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.
