Kanser tedavisi sonrası sağ kalım sürecindeki gebelik olguları; tek tersiyer merkezin deneyimi

Abstract

Amaç: Genç adolesan ve yetişkin dönemde kanser tedavisi gören kadınların gebeliklerini analiz edip obstetrik ve neonatal sonuçlarını değerlendirmektir.

Gereç ve Yöntem: Cerrahpaşa Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği’nde Ocak 2000-Aralık 2015 yılları arasında antenatal izlemi yapılan, adolesan ve genç erişkin dönemde kanser tedavisi görmüş ve izlem sürecinde gebe kalan 68 olgunun maternal ve perinatal sonuçları, retrospektif olarak değerlendirildi. Kanser tiplerinin dağılımı, kanser tanısının konulduğu yaş, uygulanan tedavi ve izlem süresi irdelendi. Maternal sonuçlar; doğum haftası, doğum kilosu ve perinatal sonuçlar değerlendirildi.

Bulgular: En sık karşılaşılan kanserler, tiroid kanseri (%26,5), hematolojik maligniteler (%22,5) ve genital kanserler (%18) olarak saptandı. Olguların ortalama yaşı 31,7±5,5 ve nulliparite oranı %48,5 olarak saptandı. Ortalama doğum haftası 37,5±2,5; ortalama doğum kilosu 3020±717, 37 hafta öncesinde doğum oranı %12,1 iken 34 hafta öncesinde doğum oranı %8,8 olarak tespit edildi. Grubumuzda sezaryen, fetal gelişim kısıtlılığı, preeklampsi ve gestasyonel diayabet oranları sırasıyla %77,2, %5,8, %2,9 ve %8,8 olarak belirlendi. 2 hastada abortus izlenirken, 3 hastaya tıbbi nedenli tahliye yapıldı. Kansere yakalanma yaş ortalaması en düşük hematolojik kanserlerde gözlenirken (22,5±6,6) sonrasında iskelet sistemi (26±8,7) ve tiroid kanseri (26,9±5,6) yer aldı. Hastaların hiçbirinde konjenital fetal anomali izlenmedi.

Sonuç: Kanser tedavisi sonrası gebe kalan hasta grubunda olumlu obstetrik sonuçlar gözlenmiş olup, bu hastaların gebelik izlemi, uygun merkezlerde, multidisipliner bir ekiple yapılmalıdır.

Keywords

• Gebelik; kanser; kanserden sağ kalım; gebelik sonuçları

Pregnancy in cancer survivors; experience of a single tertiary center

Abstract

Objective: To investigate obstetric and perinatal outcomes among pregnant female survivors of adolescent and young adult cancers.

Materials and Methods: A retrospective analysis of maternal and perinatal outcomes of 68 pregnant women with a history of cancer who received antenatal care at the Cerrahpasa Medical Faculty Obstetric and Gynecology Department between January 2000 and  December 2015 was carried out. Perinatal and maternal outcomes were evaluated according to cancer type, timing of cancer diagnosis, and treatment modality. The distribution of cancer types, the age at which the cancer was diagnosed, the treatment modalities, and the duration of follow-up were analyzed. Maternal and perinatal outcomes were evaluated.

Results: The most frequently encountered tumor types in pregnant women with a history of cancer were thyroid cancers (26.5%), hematologic malignancies (22.5%), and genital cancers (18%). The mean maternal age was 31.7±5.5 years, and the frequency of nulliparity was 48.5%. The mean gestational age at delivery was 37.5±2.5 weeks, the mean birth weight was 3020±717 g, and the frequencies of delivery before 37 and 34 weeks were 12.1% and 8.8%, respectively. The incidences of ceaserian section, fetal growth restriction, preeclampsia, and gestational diabetes were 77.2%, 5.8%, 2.9%, and 8.8%, respectively, in women with a history of cancer. There were two miscarriages and three terminations of pregnancy in women who had survived cancer. The lowest mean age at the time of cancer diagnosis was observed for haematological cancers (22.5±6.6). There were no congenital anomalies in our group.

Conclusion: Cancer survivors who became pregnant after cancer treatment had good obstetric outcomes. Pregnancy follow-up of these patients should be carried out by a multidisciplinary team at tertiary centers.

Keywords

• Pregnancy; cancer; cancer survivor; pregnancy outcome

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