Gastric and Esophageal Cancer in Pregnancy: A Review.

Importance: Upper gastrointestinal cancers such as gastric and esophageal cancers are rare malignancies with poor prognosis because it is usually diagnosed in latter stages. Presenting symptoms are frequently presumed pregnancy related rather than malignancy related. This review will raise awareness to consider these aggressive cancers in evaluating gastrointestinal complaints during pregnancy.

Objectives: This review describes pregnancies with gastric and esophageal cancers including presenting symptoms, diagnosis stage, treatments, pregnancy complications, and maternal/fetal outcomes.

Evidence Acquisition: Electronic databases (PubMed/EMBASE) were searched with English language limitation. Search terms, 1970-2023, included "stomach cancer" OR "gastric cancer" AND "etiology" OR "risk factors" OR "diagnosis" OR "treatment" OR "management" OR "prognosis" AND "pregnancy" OR "pregnancy complications" OR "Esophageal Neoplasms" OR "esophageal carcinoma" OR "esophageal malignancy" OR "esophageal cancer" OR "esophageal neoplasm" AND Pregnancy OR "Pregnancy."

Results: Of 611 abstracts reviewed, 63 full articles were identified as the basis of review. Gastric cancer stage was advanced stage III or IV in 88% of patients. Maternal mortality rate was 76%. First-trimester diagnosis occurred in 16%; second, 27%; and third, 18% totaling 61%. Thirty nine percent were found postpartum, postmortem, or undetermined. Ethnic groups most affected were East Asian. Half had cesarean delivery, 29% delivered vaginally, and the rest were not reported. Treatment varied: supportive care only, 8%; chemotherapy only, 34%; and chemotherapy and surgery, 21%. Neonatal outcomes were good overall: 90% survival among cases reported.

Conclusions: Gastric and esophageal cancers are rare and frequently asymptomatic in early stages. When diagnosed in pregnancy, it is usually advanced with poor prognosis and high maternal mortality rate. Diagnostic testing and treatment should proceed as needed during pregnancy with close maternal and fetal surveillance. Abdominal delivery is reserved for usual obstetrical indications.

Relevance: Gastric and esophageal cancers are rare conditions often missed or found late that affect management, mode of delivery, and maternal/fetal outcomes.