, they are now a thousand children born in these circumstances and the numbers are on their side: they are children, even adolescents, healthy because the oncological treatments have not caused them any harm. Discovering that you have cancer during pregnancy is a difficult experience to say the least – he stresses Phaedrus Sinners, director of the Unit of Fertility and Procreation in Oncology at the European Institute of Oncology (Ieo) in Milan, one of the leading Italian experts in this field -. for important to know that Today, expectant patients can be treated effectivelythat the therapies we prescribe do not harm the health of children, that the choice to save the child or the mother is really a borderline case.
What kind of cancer is it usually?
In half of the cases the diagnosis of breast cancer, which is the most frequent of all in women – replies Peccatori -. In the other half it is mostly lymphomas, rare sarcomas, colon neoplasms, which are more typical of young adults, before the age of 40. The numbers are still low, thankfully. And it must also be borne in mind that, as the average age of mothers rises (now the first child reaches about 33 years for Italians and 31 for foreigners), the chances of finding a tumor increase.
How often are patients asked to have an abortion?
The medical indication to terminate pregnancy is a rare event. It can happen in some cases of very aggressive cancer (such as acute leukemia), when to save the patient’s life it is really important to start treatment immediately. Most of the time, however, it is possible to wait until the thirteenth week, or the end of the first trimester of gestation, and apply the therapeutic protocols used outside of pregnancy, with some rare exceptions of medicines that are not suitable for pregnant women. Numerous studies, conducted around the world, have clearly established that once the first three months of gestation are over, chemotherapy can be done safely (without danger for the baby and for the mother). And if for radiotherapy you have to wait after delivery, access to the operating room has no limits: the patient can generally undergo surgery even in the first 13 weeks. Even under total anesthesia, if necessary – explains Sinners -: we know that, in these cases, the risk of spontaneous abortion rises to a minimum, which for the first trimester is already higher in itself. We can safely remove the tumor when needed. Just like with other urgent operations, such as appendicitis or due to road accidents.
Are chemo and radiotherapy toxic for a pregnant woman? Are anti-cancer therapies harmful to the fetus?
After the first trimester we can safely use most chemotherapy drugs, with a few exceptions (some monoclonal antibodies and tyrosine kinase inhibitors) of which we know the possible side effects. We look forward to receiving more information on other new medicines, which have entered current use a few years ago, such as target therapy or immunotherapy. Radiation therapy, on the other hand, is contraindicated until after delivery, but it depends on the area: the brain area, for example, can be irradiated without problems, while the breast too close to the uterus.
What is known about babies born to mothers treated for cancer when they were pregnant?
There are now many children born to mothers who have received chemotherapy treatments during pregnancy, about a thousand around the world. Today we have substantial information on teenagers who have been followed internationally for many years: they are healthy children and young people. There are no traces of cognitive retardation, delays in pubertal development, cardiological toxicity or the risk of cancer in the pediatric age. A study on possible neurological damage (neuro-cognitive development) in 10-year-old children – says the expert -: the brain is the most plastic organ, the one that undergoes the greatest changes during the second and third trimester of pregnancy, but research does not document any problems. Of course it is important, as with all other pregnancies, to try to reach term. And, in addition, be followed by reference centersbecause in any case it is a more “delicate” situation, which requires special attention and controls, both for pregnancy and for tumor control.
November 7, 2022 (change November 7, 2022 | 09:30)
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