Pregnancy-associated Cancer and Enhanced Recovery after Surgery Implementation in a Buccal Mucosa Cancer

Pregnancy-associated cancers present unique challenges, especially when involving rare malignancies like head-and-neck cancer. We report a 33-year-old female diagnosed with carcinoma of the gingivobuccal mucosa (T4N0M0) during the third trimester of pregnancy. Multidisciplinary management included balanced oncological treatment, maternal health and neonatal outcomes. Anaemia was corrected, and cancer pain was managed using multimodal analgesia, including a glossopharyngeal nerve block. The pregnancy culminated in an elective caesarean section at term, ensuring optimal foetal outcomes. Postpartum care emphasises early cancer treatment alongside addressing recurrent respiratory infections and optimising nutrition through prehabilitation. The patient underwent tumour resection with hemimandibulectomy, modified neck dissection and pectoralis major myocutaneous flap reconstruction 1 month post-delivery. Enhanced Recovery after Surgery (ERAS) principles were applied, including awake fibre-optic intubation for a difficult airway, multimodal analgesia, early ambulation and lactation preservation. This case highlights the challenges of implementing ERAS in postpartum advanced cancer, particularly in managing maternal physiological changes, flap viability and post-operative pain.