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Frauenheilkunde up2date 2008; 2(6): 489-506
DOI: 10.1055/s-0028-1098714
Allgemeine Gynäkologie und gynäkologische Onkologie

© Georg Thieme Verlag KG Stuttgart ˙ New York

Mamma- und gynäkologische Karzinome in der Schwangerschaft

R. Zanetti-Dällenbach, U. Güth, O. Lapaire
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Publication Date:
18 December 2008 (online)

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Kernaussagen

Maligne Tumoren, welche während der Schwangerschaft diagnostiziert werden, sind selten. Da in den westlichen Ländern das Alter von Gebärenden stetig steigt, steigt auch die Inzidenz von schwangerschaftsassoziierten Malignomen.

Die Prognose von schwangeren Tumorpatientinnen ist bei gleichem Tumorstadium mit der Prognose von nicht schwangeren Patientinnen vergleichbar. Deshalb wird heute nicht a priori zum Schwangerschaftsabbruch geraten.

Die Betreuung einer schwangeren Karzinompatientin sollte unbedingt an einem Zentrum in interdisziplinärer Zusammenarbeit erfolgen.

Im Rahmen der normalen Schwangerschaftskontrollen sollten die Adnexe, die Cervix uteri und die Mammae routinemäßig beurteilt werden.

Eine notwendige operative Therapie kann in jedem Trimenon erfolgen. Im zweiten und dritten Trimester kann eine Chemotherapie mit vertretbarem Risiko für Mutter und Kind appliziert werden. Radiotherapien sollten postpartal durchgeführt werden, ebenso eine allfällige Hormon- oder Herceptintherapie beim Mammakarzinom.

Jede Frau, die während ihrer Schwangerschaft an einem Malignom erkrankt, muss als geburtshilfliche Risikopatientin angesehen werden.

Die Geburt des Kindes sollte möglichst nach der 37. Schwangerschaftswoche erfolgen, um Probleme der Frühgeburtlichkeit zu vermeiden. Ist die Entbindung aus onkologischer oder geburtshilflicher Sicht vor der 34. Schwangerschaftswoche indiziert, sollte eine Lungenreifungsinduktion mit Kortikosteroiden durchgeführt werden. Der Geburtsmodus muss individuell, unter Berücksichtigung der geburtshilflichen und onkologischen Situation, festgelegt werden. Vorzugsweise sollte das Kind in einem Perinatalzentrum zur Welt kommen.

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Dr. med. R. Zanetti-Dällenbach

Departement für Gynäkologie und Geburtshilfe · Universitätsspital Basel

Spitalstrasse 21

CH-4031 Basel

Email: rzanetti@uhbs.ch