Women

Your Pregnancy After 35 : Your Current Medical Condition and Medications (part 6) - Cancer during Pregnancy

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Cancer during Pregnancy

Pregnancy is a happy time for most women. Occasionally, however, serious problems can occur. Cancer during pregnancy is one serious complication that occurs rarely.

This discussion is included not to scare you but to provide you with information. It may not be a pleasant subject to discuss, especially at this time. However, every woman should have this information at hand. Because many women today wait until they are older to have babies, and cancer strikes more older women, it’s good to have information available so you can discuss the situation with your healthcare provider if you are concerned about it.

Cancer occurs in about one in every 1000 pregnancies. Pregnancy may make it more difficult to diagnose the problem. Tremendous changes affect your body during pregnancy. Some researchers believe cancers influenced by increased hormones may increase in frequency during pregnancy. Increased blood flow may add to the spread of cancer to other parts of the body. Body changes during pregnancy can make it difficult to find or to diagnose an early cancer.

When cancer occurs during pregnancy, it can be very stressful for you and your partner. The healthcare provider must consider how to treat the cancer, but he or she is also concerned about the developing baby. How these issues are handled depends on when cancer is discovered. You, your partner and your healthcare provider must consider many issues before deciding on a course of treatment.

Must the pregnancy be terminated?

Can the malignancy affect the developing baby?

Can therapy be delayed until after the baby is developed or delivered?

How do medications, chemotherapy or radiation used to treat the cancer affect the fetus?

Cancer during pregnancy must be treated on an individual basis. Anti-cancer drugs stop cell division to help fight the cancer. If taken during the first part of pregnancy, they can affect cell division of the embryo.

Before a woman is treated, a procedure using letrozole and gonadotropin may be used. A woman’s ovaries are stimulated to produce the maximum number of eggs. Eggs are then harvested before chemotherapy or radiation begins.

If you’re now pregnant and have had cancer in the past, tell your healthcare provider as soon as you find out you’re pregnant. He or she may need to make decisions about individualized care for you during pregnancy.

Breast Cancer

Breast cancer is the type of cancer discovered most often during pregnancy. It is uncommon in women younger than 35. Unfortunately, it may be harder to find breast cancer during pregnancy because of changes in the breasts, including tenderness, increased size and even lumpiness. About 2% of all women who have breast cancer are pregnant when it is diagnosed.

Breast cancer can be treated during pregnancy. Treatment varies, depending on the woman; surgery, chemotherapy, radiation or all three may be required. A physician will determine a course of treatment based on a woman’s particular needs.

Some studies indicate that pregnancy is safe in women with a history of breast cancer if the cancer has been successfully treated. Other studies indicate chemotherapy for breast cancer during pregnancy may also be safe.

A form of breast cancer you should be aware of is inflammatory breast cancer (IBC). Although rare, it can occur during and after pregnancy and may be mistaken for mastitis, which is inflammation of the breast. Symptoms of inflammatory breast cancer include swelling or pain in the breast, redness, nipple discharge and/or swollen lymph nodes above the collarbone or under the arm. You may feel a lump, although one is not always present.

If you experience any of these symptoms, do not panic! Nearly all of the time it will be a breast infection related to breastfeeding. However, if you’re concerned, contact your healthcare provider. A biopsy is used to diagnose the problem.

Quan-Li was a busy executive who never had time for breakfast. She might grab a diet cola and a bag of chips for lunch, and she often ate dinner out with clients. Her plan was to continue this regimen and take a prenatal vitamin during her pregnancy. We had a frank discussion about why her plan wouldn’t work. I explained how her baby relied on her for its nourishment. I advised her that she couldn’t eat that way for the entire pregnancy; she’d feel terrible and might not be able to continue working. With some help, Quan-Li made a commitment to follow a healthful eating plan and to take her prenatal vitamins every night after dinner.

Gynecologic and Other Types of Cancers

Various cancers of the female organs, including the cervix, the uterus, the vagina, the ovaries, the bladder and the Fallopian tubes, have been reported during pregnancy. Let us reassure you—these cancers are very rare during pregnancy, no matter what your age.

Cervical cancer occurs only once in about 10,000 pregnancies. However, about 1% of the women who have cancer of the cervix are pregnant when the cancer is diagnosed. Cancer of the cervix is extremely curable, especially when discovered early. That’s one reason your Pap smear is important before and during pregnancy.

Bone tumors are rare during pregnancy. However, two types of noncancerous bone tumors can affect pregnancy and delivery. These tumors, endochondromas and benign exostosis, can involve the pelvis; tumors may interfere with labor. The possibility of having a Cesarean delivery is more likely with these tumors.

Other types of cancer, such as Hodgkin’s disease, leukemia or melanoma, are very serious complications of pregnancy. Cancers of the blood occur in one of every 6000 pregnancies. If you are diagnosed with any form of cancer, you and your healthcare provider will discuss ways to treat it.

Cancer Treatments

Treating cancer during pregnancy can be difficult because of the effects various substances and procedures have on mother and fetus. Treatment can cause a variety of problems; a pregnant woman may also experience side effects.

Discuss any questions about cancer treatment during pregnancy with your healthcare provider. He or she can give you the best answers and help reassure you.

Connecting with other women and with couples who have experienced the same situation can be very helpful. One support group, Hope for Two, may be able to help you in many ways. Another group, Pregnant with Cancer, connects new cancer patients with survivors, which can provide you with a great deal of emotional and educational support. 

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