دانلود رایگان مقاله انگلیسی سرطان در بارداری - الزویر 2018

INTRODUCTION

Because more women are waiting to have children until later in life, cancer diagnoses in pregnancy are becoming more common. Gestational cancer is defined as a new cancer diagnosis during pregnancy or in the first year postpartum.1 The most common cancers in reproductive aged women are breast, melanoma, thyroid, cervical, and lymphomas, listed in order of decreasing frequency.2 The diagnosis of cancer in the gestational period poses many difficult decisions for which multiple clinical, personal, and ethical factors need to be considered for treatment planning. We review the pertinent information for some of the more common gestational cancers, as well as some less common, but with increasing prevalence in the United States.

COLON CANCER

Colon cancer is one of the less common malignancies to encounter during pregnancy; however, the age at which colon cancer is diagnosed in women is decreasing, with a median age at diagnosis of 32 years in pregnant women.87 It is also important to consider, because many of the symptoms of colon cancer are similar to those related to pregnancy: nausea, vomiting, change in bowel habits, or rectal bleeding. The symptom of rectal bleeding is often overlooked in the pregnant patient and misdiagnosed as bleeding from hemorrhoids.87 Any of these symptoms should prompt investigation without delay. There is little evidence that establishes a different normal carcinoembryonic antigen level in pregnancy; therefore, any increase should be evaluated. These tests are typically drawn in the patient presenting with the symptoms listed above. Once colorectal cancer is suspected, the next step in a nonpregnant patient is a colonoscopy, barium enema, or a computed tomography scan. A colonoscopy, if needed, can be done safely during pregnancy.87 MRI rather than a computed tomography scan is ideal for staging purposes as well as evaluation of tumor burden.87 A systematic review of the current literature and cases of colon cancer in pregnancy concludes that survival is similar to that of nonpregnant patients; however, stage at diagnosis tends to be more advanced for pregnant women.87 Interestingly, metastasis to the ovary is more common in pregnancy-associated colon cancer, occurring in 23% versus 8% of pregnant and nonpregnant women, respectively.88,89 Placental metastasis is extremely rare.