Gebelikte Jinekolojik Kanserler ve Hemşirelik Yaklaşımları
Özet
Gebelikte jinekolojik kanserler nadir görülse de anne ve fetüs sağlığı önemli zorluklar ortaya koymaktadır. Serviks, over, vulva, endometriyum ve vajinal kanserler gibi türlerin görülme sıklığı, ileri anne yaşı ve gelişen tanı yöntemleri ile artış göstermektedir. Tedavi seçenekleri, kanserin türü, evresi ve gebelik haftasına bağlı olarak cerrahi müdahale, kemoterapi ve radyoterapi olarak değişiklik göstermektedir. Tedavi planı hastanın kendisi ve eşinin yanısıra onkoloji, perinatoloji, neonatoloji ve anestezi uzmanlarının dahil olduğu bir ekip tarafından belirlenmektedir. Tedavide gebeliği koruyucu olmayan yaklaşım ve gebeliği koruyucu yaklaşım olmak üzere iki yaklaşım esas alınmaktadır.
Gebelikteki fizyolojik değişiklikler, tanı ve tedavi süreçlerini karmaşık hale getirdiği için multidisipliner iş birliğine ihtiyaç duyulmaktadır. Kanserin tanılanmasıyla birlikte stres, anksiyete, beden imajı kaygıları ve doğurganlık ile fetüse yönelik korkuları içeren psikososyal sorunlar ortaya çıkmaktadır. Bütüncül bakım çerçevesinde Hemşireler, bu zorluklarla başa çıkılmasında duygusal destek sağlama, bilinçli karar verme süreçlerini kolaylaştırma ve sağlık ekibi ile hasta arasında etkili iletişim kurma konularında kritik bir rol üstlenmektedir.
Although gynecologic cancers in pregnancy are rare, they pose significant challenges to maternal and fetal health. The incidence of types such as cervical, ovarian, vulvar, endometrial and vaginal cancers is increasing with advanced maternal age and improved diagnostic methods. Treatment options vary between surgical intervention, chemotherapy and radiotherapy depending on the type of cancer, stage and gestational week. The treatment plan is determined by a team that includes the patient and her partner, as well as oncology, perinatology, neonatology and anesthesiologists. Treatment is based on two approaches: non-pregnancy-preserving and pregnancy-preserving.
Multidisciplinary cooperation is needed as physiological changes during pregnancy complicate the diagnosis and treatment processes. With the diagnosis of cancer, psychosocial problems including stress, anxiety, body image concerns and fears about fertility and the fetus arise. Within the framework of holistic care, nurses play a critical role in providing emotional support, facilitating informed decision-making processes and establishing effective communication between the healthcare team and the patient.
Referanslar
Eibye S, Kjaer SK, Mellemkjaer L. Incidence of pregnancy-associated cancer in Denmark, 1977-2006. Obstet Gynecol, 2013;122(3):608- 17. doi: 10.1097/AOG.0b013e3182a057a2
Lee YY, Roberts CL, Dobbins T, Stavrou E, Black K, Morris J, et al. Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study. BJOG, 2012;119(13):1572-82. https://doi.org/10.1111/j.1471-0528.2012.03475.x
Mathews TJ, Hamilton BE. First births to older women continue to rise. National Center for Health Statistics, Hyattsville, MD. NCHS Data Brief No. 152. 2014;1-8.
Oskay ÜY, Başgöl Ş, Oskay AP. Gebelik ve kanser. İçinde; Gülbeyaz C. Editör. Onkoloji Hemşireliği. İstanbul: Nobel Tıp Kitapevleri; 2015. p.1121-6.
Hatem A Azim Jr. Managing cancer during pregnancy. Hatem A. Azim Jr. Editor. Switzerland: Springer International Publishing; 2016. p.191.
Loibl S, Han SN, von Minckwitz G, Bontenbal M, Ring A, Giermek J, et al. Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol 2012;13(9):887-96.
Amant F, Halaska MJ, Fumagalli M, Dahl Steffensen K, Lok C, Van Calsteren K, et al. Gynecologic cancers in pregnancy: guidelines of a Second InternationalConsensus Meeting. Int J Gynecol Cancer 2014;24(3): 394-403. http://dx.doi.org/10.1016/
ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 474: nonobstetric surgery during pregnancy. Obstet Gynecol 2011;117:420.
Al-Halal H, Kezouh A, Abenhaim HA. Incidence and obstetrical outcomes of cervical intraepithelial neoplasia and cervical cancer in pregnancy: a population-based study on 8.8 million births. Arch Gynecol Obstet, 2013; 287(2):245-50. doı 10.1007/s00404-012-2475-3
Bilgiç D, Aypar NN. Gebelikte görülen jinekolojik kanserler ve yönetimi. Turkiye Klinikleri J Obstet Womens Health Dis Nurs-Special Topics 2017;3(1):8-26.
Fruscio R, Villa A, Chiari S, Vergani P, Ceppi L, Dell F, Dell T, Chiappa V, Bonazzi CM, Milani R, Mongioni C, Loacatelli A., Delivery delay with neoadjuvant chemotherapy for cervical cancer patients during pregnancy: A series of nine cases and literature review. Gynecologic Oncology 2012; 126 (2):192-197. https://doi.org/10.1016/j.ygyno.2012.04.027
Aggarwal P, Kehoe S. Ovarian tumours in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol 2011;155(2):119-24. https://doi.org/10.1016/j.ejogrb.2010.11.023
Mancari R, Tomasi-Cont N, Sarno MA, Azim Jr HA, Franchi D, Carinelli S, et al. Treatment options for pregnant women with ovarian tumors. Int J Gynecol Cancer 2014;24:967-72. https://doi.org/10.1097/IGC.0000000000000161
Szecsi PB, Andersen MR, Bjorngaard B, Hedengran KK, Stender S. Cancer antigen 125 after delivery in women with a normalpregnancy: a prospective cohort study. Acta Obstet Gynecol Scand 2014;93(12):1295- 301. https://doi.org/10.1111/aogs.12492
Fauvet R, Brzakowski M, Morice P, Resch B, Marret H, Graesslin O, et al. Borderline ovarian tumors diagnosed during pregnancy exhibit a high incidence of aggressive features: results of a French multicenter study. Ann Oncol 2012;23(6):1481-1487
Blake EA, Carter CM, Kashani BN, Kodama M, Mabuchi S, Yoshino K, et al. Feto-maternal outcomes of pregnancy complicated by ovarian sex cord stromal tumor: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol. 2014; 175: 1-7 https://doi.org/10.1016/j.ejogrb.2013.12.025
İlhan TT, Yılmaz SA, Kebapçılar A. Gebelikte Jinekolojik Kanserler. Arşiv Kaynak Tarama Dergisi, 2015; 24(2):211-227 https://doi.org/10.17827/aktd.15900
Admiraal JM, Reyners AK, Hoekstra-Weebers JE. Do cancer and treatment type affect distress? Psychooncology 2013;22(8):1766-73. https://doi.org/10.1002/pon.3211
Referanslar
Eibye S, Kjaer SK, Mellemkjaer L. Incidence of pregnancy-associated cancer in Denmark, 1977-2006. Obstet Gynecol, 2013;122(3):608- 17. doi: 10.1097/AOG.0b013e3182a057a2
Lee YY, Roberts CL, Dobbins T, Stavrou E, Black K, Morris J, et al. Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: a population-based linkage study. BJOG, 2012;119(13):1572-82. https://doi.org/10.1111/j.1471-0528.2012.03475.x
Mathews TJ, Hamilton BE. First births to older women continue to rise. National Center for Health Statistics, Hyattsville, MD. NCHS Data Brief No. 152. 2014;1-8.
Oskay ÜY, Başgöl Ş, Oskay AP. Gebelik ve kanser. İçinde; Gülbeyaz C. Editör. Onkoloji Hemşireliği. İstanbul: Nobel Tıp Kitapevleri; 2015. p.1121-6.
Hatem A Azim Jr. Managing cancer during pregnancy. Hatem A. Azim Jr. Editor. Switzerland: Springer International Publishing; 2016. p.191.
Loibl S, Han SN, von Minckwitz G, Bontenbal M, Ring A, Giermek J, et al. Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol 2012;13(9):887-96.
Amant F, Halaska MJ, Fumagalli M, Dahl Steffensen K, Lok C, Van Calsteren K, et al. Gynecologic cancers in pregnancy: guidelines of a Second InternationalConsensus Meeting. Int J Gynecol Cancer 2014;24(3): 394-403. http://dx.doi.org/10.1016/
ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 474: nonobstetric surgery during pregnancy. Obstet Gynecol 2011;117:420.
Al-Halal H, Kezouh A, Abenhaim HA. Incidence and obstetrical outcomes of cervical intraepithelial neoplasia and cervical cancer in pregnancy: a population-based study on 8.8 million births. Arch Gynecol Obstet, 2013; 287(2):245-50. doı 10.1007/s00404-012-2475-3
Bilgiç D, Aypar NN. Gebelikte görülen jinekolojik kanserler ve yönetimi. Turkiye Klinikleri J Obstet Womens Health Dis Nurs-Special Topics 2017;3(1):8-26.
Fruscio R, Villa A, Chiari S, Vergani P, Ceppi L, Dell F, Dell T, Chiappa V, Bonazzi CM, Milani R, Mongioni C, Loacatelli A., Delivery delay with neoadjuvant chemotherapy for cervical cancer patients during pregnancy: A series of nine cases and literature review. Gynecologic Oncology 2012; 126 (2):192-197. https://doi.org/10.1016/j.ygyno.2012.04.027
Aggarwal P, Kehoe S. Ovarian tumours in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol 2011;155(2):119-24. https://doi.org/10.1016/j.ejogrb.2010.11.023
Mancari R, Tomasi-Cont N, Sarno MA, Azim Jr HA, Franchi D, Carinelli S, et al. Treatment options for pregnant women with ovarian tumors. Int J Gynecol Cancer 2014;24:967-72. https://doi.org/10.1097/IGC.0000000000000161
Szecsi PB, Andersen MR, Bjorngaard B, Hedengran KK, Stender S. Cancer antigen 125 after delivery in women with a normalpregnancy: a prospective cohort study. Acta Obstet Gynecol Scand 2014;93(12):1295- 301. https://doi.org/10.1111/aogs.12492
Fauvet R, Brzakowski M, Morice P, Resch B, Marret H, Graesslin O, et al. Borderline ovarian tumors diagnosed during pregnancy exhibit a high incidence of aggressive features: results of a French multicenter study. Ann Oncol 2012;23(6):1481-1487
Blake EA, Carter CM, Kashani BN, Kodama M, Mabuchi S, Yoshino K, et al. Feto-maternal outcomes of pregnancy complicated by ovarian sex cord stromal tumor: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol. 2014; 175: 1-7 https://doi.org/10.1016/j.ejogrb.2013.12.025
İlhan TT, Yılmaz SA, Kebapçılar A. Gebelikte Jinekolojik Kanserler. Arşiv Kaynak Tarama Dergisi, 2015; 24(2):211-227 https://doi.org/10.17827/aktd.15900
Admiraal JM, Reyners AK, Hoekstra-Weebers JE. Do cancer and treatment type affect distress? Psychooncology 2013;22(8):1766-73. https://doi.org/10.1002/pon.3211
