Dr Charlotte Haunton1,2, Dr Prachi Khandkar1, Associate Professor Bradley De Vries1,2
1Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Camperdown, Australia, 2University of Sydney, Camperdown, Australia
Biography:
Biographies to come
Abstract:
Cancer in pregnancy (CIP) is a rare and complex diagnosis that requires the clinician to carefully balance obstetric and oncological management considerations. We present a rare case of neuroendocrine carcinoma of unknown primary site diagnosed in pregnancy, in order to highlight the challenges associated with CIP and key strategies for its management.
Case: A 39-year-old multiparous woman with a history of chronic Hepatitis B presented with right upper quadrant pain at 30 weeks and 3 days gestation. Her serology showed deranged transaminases and liver ultrasound revealed enlargement of pre-existing undifferentiated liver lesions, concerning for hepatocellular carcinoma. An urgent multidisciplinary team was convened to assess risks and benefits of continuing the pregnancy versus planned preterm delivery to facilitate rapid diagnosis and treatment. Due to high clinical suspicion of malignancy, inability to obtain a tissue diagnosis without endoscopy, and the risk of complications secondary to the liver lesions, a decision was made for planned delivery at 31 weeks gestation via classical caesarean section.
Outcomes: Endoscopic liver biopsy was performed 6 days postpartum. Histopathology revealed high grade neuroendocrine carcinoma of unknown origin. A PET scan confirmed metastatic disease involving the liver, pancreas and spleen. The patient commenced palliative chemotherapy with carboplatin and etoposide at 3 weeks postpartum. The neonate was discharged from neonatal ICU on day 43 of life, and remained well at 6 month follow-up.
Discussion: Prompt multidisciplinary decision-making allowed timely definitive diagnosis and initiation of treatment, with minimal compromise to perinatal outcomes. This case highlights the role of the multidisciplinary team as the cornerstone of CIP management and emphasises the need for highly personalised treatment that considers each patient’s unique risk profile. Such an approach to management is increasingly important as evidence for the use of cancer treatment in pregnancy accumulates, and antenatal treatment becomes more prevalent.
Keywords
Cancer in pregnancy; oncology; multidisciplinary team