Astrocytoma during pregnancy

Astrocytoma, especially its malignant variants, is more often diagnosed in male patients of middle and older age. But more often - it does not always mean. There are cases of disease in women. The difference in statistics is most likely related to professional activity, because men more often than women work in potentially dangerous industries, and besides, they could receive a certain dose of radiation while serving in the army. There are a number of cases in the literature describing pregnant women with astrocytomas that were found before pregnancy or were recently diagnosed during pregnancy [1], [2]. The annual incidence of primary malignant brain tumors in women in the United States is 2.6 per 100,000. Gliomas are the most common histological type. [3]The prevalence of astrocytomas in pregnant women is no different from non-pregnant.[4]

Causes and risk factors

The weaker sex has its own, strictly female factor, predisposing to many diseases and exacerbations of existing ones. This is a pregnancy. The relationship between astrocyte development and pregnancy remains to be seen. Several previous studies have reported that the development of gliomas during pregnancy may depend on many factors, including hormonal [5]factors, growth factors, [6]and hemodynamic changes  [7] associated with pregnancy.

The cardinal hormonal restructuring of the body for several months does not pass without a trace, weakening the body of the future mother, making him more vulnerable to pathogens. Although pregnancy, from the point of view of scientists, cannot be considered a cause of tumors, as well as an unbalanced diet, hormonal imbalance, along with a deficiency of nutrients, is a serious blow to the immune system, which can provoke its weakening or inadequate behavior.

Astrocytoma during pregnancy may begin to actively progress, if it appeared earlier, but was not seen. This happens in 75% of cases, and the fault is the placenta, as an organ that stimulates the production of hormones.

By the way, pregnancy in the first 3-5 years after treatment of cancer can be considered as a risk factor for the relapse of the disease or the appearance of a tumor of a different localization against the background of the existing predisposition.

How the tumor will grow depends on its nature, hereditary predisposition, the age of the expectant mother, as well as some other factors. For example, doctors associate many health disorders in future mothers with the stagnation of body fluids (low physical activity, high stress on the kidneys, hormonal imbalances, etc.).[8]

Symptoms and diagnosis of astrocytoma during pregnancy

But these are all assumptions, and it is often not so important for a pregnant woman to know the cause of the disease. Much more urgent is the question of how to recognize the disease at an early stage of its development, so that treatment could do with less losses, because radiation and chemotherapy of the expectant mother is the need to terminate the pregnancy and effectively refuse to become a mother, at least in the near future. When it comes to cancer, doctors first of all try to save the woman herself if they see even the slightest opportunity.

It must be said that the diagnosis of brain tumors during pregnancy is very difficult. The nonspecificity of the first signs of the disease against the background of toxicosis and other symptoms of pregnancy is even more striking. Headaches, nausea, vomiting, dizziness - these are signs that are familiar to many of those who nursed the child. Many blame the pain in the head for excitement, which is natural in this situation, but if the symptom remains for a long time, appearing mainly in the morning with the slightest exertion, it is worth understanding its causes more carefully.

Nausea and vomiting are symptoms of toxicosis that are known to many, but they are also signs of a brain disease. In future mothers, toxemia usually appears in the first trimester of pregnancy, less often in later terms (in this case, control by specialists is obligatory). The second trimester is characterized by relative calm. True, there are not so rare cases when nausea and vomiting persecute a woman during all the months, and here it is especially difficult to understand what they are caused by.

It is worth paying attention to the fact that vomiting in brain tumors, like headaches, usually appears in the morning hours, before eating. Moreover, with astrocytoma of the brain, this symptom is not associated with food at all.

As for dizziness, more characteristic of cerebellar tumors, although patients may also experience a similar condition in other sites of the neoplasm, the “normal” symptom is somewhat easier to distinguish from the pathological one. Dizziness during pregnancy does not happen so often (this may be one of the manifestations of toxemia, occurring in a mild form) and does not last long. This may be a reaction to smell, steam, sudden movement, etc. If dizziness does not go away for a long time and is accompanied by a visual split of objects, a fog in the eyes, flickering of bright flashes, it is necessary to pass an examination to identify the cause of the symptom.

Back pains in future mothers are not uncommon. The same symptom is characteristic of astrocytomas of the spinal cord or osteochondrosis. But you should pay attention to its localization. During pregnancy, women complain of pain in the lower back and lower part of the thoracic region, which is quite natural in the later periods and is associated with fetal growth. The appearance of pain in the cervical region and the upper part of the thoracic region usually has another reason that is worth finding out as soon as possible. The same should be done if the back pain appeared in the early stages and is combined with headaches, nausea, vomiting, muscle weakness, decreased body sensitivity, movement disorders.

Typically, during pregnancy, despite some inconvenience, a woman experiences a certain inner lift. Apathy, excessive drowsiness, fatigue (especially in the early stages), depression during this period can be considered as an uncharacteristic symptom indicating violations, including mental disorders. Forgetfulness and inattention of the future mother on this background should not be justified by the girl's memory and absent-mindedness. Perhaps this is a symptom of a brain disease that has affected mental functions, because a tumor can either squeeze the brain or permanently destroy its cells (in the case of a malignant character).

Treatment

Making clinical decisions for astrocytoma during pregnancy remains a big problem for the treating team. [9]

As for the treatment, then for tumors it is operational regardless of the nature of the tumor. With slowly growing benign tumors, the operation can be done after delivery, but as the disease progresses it is better not to wait long, because a large tumor cannot do without consequences for the woman herself, and she will still need to raise the child and take care of him.

In the case of a malignant tumor, doctors are categorical: you need to terminate the pregnancy and start treatment as soon as possible, which involves prompt removal of the tumor, radiation and chemotherapy, which are incompatible with carrying a child [10]. Successful pregnancy and childbirth after chemotherapy with temozolomide and radiation therapy for glioblastoma multiforme are described [11]. Cases in which women refused to have surgery in favor of childbirth usually ended tragically - with the death of women either during delivery or after a few days. The missed time and large loads on the body during pregnancy and labor were affected.