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Cancer in Pregnancy: Bone Malignancies in Pregnancy

Introduction
Primary malignant bone cancer is rarely associated with pregnancy1. The available information regarding its evaluation and management is very limited. A delay in diagnosis due to pregnancy has been suggested1.

Diagnosis
Although magnetic resonance imaging is the diagnostic method of choice2 and can be repeated many times in pregnancy 3, ultrasound, biopsy to stage the tumor, and clinical examination remain equally safe and important in arriving at the diagnosis. Independence of bone tumors from hormonal regulation was shown.4 The association of bone neoplasm with pregnancy may be fortuitous.5

Treatment
Therapeutic considerations are complex since aggressive combined modality approach including surgery, irradiation and chemotherapy is often used and should be tailored to the individual patient.

The decision making analysis should include the type and site of the primary tumor, its growth rate and associated symptoms, the use of specific diagnostic tests and appropriate treatment options 6. In cases where bone malignancy involves the pelvis caeserean section delivery should be considered to increase fetal safety 7.

Prognosis
Although based on very limited data - it was suggested that pregnancy does not appear to exacerbate tumor growth or effect the outcome of the patients 8,9.

References

  1. Dhillon MS, Singh DP, Gill SS, Sur R, Sarode VR, Nagi ON: Primary bone malignancies in pregnancy. A report of 4 cases. Orthop. Rev. 22:931-7, 1993.
  2. Malawer MM, Link MP, Donaldson SS. Sarcomas of bone, in: DeVita VT, Hellman S, Rosenberg SA: Cancer: Principles and Practice of Oncology. Lippincott-Raven Publishers. 5th edition, 1997 pp 1789-1852.
  3. Campanacci M. Gasbarrini A. Campanacci L. The value of imaging in the diagnosis and treatment of bone tumors. European Journal of Radiology. 27 Suppl 1:S116-22,1998.
  4. Komiya S. Zenmyo M. Inoue A. Bone tumors in the pelvis presenting growth during pregnancy. Archives of Orthopedic & Trauma Surgery. 119 (1-2) : 22-9, 1999.
  5. Lamovec J. Bracko M. Epithelioid hemangioma of small tubular bones : a report of three cases, two of them associated with pregnancy. Modern Pathology. 9(8):821-7, 1996.
  6. Merimsky O, Le Cense A. Soft tissue and bone sarcomas in association with pregnancy. Acta Oncol 37: 721-7, 1998.
  7. Merimsky O, Le Chevalier T, Missenard G, Lepechoux C, Cojean-Zelek I, Mesurolle B, Le Cesne A. Management of cancer in pregnancy: a case of Ewing's sarcoma of the pelvis in the therd trimester. Annals of Oncology. 10 ( 3 ):345-50, 1999.
  8. Sadat-Ali M, Ibrahim EM. Malignant bone tumors in pregnancy. Indian J of Can 26:151-5, 1989.
  9. Simon MA, Philips WA, Bonfiglio M. Pregnancy and aggressive or malignant primary bone tumors. Cancer 53:2564-9, 1984.
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