Decision-making in cancer during pregnancy: Real-world management patterns and outcomes from Nepal.

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Background: Cancer occurring one in every 1,000 pregnancies is rare and poses immense diagnostic and management challenges. Decision making should involve multidisciplinary approach, always considering detailed perspective into account. Evidence on real-world outcomes of multimodal treatment including surgery and systemic therapy during pregnancy in LMICs remains scarce. This study reports obstetric and oncologic outcomes of pregnancies complicated by cancer from a tertiary care center in Nepal. Methods: A descriptive study was done on patients with cancer and pregnancy attending Civil Service Hospital from January 2015 to January 2026. Clinical data were collected from hospital registry of past ten years and telephonic inquiry followed by in-person interview and thorough relevant investigations regarding their present status in terms of maternal and neonatal wellbeing. Information on demographics, cancer type, gestational age at diagnosis, treatment during pregnancy, obstetric outcomes, and maternal status at last follow-up was collected and analyzed. Results: Fifteen women had cancer with pregnancy (mean 29.7 years, range 19–35). Gestational timing at diagnosis was first trimester 3/15 (20%), second trimester 7/15 (47%), third trimester 5/15 (33%), The types of cancers: ovarian cancers (n = 4; endometrioid carcinoma-1; squamous cell carcinoma arising in dermoid cyst-1; high grade serous carcinoma-1, Krukenberg tumor secondary to primary gastric adenocarcinoma-1), chronic myeloid leukemia (CML) (n = 4), non-Hodgkin lymphoma (NHL) (n = 3), breast cancer (n = 1), CLL (n = 1), APML (n = 1) and thyroid carcinoma (n = 1). Five (33%) women terminated pregnancy before 18 weeks {leukemia: 3 [ CML (2); CLL (1)]; NHL (2)} followed by chemotherapy. Of the rest ten, delivery occurred in six [vaginal (1); cesarean section (5)]/ [term (2); preterm (4)]. No major congenital malformations documented and normal growth and development reported at follow up. Systemic therapy (including targeted agents such as imatinib or systemic chemotherapy/CHOP/ATO+ATRA where indicated) was administered in 10/15 (66%). All four cases of ovarian cancer diagnosed following surgery for adnexal masses during second trimester. None received radiotherapy during pregnancy. Except for one defaulted woman with leukemia, lost to follow up, 10/15 (66%) are currently in remission and 4/15 (27%) had died of disease. Conclusions: Cancer diagnosis and management during pregnancy is challenging, yet can be promising with a multidisciplinary team providing timely and appropriate therapy while carefully balancing the potential risks and benefits to mother and unborn fetus. These results support individualized multidisciplinary decision making and contribute real-world outcome data from a resource-limited setting to the growing evidence that carefully timed surgery and systemic therapy can be considered during pregnancy.