At the time of referral to the maxillofacial surgeon, the patient underwent a biopsy of the tongue and throat by accepting the risk of a biopsy under complete anesthesia. At this point, the patient was 31 weeks pregnant.
After 10 days, the pathologic result with the diagnosis of squamous cell carcinoma (SCC), poorly-differentiated (G3), was reported to the referring physician and the patient. The patient was immediately referred to an oncologist. Since the patient was at her 33 weeks of gestation, the physician decided to terminate her pregnancy so that she could begin chemotherapy as soon as possible. The patient was hospitalized for cesarean section and hydrocortisone was prescribed for fetal lung development. After conducting the cesarean section, a healthy infant was born and was discharged with the mother after routine care. 10 days after the cesarean section, chemotherapy and radiotherapy were simultaneously initiated. After finishing the course of treatment, the tumor became quite small such that there was no need for surgery or removal of the tongue or larynx. The patient was able to talk again so that she could communicate with others without the need to write. The patient is currently undergoing the follow-up after the treatment and, fortunately, her current condition is satisfactory.
Oral cancer is usually considered a disease that occurs in the late stages of life. However, tongue cancer is also found among young patients of childbearing age. These women often have risk factors for developing oral malignancies. Numerous cases of oral cancer have been reported in association with systemic lupus erythematosus (7). Other risk factors for this issue include smoking and abusing alcohol, as well as having a history of cancer in first-degree family members (8–10).
Effective cancer treatment can pose a great risk to the fetus. Chemotherapy and radiotherapy prescribed in the first trimester increase the risk of fetal impairments or spontaneous abortion (8,9). However, this may take a different form at the end of pregnancy. In such a circumstance, optimal delivery time at 34 weeks of gestation can be brought forward due to recent advances in perinatal and neonatal medicine. The mortality rate at and after 30 weeks of gestation is only 1% (10). Managing tongue carcinoma during pregnancy is complicated; its treatment is primarily based on oncological and surgical evaluations of the malignancy, which raise emotional and ethical challenges. Available data emphasize the delicate balance between fetal and maternal health in this situation. When planning the treatment, the best decision should be taken to ensure maternal and fetal health. In this case, since the diagnosis was ultimately made in the late stages of pregnancy, the decision to terminate the pregnancy and maintain fetal health was not difficult and the patient received the appropriate treatment. It seems that a complete multidisciplinary study, with a thorough and straightforward discussion, is needed to minimize fetal health risks and to optimize maternal treatment outcomes.
In this particular case, consulting the oncologist at the appropriate time led to appropriate treatment, and given the patient's specific circumstances, the best treatment for the patient occurred.
The authors would like to thank the director and staff of Sarem Women’s Hospital.
Conflicts of Interest
The authors declared no conflict of interest regarding the publication of this article.