Research

13 pages, 376 KiB

Open AccessArticle

Reproductive Pattern of Parous Women and the Risk of Cancer in Later Life

by Zahra Pasdar, Neil W. Scott, Lisa Iversen, Philip C. Hannaford, Phyo Kyaw Myint and Sohinee Bhattacharya

Cancers 2021, 13(15), 3731; https://doi.org/10.3390/cancers13153731 - 24 Jul 2021

Cited by 4 | Viewed by 1841

Abstract

We assessed the risk of any and site-specific cancers in a case-control study of parous women living in northeast Scotland in relation to: total number of pregnancies, cumulative time pregnant, age at first delivery and interpregnancy interval. We analysed 6430 women with cancer [...] Read more.

We assessed the risk of any and site-specific cancers in a case-control study of parous women living in northeast Scotland in relation to: total number of pregnancies, cumulative time pregnant, age at first delivery and interpregnancy interval. We analysed 6430 women with cancer and 6430 age-matched controls. After adjustment for confounders, women with increasing number of pregnancies had similar odds of cancer diagnosis as women with only one pregnancy. The adjusted odds of cancer diagnosis were no higher in women with cumulative pregnancy time 50–150 weeks compared to those pregnant ≤ 50 weeks. Compared with women who had their first delivery at or before 20 years of age, the adjusted odds ratio (AOR) among those aged 21–25 years was 0.81, 95% CI 0.74, 0.88; 26–30 years AOR 0.77, 95% CI 0.69, 0.86; >30 years AOR 0.63, 95% CI 0.55, 0.73. After adjustment, the odds of having any cancer were higher in women who had an inter-pregnancy interval >3 years compared to those with no subsequent pregnancy (AOR 1.17, 95% CI 1.05, 1.30). Older age at first pregnancy was associated with increased risk of breast and gastrointestinal cancer, and reduced risk of invasive cervical, carcinoma in situ of the cervix and respiratory cancer. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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12 pages, 650 KiB

Open AccessArticle

Maternal and Neonatal Outcome after the Use of G-CSF for Cancer Treatment during Pregnancy

by Claudia Berends, Charlotte Maggen, Christianne A. R. Lok, Mathilde van Gerwen, Ingrid A. Boere, Vera E. R. A. Wolters, Kristel Van Calsteren, Heidi Segers, Marry M. van den Heuvel-Eibrink, Rebecca C. Painter, Mina Mhallem Gziri and Frédéric Amant

Cancers 2021, 13(6), 1214; https://doi.org/10.3390/cancers13061214 - 10 Mar 2021

Cited by 10 | Viewed by 2704

Abstract

Data on the use of Granulocyte colony-stimulating factor (G-CSF) in pregnant cancer patients are scarce. The International Network of Cancer, Infertility and Pregnancy (INCIP) reviewed data of pregnant patients treated with chemotherapy and G-CSF, and their offspring. Among 2083 registered patients, 42 pregnant [...] Read more.

Data on the use of Granulocyte colony-stimulating factor (G-CSF) in pregnant cancer patients are scarce. The International Network of Cancer, Infertility and Pregnancy (INCIP) reviewed data of pregnant patients treated with chemotherapy and G-CSF, and their offspring. Among 2083 registered patients, 42 pregnant patients received G-CSF for the following indications: recent chemotherapy induced febrile neutropenia (5; 12%), dose dense chemotherapy (28, 67%), poly chemotherapy (7, 17%), or prevention of neutropenia at delivery (2; 5%). Among 24 women receiving dose dense chemotherapy, three (13%) patients recovered from asymptomatic neutropenia within 5 days. One patient developed pancytopenia following polychemotherapy after which the pregnancy was complicated by chorioamnionitis and intrauterine death. Nineteen singleton livebirths (49%) were born preterm. Sixteen neonates (41%) were admitted to the Neonatal Intensive care Unit (NICU). No neonatal neutropenia occurred. Two neonates had congenital malformations. Out of 21 children in follow-up, there were four children with a motor development delay and two premature infants had a delay in cognitive development. In conclusion, the rate of maternal and neonatal complications are similar to those described in (pregnant) women treated with chemotherapy. Due to small numbers and limited follow-up, rare or delayed effects among offspring exposed to G-CSF in utero cannot be ruled out yet. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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17 pages, 2037 KiB

Open AccessArticle

Time to Pregnancy, Obstetrical and Neonatal Outcomes after Breast Cancer: A Study from the Maternity Network for Young Breast Cancer Patients

by Julie Labrosse, Anne Lecourt, Alice Hours, Clara Sebbag, Aullene Toussaint, Enora Laas, Florence Coussy, Beatriz Grandal, Elise Dumas, Eric Daoud, Charlotte Morel, Jean-Guillaume Feron, Matthieu Faron, Jean-Yves Pierga, Fabien Reyal and Anne-Sophie Hamy

Cancers 2021, 13(5), 1070; https://doi.org/10.3390/cancers13051070 - 03 Mar 2021

Cited by 4 | Viewed by 2153

Abstract

Although an increasing number of young breast cancer (BC) patients have a pregnancy desire after BC, the time necessary to obtain a pregnancy after treatment and subsequent outcomes remain unknown. We aimed to determine the time to evolutive pregnancy in a cohort of [...] Read more.

Although an increasing number of young breast cancer (BC) patients have a pregnancy desire after BC, the time necessary to obtain a pregnancy after treatment and subsequent outcomes remain unknown. We aimed to determine the time to evolutive pregnancy in a cohort of BC survivors and subsequent obstetrical and neonatal outcomes. We analyzed BC patients treated at Institut Curie from 2005–2017, aged 18–43 years old (y.o.) at diagnosis having at least one subsequent pregnancy. 133 patients were included, representing 197 pregnancies. Mean age at BC diagnosis was 32.8 y.o. and at pregnancy beginning was 36.8 y.o. 71% pregnancies were planned, 18% unplanned and 86% spontaneous. 64% pregnancies resulted in live birth (n = 131). Median time from BC diagnosis to pregnancy beginning was 48 months and was significantly associated with endocrine therapy (p < 0.001). Median time to pregnancy was 4.3 months. Median time to evolutive pregnancy 5.6 months. In multivariate analysis, menstrual cycles before pregnancy remained significantly associated with time to pregnancy and endocrine therapy with time evolutive to pregnancy. None of the BC treatments (chemotherapy/endocrine therapy/trastuzumab) was significantly associated with obstetrical nor neonatal outcomes, that seemed comparable to global population. Our findings provide reassuring data for pregnancy counseling both in terms of delay and outcome. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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12 pages, 1276 KiB

Open AccessArticle

Evolution of Angiogenic Factors in Pregnant Patients with Breast Cancer Treated with Chemotherapy

by Cristina Saura, Olga Sánchez, Sandra Martínez, Carmen Domínguez, Rodrigo Dienstmann, Fiorella Ruíz-Pace, Maria Concepció Céspedes, Ángeles Peñuelas, Javier Cortés, Elisa Llurba and Octavi Córdoba

Cancers 2021, 13(4), 923; https://doi.org/10.3390/cancers13040923 - 23 Feb 2021

Cited by 1 | Viewed by 2373

Abstract

High prevalence of placental-derived complications, such as preeclampsia and intrauterine growth restriction, has been reported in women with breast cancer (BC) treated with chemotherapy during pregnancy (PBC-CHT). Aim: To ascertain whether PBC-CHT is associated with an imbalance of angiogenic factors, surrogate markers for [...] Read more.

High prevalence of placental-derived complications, such as preeclampsia and intrauterine growth restriction, has been reported in women with breast cancer (BC) treated with chemotherapy during pregnancy (PBC-CHT). Aim: To ascertain whether PBC-CHT is associated with an imbalance of angiogenic factors, surrogate markers for placental insufficiency, that could explain perinatal outcomes. Methods: Prospective study between 2012 and 2016 in a single institution. Soluble fms-like tyrosine kinase (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng) in maternal blood were assessed throughout pregnancy in 12 women with BC and 215 controls. Results: Cancer patients were treated with doxorubicin-based regimes and with taxanes. Ten PBC-CHT (83%) developed obstetrical complications. At the end of the third trimester, significantly higher levels of sFlt-1; sFlt-1/PGF ratio, and sEng levels were observed in BC women as compared to controls. Moreover; there was a significant correlation between plasma levels of sFlt-1 and the number of chemotherapy cycles administered. Besides, more chemotherapy cycles correlated with lower birthweight and head circumference at birth. Conclusions: Women with BC treated during pregnancy showed an antiangiogenic state compatible with placental insufficiency. Angiogenic factors could be useful in the clinical obstetric management of these patients; although further studies will be required to guide clinical decision-making. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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12 pages, 1092 KiB

Open AccessArticle

Fifteen Year Regional Center Experience in Sperm Banking for Cancer Patients: Use and Reproductive Outcomes in Survivors

by Sara Stigliani, Claudia Massarotti, Caterina De Leo, Elena Maccarini, Fausta Sozzi, Angelo Cagnacci, Paola Anserini and Paola Scaruffi

Cancers 2021, 13(1), 116; https://doi.org/10.3390/cancers13010116 - 01 Jan 2021

Cited by 13 | Viewed by 2455

Abstract

Cancer treatments frequently impair the reproductive ability of patients by damaging spermatogenesis. International guidelines recommend semen cryopreservation to preserve the fertility of oncological adult males and pubertal boys. However, due to the low usage rate of banked samples, not a lot of data [...] Read more.

Cancer treatments frequently impair the reproductive ability of patients by damaging spermatogenesis. International guidelines recommend semen cryopreservation to preserve the fertility of oncological adult males and pubertal boys. However, due to the low usage rate of banked samples, not a lot of data on assisted reproductive treatments (ART) success rates in this population and follow-up data for children born are available in the literature. The aims of this study were to report our 15 years of experience, the clinical outcomes of ART as well as neonatal characteristics of babies born. We retrospectively reviewed 682 oncological patients who were referred to our center from 2004 to 2019 for fertility preservation. Over the years, only 26 patients (4%) returned to use their sperm by ART. They were survivors of leukemia and lymphomas (52%), testicular cancer (20%), and other malignant diseases (28%). These couples performed 45 cycles: 34 intracytoplasmic sperm injection (ICSI) plus 11 frozen embryo transfers. A total of 13 children were born, with 35% of the cumulative live-birth delivery rate per couple. No stillbirths or malformations were recorded. These successful findings demonstrated that pregnancy could be safely achieved using frozen-thawed sperm of cancer survivors who cryopreserved before gonadotoxic therapies. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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12 pages, 1933 KiB

Open AccessArticle

Cancer During Pregnancy: The Role of Vascular Toxicity in Chemotherapy-Induced Placental Toxicity

by Hadas Bar-Joseph, Fedro Alessandro Peccatori, Tal Goshen-Lago, Fulvia Milena Cribiù, Giovanna Scarfone, Irit Miller, Luba Nemerovsky, Mattan Levi, Ruth Shalgi and Irit Ben-Aharon

Cancers 2020, 12(5), 1277; https://doi.org/10.3390/cancers12051277 - 18 May 2020

Cited by 9 | Viewed by 2736

Abstract

Breast cancer is diagnosed in ~0.3% of pregnant women. Studies that have addressed gestational and neonatal outcomes of chemotherapy during pregnancy have demonstrated increased gestational complications including preeclampsia and intrauterine growth retardation. We hypothesized that anthracycline-induced gestational complications could be derived from direct [...] Read more.

Breast cancer is diagnosed in ~0.3% of pregnant women. Studies that have addressed gestational and neonatal outcomes of chemotherapy during pregnancy have demonstrated increased gestational complications including preeclampsia and intrauterine growth retardation. We hypothesized that anthracycline-induced gestational complications could be derived from direct toxicity on the placenta vasculature. Pregnant ICR mice (day E12.5) were treated with doxorubicin (DXR; 8 mg/kg) or saline, while their umbilical cord blood flow was imaged by pulse-wave (PW) Doppler. Mice were euthanized on day E18.5, and their embryos and placentae were collected for further analysis. Unlike control mice, the DXR-treated mice presented an acute change in the umbilical cord’s blood flow parameters (velocity time integral and heart rate interval), reduced embryos’ weight, reduced placenta efficiency, and modulation in vascular-related pathways of treated placenta proteomics. Apoptosis and proliferation were also enhanced, as demonstrated by TUNEL and proliferating cell nuclear antigen (PCNA) analysis. We further examined the placentae of patients treated with epirubicin (EPI), who had been diagnosed with breast cancer during pregnancy (weeks 27–35). The immunohistochemistry of the EPI-treated human placentae showed enhanced proliferation and apoptosis as compared with matched chemo-naïve placentae, as well as reduced neovascularization (CD34). Our findings suggest that anthracycline-induced vascular insult promotes placental toxicity, and could point to potential agents designated to offset the damage and to reduce gestational complications in pregnant cancer patients. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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Review

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17 pages, 339 KiB

Open AccessReview

Endometrial Cancer in Reproductive Age: Fertility-Sparing Approach and Reproductive Outcomes

by Levent Mutlu, Diego D. Manavella, Giuseppe Gullo, Blair McNamara, Alessandro D. Santin and Pasquale Patrizio

Cancers 2022, 14(21), 5187; https://doi.org/10.3390/cancers14215187 - 22 Oct 2022

Cited by 25 | Viewed by 2032

Abstract

Endometrial cancer is the most common gynecologic malignancy in developed countries and approximately 7% of the women with endometrial cancer are below the age of 45. Management of endometrial cancer in young women who desire to maintain fertility presents a unique set of [...] Read more.

Endometrial cancer is the most common gynecologic malignancy in developed countries and approximately 7% of the women with endometrial cancer are below the age of 45. Management of endometrial cancer in young women who desire to maintain fertility presents a unique set of challenges since the standard surgical treatment based on hysterectomy and salpingo-oophorectomy is often not compatible with the patient’s goals. A fertility-preserving approach can be considered in selected patients with early stage and low-grade endometrial cancer. An increasing amount of data suggest that oncologic outcomes are not compromised if a conservative approach is utilized with close monitoring until childbearing is completed. If a fertility-preserving approach is not possible, assisted reproductive technologies can assist patients in achieving their fertility goals. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

21 pages, 383 KiB

Open AccessReview

Cancer and Pregnancy: A Comprehensive Review

by Roxana Schwab, Katharina Anic and Annette Hasenburg

Cancers 2021, 13(12), 3048; https://doi.org/10.3390/cancers13123048 - 18 Jun 2021

Cited by 19 | Viewed by 3872

Abstract

Cancer diagnosis and treatment in pregnant women is a challenging situation. A multidisciplinary network of specialists is required to guide both, the expecting mother and the unborn child through the diagnostic workup and the cytotoxic therapy, by balancing the respective risks and benefits. [...] Read more.

Cancer diagnosis and treatment in pregnant women is a challenging situation. A multidisciplinary network of specialists is required to guide both, the expecting mother and the unborn child through the diagnostic workup and the cytotoxic therapy, by balancing the respective risks and benefits. Tumor entity, stage, biology and gestational week at diagnosis determine the appropriate approach. As premature delivery emerged as one of the main risk factors for adverse long-term outcome of the progeny, it should be avoided, if reasonable from the oncological perspective. This article offers a comprehensive review with respect to the various aspects of cancer in pregnancy. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

16 pages, 808 KiB

Open AccessReview

Pregnancy and Cancer: Cellular Biology and Mechanisms Affecting the Placenta

by Melina de Moraes Santos Oliveira, Carla de Moraes Salgado, Lais Rosa Viana and Maria Cristina Cintra Gomes-Marcondes

Cancers 2021, 13(7), 1667; https://doi.org/10.3390/cancers13071667 - 01 Apr 2021

Cited by 7 | Viewed by 2877

Abstract

Cancer during pregnancy is rarely studied due to its low incidence (1:1000). However, as a result of different sociocultural and economic changes, women are postponing pregnancy, so the number of pregnant women with cancer has been increasing in recent years. The importance of [...] Read more.

Cancer during pregnancy is rarely studied due to its low incidence (1:1000). However, as a result of different sociocultural and economic changes, women are postponing pregnancy, so the number of pregnant women with cancer has been increasing in recent years. The importance of studying cancer during pregnancy is not only based on maternal and foetal prognosis, but also on the evolutionary mechanisms of the cell biology of trophoblasts and neoplastic cells, which point out similarities between and suggest new fields for the study of cancer. Moreover, the magnitude of how cancer factors can affect trophoblastic cells, and vice versa, in altering the foetus’s nutrition and health is still a subject to be understood. In this context, the objective of this narrative review was to show that some researchers point out the importance of supplementing branched-chain amino acids, especially leucine, in experimental models of pregnancy associated with women with cancer. A leucine-rich diet may be an interesting strategy to preserve physiological placenta metabolism for protecting the mother and foetus from the harmful effects of cancer during pregnancy. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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18 pages, 856 KiB

Open AccessReview

Ovarian Cancer and Pregnancy—A Current Problem in Perinatal Medicine: A Comprehensive Review

by Dominik Franciszek Dłuski, Radzisław Mierzyński, Elżbieta Poniedziałek-Czajkowska and Bożena Leszczyńska-Gorzelak

Cancers 2020, 12(12), 3795; https://doi.org/10.3390/cancers12123795 - 16 Dec 2020

Cited by 9 | Viewed by 4601

Abstract

The frequency of concomitant adnexal tumors in pregnancy is reported to be at 0.15–5.7%, while ovarian cancer complicates 1 in 15,000 to 1 in 32,000 pregnancies, being the second most common gynecologic cancer diagnosed during pregnancy. The aim of this review is to [...] Read more.

The frequency of concomitant adnexal tumors in pregnancy is reported to be at 0.15–5.7%, while ovarian cancer complicates 1 in 15,000 to 1 in 32,000 pregnancies, being the second most common gynecologic cancer diagnosed during pregnancy. The aim of this review is to discuss the problem of ovarian cancer complicating pregnancy and the current recommendations for diagnostics and treatment, with an emphasis on the risk to the fetus. A detailed analysis of the literature found in the PubMed and MEDLINE databases using the keywords “ovarian cancer”, “ovarian malignancy”, “adnexal masses”, “ovarian tumor” and “pregnancy” was performed. There were no studies on a large series of pregnant women treated for ovarian malignancies and the management has not been well established. The diagnostics and therapeutic procedures need to be individualized with respect to the histopathology of the tumor, its progression, the gestational age at the time of diagnosis and the mother’s decisions regarding pregnancy preservation. The multidisciplinary cooperation of specialists in perinatal medicine, gynecological oncology, chemotherapy, neonatology and psychology seems crucial in order to obtain the best possible maternal and neonatal outcomes. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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16 pages, 477 KiB

Open AccessReview

Long-Term Neurodevelopmental Outcome of Children after in Utero Exposure to Chemotherapy

by Anna-Maria Korakiti, Eleni Zografos, Mathilde van Gerwen, Frédéric Amant, Meletios-Athanasios Dimopoulos and Flora Zagouri

Cancers 2020, 12(12), 3623; https://doi.org/10.3390/cancers12123623 - 03 Dec 2020

Cited by 9 | Viewed by 2140

Abstract

Pregnancy-related cancer management represents a real challenge for both the patients and the physicians. The long-term neurodevelopmental outcome of children in utero exposed to chemotherapeutic agents has only recently been addressed. This review aims to systematically integrate and highlight all existing data from [...] Read more.

Pregnancy-related cancer management represents a real challenge for both the patients and the physicians. The long-term neurodevelopmental outcome of children in utero exposed to chemotherapeutic agents has only recently been addressed. This review aims to systematically integrate and highlight all existing data from the literature regarding the effect of prenatal exposure to chemotherapy on fetal brain growth and child development. All eligible studies are based on validated neurodevelopmental testing scales (e.g., Bayley Scales of Infant Development, Wechsler Preschool and Primary Scale of Intelligence) and/or well-defined questionnaires. Our systematic review including 17 studies demonstrates that no major consequences on the neurodevelopment of children after in utero exposure to anti-cancer drugs have been reported; nevertheless, longer and more thorough follow-up with large-scale multicenter prospective studies is certainly required in order to draw firm conclusions. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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17 pages, 734 KiB

Open AccessReview

Update on the Management of Breast Cancer during Pregnancy

by Francesca Poggio, Marco Tagliamento, Chiara Pirrone, Davide Soldato, Benedetta Conte, Chiara Molinelli, Maurizio Cosso, Piero Fregatti, Lucia Del Mastro and Matteo Lambertini

Cancers 2020, 12(12), 3616; https://doi.org/10.3390/cancers12123616 - 03 Dec 2020

Cited by 35 | Viewed by 5541

Abstract

The diagnosis of breast cancer during pregnancy represents a challenging situation for the patient, her caregivers and physicians. Pregnancy adds complexity to oncological treatment planning, as many therapies can be potentially dangerous to the fetus. Therefore, a multidisciplinary approach is needed to offer [...] Read more.

The diagnosis of breast cancer during pregnancy represents a challenging situation for the patient, her caregivers and physicians. Pregnancy adds complexity to oncological treatment planning, as many therapies can be potentially dangerous to the fetus. Therefore, a multidisciplinary approach is needed to offer a proper care for obtaining the best possible outcomes for the mother and the future child. Breast surgery is feasible throughout the pregnancy while radiotherapy should be postponed after delivery. Administration of chemotherapy is considered safe and can be given during the second and third trimesters, while it is contraindicated in the first trimester due to the high risk of fetal malformations. Endocrine therapy and targeted agents are not recommended during the whole pregnancy period; however, limited data are available on the use of the majority of new anticancer drugs in this context. The aim of the current review is to provide an update on the current state of art about the management of women diagnosed with breast cancer during pregnancy. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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12 pages, 1295 KiB

Open AccessReview

Frequency of Pregnancy-Associated Cancer: A Systematic Review of Population-Based Studies

by Michela Dalmartello, Eva Negri, Carlo La Vecchia, Giovanna Scarfone, Barbara Buonomo, Fedro A. Peccatori and Fabio Parazzini

Cancers 2020, 12(6), 1356; https://doi.org/10.3390/cancers12061356 - 26 May 2020

Cited by 28 | Viewed by 2428

Abstract

Despite numerous available resources of evidence, the results about the frequency of pregnancy-associated cancer (PAC) still show poor comparability due to dissimilarities in the study design and methodology, inclusion criteria, incoherent duration of follow-up and a heterogeneous reference population. We conducted a systematic [...] Read more.

Despite numerous available resources of evidence, the results about the frequency of pregnancy-associated cancer (PAC) still show poor comparability due to dissimilarities in the study design and methodology, inclusion criteria, incoherent duration of follow-up and a heterogeneous reference population. We conducted a systematic review of population-based studies on PAC published up to December 2019, to provide updated research on this topic, highlighting strengths and limitations. Of the 24 papers included, 11 considered all types of tumors and 13 dealt with specific types of cancer. Differences in the procedures for estimating the frequency of PAC emerged even among population studies. However, we found consistent results for overall frequency of PAC— around 1/1000 pregnancies. Our review suggests that about 25% of PAC cases are diagnosed during pregnancy, confirming the hypothesis of an excess of diagnosis in the postpregnancy period. Sparse and inconsistent results were found regarding a potential increase in the frequency of PAC over calendar years. Alignments in the strategy to identify PAC are needed to overcome methodological weaknesses. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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19 pages, 360 KiB

Open AccessSystematic Review

Cancer during Pregnancy: A Review of Preclinical and Clinical Transplacental Transfer of Anticancer Agents

by Laure Benoit, Olivier Mir, François Vialard and Paul Berveiller

Cancers 2021, 13(6), 1238; https://doi.org/10.3390/cancers13061238 - 11 Mar 2021

Cited by 16 | Viewed by 2644

Abstract

The occurrence of cancer during pregnancy is observed in 1 in 1000 pregnancies and is expected to increase given the trend of delaying childbearing. While breast cancer is the most common, the incidence of other cancers, such as cervical, ovarian, and lung cancers [...] Read more.

The occurrence of cancer during pregnancy is observed in 1 in 1000 pregnancies and is expected to increase given the trend of delaying childbearing. While breast cancer is the most common, the incidence of other cancers, such as cervical, ovarian, and lung cancers as well as hemopathies and melanomas, is also increasing. Thus, cancer occurrence in pregnant women raises questions of management during pregnancy and, especially, assessment of the treatment benefit–risk ratio to ensure optimal management for the mother while ensuring the safety of the fetus. Chemotherapy remains a cornerstone of cancer management. If the use of anticancer agents appears possible during pregnancy, while avoiding the first trimester, the extent of placental transfer of different anticancer agents varies considerably thereafter. Furthermore, the significant physiological pharmacokinetic variations observed in pregnant women may have an impact on the placental transfer of anticancer agents. Given the complexity of predicting placental transfer of anticancer agents, preclinical studies are therefore mandatory. The aim of this review was to provide updated data on in vivo and ex vivo transplacental transfer of anticancer agents used in the management of the most common pregnancy-associated cancers to better manage these highly complex cases. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

23 pages, 746 KiB

Open AccessEditor’s ChoiceSystematic Review

Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review

by Teska Schuurman, Sanne Zilver, Sanne Samuels, Winnie Schats, Frédéric Amant, Nienke van Trommel and Christianne Lok

Cancers 2021, 13(5), 1008; https://doi.org/10.3390/cancers13051008 - 28 Feb 2021

Cited by 23 | Viewed by 4091

Abstract

Fertility-sparing surgery (FSS) is increasingly being offered to women with a gynecological malignancy who wish to preserve fertility. In this systematic review, we evaluate the best evidence currently available on oncological and reproductive outcome after FSS for early stage cervical cancer, epithelial ovarian [...] Read more.

Fertility-sparing surgery (FSS) is increasingly being offered to women with a gynecological malignancy who wish to preserve fertility. In this systematic review, we evaluate the best evidence currently available on oncological and reproductive outcome after FSS for early stage cervical cancer, epithelial ovarian cancer, and endometrial cancer. An extensive literature search was conducted using the electronic databases Medline (OVID), Embase, and Cochrane Library to identify eligible studies published up to December 2020. In total, 153 studies were included with 7544, 3944, and 1229 patients who underwent FSS for cervical, ovarian, and endometrial cancer, respectively. We assessed the different FSS techniques that are available to preserve fertility, i.e., omitting removal of the uterine body and preserving at least one ovary. Overall, recurrence rates after FSS are reassuring and therefore, these conservative procedures seem oncologically safe in the current selection of patients with low-stage and low-grade disease. However, generalized conclusions should be made with caution due to the methodology of available studies, i.e., mostly retrospective cohort studies with a heterogeneous patient population, inducing selection bias. Moreover, about half of patients do not pursue pregnancy despite FSS and the reasons for these decisions have not yet been well studied. International collaboration will facilitate the collection of solid evidence on FSS and the related decision-making process to optimize patient selection and counseling. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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23 pages, 2516 KiB

Open AccessSystematic Review

How Can We Treat Vulvar Carcinoma in Pregnancy? A Systematic Review of the Literature

by Andrea Palicelli, Lucia Giaccherini, Magda Zanelli, Maria Paola Bonasoni, Maria Carolina Gelli, Alessandra Bisagni, Eleonora Zanetti, Loredana De Marco, Federica Torricelli, Gloria Manzotti, Mila Gugnoni, Giovanni D’Ippolito, Angela Immacolata Falbo, Filomena Giulia Sileo, Lorenzo Aguzzoli, Valentina Mastrofilippo, Martina Bonacini, Federica De Giorgi, Stefano Ricci, Giuditta Bernardelli, Laura Ardighieri, Maurizio Zizzo, Antonio De Leo, Giacomo Santandrea, Dario de Biase, Moira Ragazzi, Giulia Dalla Dea, Claudia Veggiani, Laura Carpenito, Francesca Sanguedolce, Aleksandra Asaturova, Renzo Boldorini, Maria Giulia Disanto, Margherita Goia, Richard Wing-Cheuk Wong, Naveena Singh and Vincenzo Dario Mandato Show full author list Hide full author list

Cancers 2021, 13(4), 836; https://doi.org/10.3390/cancers13040836 - 17 Feb 2021

Cited by 9 | Viewed by 2943

Abstract

According to our systematic literature review (PRISMA guidelines), only 37 vulvar squamous cell carcinomas (VSCCs) were diagnosed during pregnancy (age range: 17–41 years). The tumor size range was 0.3–15 cm. The treatment was performed after (14/37, 38%), before (10/37, 27%), or before-and-after delivery [...] Read more.

According to our systematic literature review (PRISMA guidelines), only 37 vulvar squamous cell carcinomas (VSCCs) were diagnosed during pregnancy (age range: 17–41 years). The tumor size range was 0.3–15 cm. The treatment was performed after (14/37, 38%), before (10/37, 27%), or before-and-after delivery (11/37, 30%). We found that 21/37 (57%) cases were stage I, 2 II (5%), 11 III (30%), and 3 IVB (8%). HPV-related features (condylomas/warts; HPV infection; high-grade squamous intraepithelial lesion) were reported in 11/37 (30%) cases. We also found that 9/37 (24%) patients had inflammatory conditions (lichen sclerosus/planus, psoriasis, chronic dermatitis). The time-to-recurrence/progression (12/37, 32%) ranged from 0 to 36 (mean 9) months. Eight women died of disease (22%) 2.5–48 months after diagnosis, 2 (5%) were alive with disease, and 23 (62%) were disease-free at the end of follow-up. Pregnant patients must be followed-up. Even if they are small, newly arising vulvar lesions should be biopsied, especially in women with risk factors (HPV, dermatosis, etc.). The treatment of VSCCs diagnosed in late third trimester might be delayed until postpartum. Elective cesarean section may prevent vulvar wound dehiscence. In the few reported cases, pregnancy/fetal outcomes seemed to not be affected by invasive treatments during pregnancy. However, clinicians must be careful; larger cohorts should define the best treatment. Definite guidelines are lacking, so a multidisciplinary approach and discussion with patients are mandatory. Full article

(This article belongs to the Special Issue Cancer and Pregnancy)

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