Психолошки и етички аспекти малигне болести у трудноћи

Description

Abstract (English)

Malignant diseases develop, as a rule, in the advanced age. However, due to the increasing number of women who decide to postpone pregnancy, the association between the malignant disease (cancer) and pregnancy is becoming an increasing problem. 
The risk of association of pregnancy with a malignant disease is approximately 0.1% (1 case per 1, 000 deliveries). The most frequent cancers diagnosed during pregnancy are breast cancer, cervical cancer, melanoma and hematological malignancies.
Management of cancer during pregnancy is difficult. Both diagnostic and therapeutic interventions must be performed carefully, having in mind risk factors associated with both pregnant women and the fetus. The treatment which is essential for women may be highly dangerous or even fatal for the fetus. Therapeutic options in malignant tumors during pregnancy are limited and none of them is ideal. Over the last years the concept of treatment of malignant diseases in pregnancy has evolved from complete negligence of pregnancy and frequently immediate termination of pregnancy to much serious approach aimed at reduction of risk of mortality or injury for both mother and the unborn child. 
The association of cancer with pregnancy is a great emotional conflict, in which the joy of creating life is intertwined with a life-threatening situation for the mother. Malignancy in pregnancy is extremely stressful for both the patient and the doctor, and the ethical dilemmas associated with this condition require serious consideration. Decision making is very complex. With medical, psychological, religious, social and moral dilemmas facing them, both patient and doctor will struggle to find the right balance that combines maximum benefit for the woman with minimal adverse consequences for the baby.
The information provided by a doctor who has far more medical knowledge than the average patient, and the emphasis he puts on that information, influences the patient’s treatment decisions. He should offer the woman a choice between three possible options: postponing the treatment of the tumor until the fetus matures and gives birth, terminating the pregnancy in order to start the treatment of the tumor as quickly as possible, and treating the tumor while continuing the pregnancy (while monitoring the fetus to detect potential side effects of the treatment).
Caring for a pregnant woman with cancer is extremely complex and represents a great challenge. It inevitably requires a multidisciplinary approach with the close cooperation of oncologists, obstetricians, surgeons, neonatologists, geneticists, nurses, psychiatrists, psychologists and social workers. For a number of women, the help of priest is also very important. This team should care for the patient and her family, provide them with the right information and guide them through the decision-making process.
Plan of the procure must be formulated within the medical, moral, ethical, legal and religious frameworks acceptable for the patient. Help to a woman to make appropriate choice necessitates absolute sincerity and most accurate information. The way in which the information is presented will influence the decision to be made by the patient. The procedure in malignant diseases during pregnancy necessitates not only scientific knowledge on the risks associated with treatment based on the facts but also the art of communication with patients and above all high dose of humanity.