Secrets of Chemotherapy II

  During the Chenghua period of the Ming Dynasty, Emperor Xianzong favored Wan Guifei alone, but as a famous imperial concubine in history, Wan Guifei’s child died and could not have another child. Wan Guifei then did not allow other concubines to give birth to children, according to Ming history, “tucked away in the imperial court to have a body, drink medicine to hurt the fall of countless”.  But even in such a situation, a court lady surnamed Ji still pregnant with the emperor’s child. The court lady Ji was very smart and never told anyone about her pregnancy, but later when her abdomen grew, Wan Guifei did send someone to force her to take abortion pills. She cried and begged the eunuch who sent the pills and told him that if he let Wan Guifei do what she wanted, the emperor would end up without a queen and there would be no one to inherit the kingdom, arousing the eunuch’s sympathy. But Wan Guifei has many ears and eyes, not to take the medicine is never possible. In the end, the eunuchs privately reduced the abortion pill by half and let the court lady Ji take it. A few months later, Ji Gongmu secretly gave birth to a boy in the cold palace, which is later Ming Xiaozong Zhu v gong. The subsequent story is also rich in tears, all in all, Zhu was a wise and virtuous emperor, creating the “Hongzhi Zhongxing” in the middle of the Ming Dynasty.  More than 500 years later, around 2010, oncologists began to focus on a similar question: Should pregnant women with cancer be treated with radiotherapy?  If this question were asked in today’s society, most people would say, “Nani? Chemotherapy for pregnant women? How is that possible? Even if a pregnant woman wants to take an antibiotic, it would make the public nervous for half a day.  But for pregnant women, the problem is very contradictory and realistic: if pregnant women cannot have chemotherapy, they have only two choices. The first is to abort or induce labor and receive radiotherapy. However, abortion and induction of labor can only be limited to early and mid-term pregnancies. Not only that, after receiving radiotherapy, pregnancy cannot be considered in the short term, and these women may be childless for life; second, receive radiotherapy after childbirth, but the development of tumor is rapid, and waiting for childbirth is likely to miss the best treatment time (especially for breast cancer and gynecological tumor), which directly causes the death of patients.  It is well known that fetal development is mainly completed in early pregnancy, and in recent years, some scholars in Europe and the United States have begun to evaluate the feasibility of radiotherapy beyond early pregnancy. in 2013, a retrospective study of 12 women with breast cancer treated with chemotherapy during pregnancy found that they all delivered healthy babies. A cohort study of 38 children with a history of intrauterine chemotherapy exposure showed that by the time these children were 2 years old, their growth, intellectual development, and cardiac function, did not differ from controls.  Another retrospective study of 16 children with a history of intrauterine chemotherapy exposure showed that at 1.5, 3, 6, and 9 years of age, the children’s physiological, psychological, behavioral, and cardiac function, were in the normal range. Therefore, it has been suggested that concerns about the risks of managing radiotherapy should not be a reason to terminate a pregnancy, delay maternal cancer treatment, or deliver a fetus prematurely.  Only small samples of nonprospective studies are available on the safety of radiotherapy during pregnancy. From the perspective of evidence-based medicine, it is inconclusive. However, this issue can be said to be a microcosm of the general chemotherapy issue. That is, people tend to focus on the possible harms of chemotherapy, but overlook that it is not the chemotherapy but the tumor itself that is most likely to harm the patient. The side effects of chemotherapy are actually very mild and mostly acceptable compared to the consequences caused by the tumor.  Back to the beginning of the story. Why didn’t Wan Guifei manage to kill Zhu Zhu? It has to do with the fact that Zhuv had a wise mother. Ji Gongmu, or rather Empress Dowager Ji, concealed herself from the early stages of pregnancy and was already in the middle or late stages of pregnancy when she took the abortifacient, and according to recent clinical trials, exposure to cytotoxic drugs in the middle and late stages of pregnancy does not seem to increase the chances of miscarriage, stillbirth, and does not have much effect on the growth and development of children after birth. In contrast, the poisoning of the imperial heir by Princess Orihime is mostly around the time of pregnancy or in early pregnancy.  Well, if anything, fetuses after mid-pregnancy are able to tolerate chemotherapy. Why are adults afraid of chemotherapy?  Postscript: There are two parts to the development of medicine: hardware and software. From the hardware point of view, especially in the big cities in China, medical equipment and drugs, and the international advanced level are comparable; but from the software point of view, the concept of the public, the trust between doctors and patients, still need too much progress. Several studies related to radiotherapy during pregnancy are mentioned in this article, which at least shows that chemotherapy during pregnancy is accepted abroad, and the results show that chemotherapy is generally good for the mother and child.  However, in this country, this is seen by the public as a pipe dream. What this perception leads to is a mother who may face a lifetime of suffering without a child, or a mother who dies and the child grows up alone – perhaps chemotherapy cannot prove to be completely harmless to the growth of the child, but a childhood without a mother must be harmful to the child’s development. In other words, the availability of advanced equipment and drugs and the lack of advanced concepts can just as easily prevent patients from receiving the most effective treatment. This, perhaps, is what we need to progress the most.