Diagnostic and therapeutic dilemmas in malignancy during pregnancy

In four pregnant women, aged 28, 29, 30, and 35, malignancies were diagnosed: synoviosarcoma, gastric carcinoma, non-Hodgkin B cell lymphoma and undifferentiated adenocarcinoma in one of the labia vulvae, respectively. The first three women eventually died, the first before giving birth, the last woman was treated surgically and was alive without recurrence two years after treatment. Pregnancy can lead to diagnostic dilemma and delay as many symptoms of a malignancy are not recognised as such but are attributed to the pregnant state and because of reluctance to apply diagnostic tools which can be harmful to the foetus. It can also lead to therapeutic dilemma and delay because several therapies may also harm the foetus.