Radiological staging in pregnant patients with cancer

Malignant diseases during pregnancy are relatively rare, with an estimated incidence of 1 in 1000 pregnancies.1 Owing to an increasing delay of pregnancy to the third and fourth decades of life, cancer will occur increasingly more frequently during pregnancy. Diagnosis is reportedly often delayed during pregnancy, due to overlapping symptoms of pregnancy and malignant disease, leading to higher stages of disease at diagnosis.1 After a malignant tumour is diagnosed during pregnancy, the pregnant patients with cancer must be provided with diagnostic imaging for the evaluation of disease extent, and to allow the same high-quality therapy planning as that received by a non-pregnant patient. At the same time, it is of the utmost importance to limit harm to the fetus from diagnostics and therapeutics as much as possible. Diagnostic imaging for staging purposes relies, to a large extent, on ionising radiation used in CT and in nuclear imaging modalities, as well as on the intravenous application of contrast agents. These methods cannot be recommended outright during pregnancy, due to possible detrimental effects on the fetus. In the pregnant patient, the attending physician is challenged with the choice of diagnostic imaging modalities, while limiting danger to the fetus as much as possible, and still enabling disease management similar to that in a non-pregnant patient. Therefore, malignant disease in pregnant patients should be managed by a multidisciplinary tumour board that has the competence to evaluate different strategies for staging, including invasive and non-invasive methods. In this article, the challenging task of finding appropriate imaging modalities for the staging of different malignant tumours that occur during pregnancy will be discussed. Proliferating cells are more sensitive to radiation effects than cells that have completed cell division.2 The human embryo or fetus is a rapidly proliferating organism and, therefore, especially sensitive to radiation …