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Cancer During Pregnancy
Pregnancy is supposedly one of the happiest time of our lives — full of joy, anticipation, planning, and excitement. But what if pregnancy is marred by cancer? Whether cancer was a preexisting condition prior to pregnancy or diagnosed during pregnancy, it doesn’t make it any easier or less scary.
Common Cancers During Pregnancy
Diagnosis of a tumor during pregnancy is not common, but it can happen. If cancer is diagnosed during pregnancy, the most common types are breast cancer, melanoma, cervical cancer and lymphoma. These cancers are typically harmful to the mother, but not to the baby.
Gestational trophoblastic disease (GTD) is a tumor that occurs during pregnancy and is caused by a fertilized egg that does not become a fetus. GTD is typically benign but can be malignant. One common type of GTD is a molar pregnancy.
Diagnosis of Cancer During Pregnancy
Certain cancers are diagnosed due to pregnancy. For example, a routine pap smear done at the beginning of pregnancy may uncover a cervical cancer diagnosis. A routine ultrasound may detect ovarian cancer.
However, it is likely that pregnancy can delay a cancer diagnosis. Cancer symptoms, such as rectal bleeding, breast changes, headaches, and bloating, are all also common symptoms during pregnancy.
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If a cancer diagnosis is expected, diagnostic tests may be performed:
- X-rays: while X-rays do emit radiation, studies show that the levels used are not enough to harm the developing fetus. A woman may also protect the fetus by using a lead shield during the X-ray.
- Computed tomography (CT scans): a CT scan is a diagnostic tool that is more accurate than X-rays. They can be done safely to head and chest, especially if a lead shield is placed over the abdomen. However, CT scans should be done on the abdomen only if the pros outweigh the cons.
- Magnetic resonance imaging (MRI): an MRI is typically considered safe if it doesn’t use contrast dye. MRIs using contrast should only be used if the pros outweigh the cons.
- Ultrasounds: are considered safe because no radiation is emitted during the procedure and can provide valuable information about internal structures.
Treatment of Cancer During Pregnancy
Keep in mind that being pregnant does not affect the efficacy of cancer treatment; this means that if two people are diagnosed with breast cancer at the same stage, with similar health statuses, with one woman being pregnant and the other not, both can expect to have a similar outcome.
Treatment may NOT be as effective during pregnancy, however, if the diagnosis of the cancer is delayed due to pregnancy. This means that if cancer has reached a more advanced stage due to delayed diagnosis, treatment may not be as effective as it would have been in early stages (or earlier pregnancy).
The pros and cons of cancer treatment during pregnancy should be weighed carefully with the pregnant woman. If possible, it may be delayed until after pregnancy. However, this is not always the ideal situation and treatment must begin immediately for a positive outcome.
Often, chemotherapy is the treatment of choice for cancer during pregnancy. There have been many research studies performed on administering chemotherapy during pregnancy.
Recent research suggests that administering chemotherapy in the first trimester can be dangerous to the developing baby due to the risk of birth defects, but beginning chemotherapy in the second or third trimester, when feasible, has no ill effects on the baby.
In fact, a European study showed that 70 children who were exposed to chemotherapy in utero and they developed at the same rate as those who were not exposed to chemotherapy.
Historically, babies were delivered early to begin chemotherapy. Through research, it has been found that babies delivered early have lower IQs than those who were not delivered early — and this is attributed to early delivery as opposed to the mother’s cancer.
Radiation is typically not recommended during pregnancy, as it increases the risk of birth defects. However, as with all treatment options, weighing of pros and cons is necessary.
For most types of cancer diagnosed during or before pregnancy, a full-term labor can be achievable. This is true even for gynecologic types of cancer, such as uterine and cervical cancer.
However, blood cancers, such as leukemia and lymphomas, are difficult to treat during pregnancy, especially if diagnosed in the first trimester. With these types of cancers, it is not recommended to wait until a later trimester to begin chemotherapy; this may mean that terminating the pregnancy is necessary in order to save the mother’s life.
For a woman receiving chemotherapy or cancer treatment, breastfeeding is not recommended. Chemotherapeutic medications can transfer to the breast milk, harming the baby.