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      High-Risk Adult Wilms' Tumour in Pregnancy: A Case Report

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          Abstract

          Wilms' tumour is the most common renal neoplasm in children with an incidence of 10 cases per 1 million children and a median age at diagnosis of 3.5 years. In Western countries its occurrence in adults is 0.2 cases per million people in western countries and carries a poorer prognosis. The co-existence of Adult Wilms' tumour and pregnancy is extremely rare with less than 20 cases published in the English literature. We present a case of a Malawian woman who had progressive high-risk metastatic Adult Wilms' tumour in pregnancy after nephrectomy, radiotherapy and two lines of chemotherapy.

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          Most cited references 46

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          Cancer and pregnancy: poena magna, not anymore.

          Cancer diagnosed during pregnancy constitutes a difficult clinical condition with a devastating impact on the patient's somatic and psychosocial health and possibly on foetal integrity. This circumstance also raises several moral, religious, social and familial dilemmas. In this review we critically present available evidence regarding the incidence, epidemiology and genetics of cancer in pregnant women, its presentation, diagnosis and staging as well as therapeutic management. Issues such as maternal/foetal prognosis, need for termination of pregnancy, risk of foetal health injury and necessity of psychosocial support are reviewed. Recent accumulating evidence suggests that, with appropriate management, poena magna should not be used to define neither cancer nor pregnancy.
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            Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients

            Awareness is growing that cancer can be treated during pregnancy, but the effect of this change on maternal and neonatal outcomes is unknown. The International Network on Cancer, Infertility and Pregnancy (INCIP) registers the incidence and maternal, obstetric, oncological, and neonatal outcomes of cancer occurring during pregnancy. We aimed to describe the oncological management and obstetric and neonatal outcomes of patients registered in INCIP and treated in the past 20 years, and assess associations between cancer type or treatment modality and obstetric and neonatal outcomes.
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              Incidence and outcomes of pregnancy-associated cancer in Australia, 1994–2008: a population-based linkage study

              Objective To determine trends in pregnancy-associated cancer and associations between maternal cancer and pregnancy outcomes. Design Population-based cohort study. Setting New South Wales, Australia, 1994–2008. Population A total of 781 907 women and their 1 309 501 maternities. Methods Cancer and maternal information were obtained from linked cancer registry, birth and hospital records for the entire population. Generalised estimating equations with a logit link were used to examine associations between cancer risk factors and pregnancy outcomes. Main outcome measures Incidence of pregnancy-associated cancer (diagnosis during pregnancy or within 12 months of delivery), maternal morbidities, preterm birth, and small- and large-for-gestational-age (LGA). Results A total of 1798 new cancer diagnoses were identified, including 499 during pregnancy and 1299 postpartum. From 1994 to 2007, the crude incidence rate of pregnancy-associated cancer increased from 112.3 to 191.5 per 100 000 maternities (P < 0.001), and only 14% of the increase was explained by increasing maternal age. Cancer diagnosis was more common than expected in women aged 15–44 years (observed-to-expected ratio 1.49; 95% CI 1.42–1.56). Cancers were predominantly melanoma (33.3%) and breast cancer (21.0%). Women with cancer diagnosed during pregnancy had high rates of labour induction (28.5%), caesarean section (40.0%) and planned preterm birth (19.7%). Novel findings included a cancer association with multiple pregnancies (adjusted odds ratio 1.52, 95% CI 1.13–2.05) and LGA (aOR 1.47, 95% CI 1.14–1.89). Conclusions Pregnancy-associated cancers have increased, and this increase is only partially explained by increasing maternal age. Pregnancy increases women’s interaction with health services and the possibility for diagnosis, but may also influence tumour growth.
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                Author and article information

                Journal
                Malawi Med J
                Malawi Med J
                Malawi Medical Journal
                The Medical Association Of Malawi (Malawi )
                1995-7262
                1995-7270
                June 2019
                : 31
                : 2
                : 155-158
                Affiliations
                [1 ] Blantyre District Health Office, Blantyre, Malawi
                [2 ] Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
                [3 ] Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
                [4 ] Department of Obstetrics and Gynaecology Department, University of Malawi College of Medicine, Blantyre, Malawi
                [5 ] Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi
                Author notes
                Correspondence: Stephen Kasenda kasendas00@ 123456gmail.com
                Article
                10.4314/mmj.v31i2.9
                6698624
                © 2019 The College of Medicine and the Medical Association of Malawi.

                This work is licensed under the Creative Commons Attribution 4.0 International License. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/)

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                Case Report

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