Synopsis
Cancer and Pregnancy covers the clinical challenges to diagnosing and treating malignancies in the pregnant patient; however, the book also shows how an understanding of the common features of both processes (rapid cell proliferation) may lead to novel anti-cancer treatment options. The book should be read by obstetricians and gynaecologists, clinical oncologists, reproduction specialists, and those involved in investigation of development, biology, toxicology, immunology, as well as cancer research.
Reviews
Few, if any, problems in medicine present as great a challenge to the clinician as cancer during pregnancy. The anxiety of the health care team results from the need to care for both the mother and the fetus. The diagnostic techniques and therapeutic interventions routinely used for patients with cancer are frequently contraindicated during pregnancy and can delay diagnosis and therapy until after delivery. There is also concern about the possible effects of pregnancy on the cancer, especially in the case of hormone-receptor-positive tumors. The optimal treatment of a pregnant woman with cancer involves an interdisciplinary approach in which the effects of therapy can be balanced with respect to the maternal and fetal conditions. In addition, complex ethical issues, religious beliefs, and emotional considerations are superimposed on the medical problem and must be considered. These are some of the reasons why the care of a pregnant woman with cancer must be individualized. The oncologist requires basic principles to guide clinical management, but unfortunately, oncology textbooks usually do not dwell on cancer in pregnant women. This book, edited by Barnea and colleagues, nicely summarizes the general principles of the management of a variety of cancers during pregnancy. The strengths of this book are its style and organization. The book has two parts: the first offers a clear plan for the diagnosis and therapy of cancer in pregnant women, according to disease sites. The second part is unique and covers a wide spectrum of biologic, pharmacokinetic, and ethical issues that may affect the outcome of the pregnancy. One of the best chapters discusses the effects of radiation and chemotherapy on gestation during the three trimesters. The authors provide an evidence-based table in which exposure to various chemotherapeutic agents during the first trimester is related to the outcome of the pregnancy. Another intriguing chapter provides case discussions of gynecologic, colon, and hematologic cancers. There is no doubt about the lack of large-scale experience with cancer during pregnancy. Under these circumstances, there is nothing better than the views of clinicians who have extensive experience in the field. Many of the comments in this book are based on years of experience and, in the absence of data from clinical trials, really made me think about the care of my own patients. I recommend this book to any physician who may be involved in the care of a pregnant patient with cancer. The 21st century has opened with a trend among women to delay childbearing, and the age at which women become pregnant continues to rise. With advances in assisted reproductive technology, too, pregnancy in the fifth decade of life has become commonplace. For this reason, cancers that only rarely occurred during pregnancy are becoming increasingly common. There is a lack of consensus about the management of cancer during pregnancy. I found this book to be comprehensive, detailed, and written with a keen sense of commitment to the sound clinical care of these patients. This book is a very timely addition to the literature. Ramin Mirhashemi, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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