title: Evaluation and management of the pregnant patient with suspected primary musculoskeletal tumor or metastatic carcinoma to bone.
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.
authors: Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Varun
authors: V
authors: Puvanesarajah
authors: Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Andrea M
authors: AM
authors: Spiker
authors: Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Brett A
authors: BA
authors: Shannon
authors: Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Maureen
authors: M
authors: Grundy
authors: Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Adam S
authors: AS
authors: Levin
authors: Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: cmorri61@jhmi.edu.
authors: Carol D
authors: CD
authors: Morris
mesh_terms: D001859:Bone Neoplasms / Q000556:secondary / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D019042:Muscle Neoplasms / Q000473:pathology / Q000628:therapy*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012509:Sarcoma / Q000473:pathology / Q000628:therapy*
keywords: Cancer; Chemotherapy; Musculoskeletal malignancy; Orthopaedic surgery; Pregnancy; Radiation