Evaluation and management of the pregnant patient with suspected primary musculoskeletal tumor or metastatic carcinoma to bone

Surg Oncol. 2016 Sep;25(3):212-22. doi: 10.1016/j.suronc.2016.05.024. Epub 2016 May 21.

Abstract

Primary musculoskeletal cancer and metastatic disease to bone in pregnant patients presents major treatment challenges. Although uncommon, musculoskeletal malignancies in pregnant women have been reported. When diagnosing and treating these patients, the mother's health must be managed appropriately while ensuring that fetal development is not deleteriously affected. Extensive radiographic imaging and more advanced techniques are often necessary to fully characterize the extent of disease. When possible, magnetic resonance imaging should be used instead of computed tomography to limit exposure of the conceptus to radiation. If treatment is needed, therapeutic radiation, chemotherapy, and surgery should be considered. Surgical resection is the foundation of treatment of early-stage primary bone tumors and soft-tissue sarcomas during pregnancy. With surgery, anesthesia and thromboprophylaxis are important considerations. If chemotherapy is required, administration should be avoided in the first trimester to limit harm to the fetus. Therapeutic radiation should similarly be avoided during the first trimester and often can be postponed until after delivery.

Keywords: Cancer; Chemotherapy; Musculoskeletal malignancy; Orthopaedic surgery; Pregnancy; Radiation.

Publication types

  • Review

MeSH terms

  • Bone Neoplasms / secondary
  • Bone Neoplasms / therapy*
  • Disease Management
  • Female
  • Humans
  • Muscle Neoplasms / pathology
  • Muscle Neoplasms / therapy*
  • Pregnancy
  • Pregnancy Complications, Neoplastic / pathology
  • Pregnancy Complications, Neoplastic / therapy*
  • Prognosis
  • Sarcoma / pathology
  • Sarcoma / therapy*