Cancer in Pregnancy: Therapeutic Decisions at the Intersection of Two Lives

Background: Cancer during pregnancy is a rare but increasingly encountered condition due to delayed childbearing and improved survival of women with cancer. The coexistence of malignancy and pregnancy poses complex diagnostic and therapeutic challenges, requiring careful balance between maternal prognosis and fetal safety. Objective: This review aims to summarize current evidence on the diagnosis and multidisciplinary management of cancer during pregnancy, focusing on the safe use of oncologic therapies, obstetric decision-making, and maternal and fetal outcomes. Methods: A narrative review was conducted based on literature identified in PubMed/MEDLINE, Scopus, and Web of Science from January 2000 to September 2025. Search terms included pregnancy-associated cancer, oncologic treatment during pregnancy, obstetric management, and fetal outcomes. Relevant clinical guidelines, registry data, and reference lists were also reviewed. Results: Breast cancer, cervical cancer, melanoma, hematologic malignancies, and gestational trophoblastic neoplasia represent the most frequently reported cancers during pregnancy. Evidence indicates that selected cancer treatments can be administered safely without compromising maternal prognosis. Chemotherapy after the first trimester is generally associated with acceptable fetal outcomes. Physiological changes in pregnancy may delay diagnosis and influence drug pharmacokinetics. Radiotherapy, targeted therapies, and immunotherapies remain limited because of potential fetal toxicity. Avoiding iatrogenic prematurity is a central principle of obstetric management. Conclusions: Cancer during pregnancy should no longer be considered an absolute therapeutic dilemma. With individualized multidisciplinary care, effective maternal treatment and favorable fetal outcomes are increasingly achievable.