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Malignant melanoma in pregnancy
What is malignant melanoma?
This is a type of cancer, usually of the skin but occasionally arising from the eye. It tends to arise from pigmented "birthmarks" but can appear anywhere on the skin surface.
Why is malignant melanoma especially important in pregnancy?
Firstly, it is relatively common in pregnancy, affecting up to one in every four hundred pregnant women; secondly, it is probably the one malignancy that is definitely known to be adversely affected by pregnancy, being more aggressive at this time; and thirdly, it is one of the very rare forms of cancer which could metastasize (extend to) the placenta and/or the fetus.
On a positive note, regression of the cancer can occur following the end of the pregnancy.
On a positive note, regression of the cancer can occur following the end of the pregnancy.
Should a pigmented birthmark be considered for surgical removal before trying to conceive?
It is fair to say that most birthmarks will remain innocent and without any changes throughout life. It is, however, prudent to ask a doctor to look at a birthmark, not only before conception but early in life, to see if it may have potential for malignant transformation.
Any changes to such lesions, however innocuous they may seem, require immediate medical attention. Such changes may be an increase in size, a change in shape or colour, or development of irritation/itchiness.
There is no time to waste because malignant melanoma can be incredibly aggressive.
Any changes to such lesions, however innocuous they may seem, require immediate medical attention. Such changes may be an increase in size, a change in shape or colour, or development of irritation/itchiness.
There is no time to waste because malignant melanoma can be incredibly aggressive.
What will be the treatment if malignant melanoma is diagnosed in pregnancy?
As in the non-pregnant state, surgery is the mainstay. There is usually no need to terminate the pregnancy. If the disease is discovered at a late stage and surgery is unable to remove the disease entirely, chemotherapy is supplemented. This is not very effective. Radiotherapy is hardly ever useful.
Why is Hodgkin's disease important in relation to pregnancy?'
Only because this is a type of cancer relatively common in young people. The peak incidence of this disease is in the early to mid-thirties. Pregnancy itself has no effect on the disease.
How can one suspect development of Hodgkin's disease?
Enlargement of lymph glands (lymph nodes), especially in the neck area, is the most common presentation. Other symptoms may include fatigue, weight loss and night sweats. Such symptoms should be immediately reported to the doctor.
If an enlarged lymph node is found, a biopsy will be taken for analysis. This should establish the diagnosis. The whole process takes only a few days.
If an enlarged lymph node is found, a biopsy will be taken for analysis. This should establish the diagnosis. The whole process takes only a few days.
Once the diagnosis of Hodgkin's disease is made, what then?
In relative terms, this is a type of cancer with a good prognosis because it responds to treatment. However, most treatment forms are incompatible with pregnancy.
The form of treatment adopted will depend on the stage at which the diagnosis is made. The obstetrician, together with the oncologist (cancer specialist), will explain everything exhaustively for the expectant mother to make an informed choice.
The form of treatment adopted will depend on the stage at which the diagnosis is made. The obstetrician, together with the oncologist (cancer specialist), will explain everything exhaustively for the expectant mother to make an informed choice.
In summary, in the early stages, the disease is best treated with radiotherapy. Termination of pregnancy is necessary, in most cases. However, if the disease is confined to the upper part of the body, a form of shielding of the uterus and its contents is possible. The advanced disease is treated by combined chemotherapy.
Unfortunately, the types of drugs used for this disease are incompatible with pregnancy and therefore termination is mandatory. Some patients insist on waiting until the fetus has reached a viable stage before terminating the pregnancy. This is a risky strategy, as the intervening days or weeks could make the difference between successful treatment and missing the boat. The patient is made aware of all these facts.