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A 40-year-old woman at 25 weeks’ gestation was evaluated for persistent pain and imaging findings consistent with lung cancer. A multidisciplinary team prioritized early intervention, leading to Caesarean delivery at 27 weeks. Post-delivery, lung adenocarcinoma with bone metastasis was confirmed, with opioid titration, radiation, and subsequent chemotherapy paired with an advanced care plan. The report emphasizes early delivery to accelerate diagnosis and treatment.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/management-of-advanced-lung-cancer-in-pregnancy-multidisciplinary-treatment-and-early-delivery/371072/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/management-of-advanced-lung-cancer-in-pregnancy-multidisciplinary-treatment-and-early-delivery/371072.png","ImageObject",300,407,{"name":92,"@type":93},"mieayamfan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What clinical situation led to diagnosis in this case?","Question",{"text":113,"@type":114},"A 40-year-old woman at 25 weeks’ gestation was admitted for persistent back pain, and imaging findings suggested lung cancer.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why was early delivery chosen?",{"text":118,"@type":114},"The multidisciplinary team determined that early intervention was crucial, and Caesarean delivery was performed at 27 weeks’ gestation to expedite diagnosis and treatment.",{"name":120,"@type":111,"acceptedAnswer":121},"What treatments were used after the delivery?",{"text":122,"@type":114},"After diagnosis of lung adenocarcinoma with bone metastasis, the patient received rapid opioid titration, radiation therapy for bone metastases, and chemotherapy, along with an advanced care plan.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},371072,1790433470,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","doi: 10.2169/internalmedicine.5355-25  \nIntern Med 64: 3438-3442, 2025  \n[http://internmed.jp](http://internmed.jp)  \n【CASE REPORT】  \nManagement of Advanced Lung Cancer in Pregnancy: Multidisciplinary Treatment and Early Delivery  \nHiroaki Nagamine 1, Hiroyasu Kaneda 2, Syotaro Yamamoto 3, Kohei Kitada 3, Yoko Tani 2, Takako Oka 2, Yoshiya Matsumoto 1, Toshiyuki Nakai 1, Kazuhiro Yamada 1, Tetsuya Watanabe 1, Kazuhisa Asai 1, Yoshitaka Nakao 2,  \nDaisuke Tachibana 3 and Tomoya Kawaguchi 1,2  \n\n| Abstract:\u003Cbr>The poor prognosis of lung cancer during pregnancy requires complicated management. A 40-year-old woman at 25 weeks’ gestation was admitted with persistent back pain. Imaging findings suggested lung cancer. A multidisciplinary team determined that early intervention was crucial, and Caesarean delivery was performed at 27 weeks’ gestation. Thereafter, the patient was diagnosed with lung adenocarcinoma with bone metastasis. The patient underwent rapid opioid titration and radiation therapy for the bone metastases. We then introduced chemotherapy and offered an advanced care plan. A multidisciplinary approach is essential for pregnant women with lung cancer. Early delivery is recommended to expedite the diagnosis and treatment.\u003Cbr>Key words: advanced care planning, case report, multidisciplinary team, lung cancer, palliative care, pregnancy\u003Cbr>(Intern Med 64: 3438-3442, 2025)\u003Cbr>(DOI: 10.2169/internalmedicine.5355-25) |  |\n| --- | --- |\n| \u003Cbr>Introduction | We herein report an intricate scenario of advanced lung cancer that was detected at 25 weeks of pregnancy. A multidisciplinary team discussed the treatment strategy and ulti- |\n| Lung cancer during pregnancy is extremely rare (1) and | mately decided on an early Caesarean delivery. This case |\n| associated with a very poor prognosis (2) . In addition, con- | underscores the challenges of managing advanced lung can- |\n| cerns about the effects of radiation and chemotherapy on the | cer during pregnancy and emphasizes the critical role of a |\n| fetus often limit diagnostic and therapeutic options. Consequently, delays in the diagnosis, inaccuracies in staging, | multidisciplinary approach. |\n| postponement of treatment, and difficulties in managing drug treatments may occur. Bone metastases, commonly ob- | \u003Cbr>Case Report |\n| served in advanced lung cancer (3), are often associated | A 40-year-old woman (gravida 4, para 2, abortus 1) at 25 |\n| with severe pain that necessitates opioid use for manage- | weeks’ gestation with a history of smoking (13 pack years) |\n| ment (4) . In pregnant patients, opioid use must be carefully | presented to the referring hospital with worsening lower |\n| managed to mitigate the risk of neonatal opioid withdrawal | back pain and numbness in her right arm and leg that had |\n| syndrome (5) . Lung cancer in pregnant patients poses sub- | persisted for several months. The patient had no history of |\n| stantial challenges in both the diagnosis and treatment, mak- | malignancy, although there was a family history of brain tu- |\n| ing its management highly complex. | mor in her younger sister. Magnetic resonance imaging |\n\n1 Department of Respiratory Medicine, Graduate School of Medicine, Osaka Metropolitan University, Japan, 2 Department of Clinical Oncology, Graduate School of Medicine, Osaka Metropolitan University, Japan and 3 Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka Metropolitan University, Japan  \nReceived: January 23, 2025; Accepted: April 17, 2025; Advance Publication by J-STAGE: June 5, 2025  \nCorrespondence to Dr. Hiroyasu Kaneda, [kaneda.hiroyasu@omu.ac.jp](kaneda.hiroyasu@omu.ac.jp)  \n(A) (B) (C)  \nFigure 1. MRI and CT images. (A) Thoracic spine MRI image. Metastatic bone tumors are observed in the T8-10 vertebrae (white arrows). (B) Brain T2-weighted MRI image. Edematous changes (white arrows) due to metastatic brain tumors are observed in both parietal lobes. (C) Chest CT scan. A mass with a maximum di","cbCailueSkUNVEQ7","https://ap.wps.com/l/cbCailueSkUNVEQ7","pdf",342799,"English","# Abstract\n# Introduction\n# Case Report","[{\"question\":\"What clinical situation led to diagnosis in this case?\",\"answer\":\"A 40-year-old woman at 25 weeks’ gestation was admitted for persistent back pain, and imaging findings suggested lung cancer.\"},{\"question\":\"Why was early delivery chosen?\",\"answer\":\"The multidisciplinary team determined that early intervention was crucial, and Caesarean delivery was performed at 27 weeks’ gestation to expedite diagnosis and treatment.\"},{\"question\":\"What treatments were used after the delivery?\",\"answer\":\"After diagnosis of lung adenocarcinoma with bone metastasis, the patient received rapid opioid titration, radiation therapy for bone metastases, and chemotherapy, along with an advanced care plan.\"}]","Management of Advanced Lung Cancer in Pregnancy - Multidisciplinary Treatment and Early Delivery | PDF",1790191177,13]