Finding out you are pregnant may be one of the most exciting times in your life. It is a time of looking toward the future, anticipation, excitement and planning. What could ever bring you down from the emotional high of a new baby and all the possibilities that pregnancy brings?
Finding out you that you may have a medical problem that will complicate your pregnancy is always terrifying. No medical condition strikes with such universal fear as a cancer diagnosis. It is hard to comprehend that while you are growing a new life you could also be growing something so life threatening. Cancer doesn’t wait until the timing is convenient. It’s not fair.
Finding cancer during pregnancy is not very common, however it is being reported more frequently. Current statistics report a rate as high as one in 1,000 pregnancies are affected by a cancer diagnosis. The reasons why cancer is being seen in more pregnant women is not completely understood. One theory is many women are choosing to delay pregnancy until later in life. Pregnancies later in your 30s or 40s can be complicated by other medical concerns, but increasing age is a risk factor for many cancers.
The most common cancer found during pregnancy is breast cancer. Breast cancer, at any age, is life-changing, but those that are found in woman between the ages of 20 and 40 can be even more concerning. Breast cancer in younger women tends to have a different response to hormones than breast cancers found in older women. This can change the types of treatment needed.
Also, breast cancer can be particularly devastating on an emotional level for women. Much of our ideas of healthy pregnancies are focused on the changes of our bodies. Breast changes can be one of the first signs of pregnancy for some women. Breasts are made to produce milk, grow with pregnancy, and nourish our babies. The thought they could contain a cancer feels like a betrayal for many women.
Other common cancers found in pregnant women:
- Cervical cancer
- Thyroid cancer
- Gestational trophoblastic disease
Pregnancy symptoms can sometimes mask cancer symptoms. With respect to breast cancer, many women experience breast changes: skin changes, masses or lumps that they attribute to early pregnancy or milk production. Although many breast changes are normal in pregnancy; those same symptoms could be warning signs of a cancer.
Also, early cancers may be difficult to detect unless you discuss your concerns with your doctor early. Other common concerns such as fatigue, weight gain or loss, headaches and bloating are typical in pregnancy. And most of the time they are normal pregnancy problems, but they could also be more serious symptom of an underlying disease.
Although pregnancy does not increase you risk of cancer, it may be detected more at that time in your life because of access to health care. Pregnancy brings many women in to see a doctor; something they may have not done in many years. Finding a cancer while you are pregnant may be a cruel coincidence, or a blessing in disguise.
Many women delay their own health care due to busy lives, career or families until they are pregnant. Often times early symptoms are ignored by busy woman. An OB appointment to discuss your new pregnancy may be the first physical exam you have had in many years. Important screening tests such as pap smears, breast exams, ultrasounds and blood tests can bring to light an unexpected cancer that would have otherwise not been found.
If cancer is suspected, it is important to evaluate this more to confirm a diagnosis as soon as possible. Most tests to work up a possible cancer are safe in pregnancy. Ultrasounds, MRIs and biopsies are all safe in pregnancy. X-rays can typically be done safely as the amount of radiation is so low. Even CT scans can be done without harm to the growing baby if required. Occasionally the pregnant uterus will be shielded with a lead apron during CT scans or X-rays, but that may not even need to be done. Blood tests can be taken anytime during the pregnancy.
So, what now? What does this mean for you and your unborn baby?
You automatically become a high-risk pregnancy and will be cared for by a team of experts. You will be seeing your OB doctor, a high-risk pregnancy specialist (MFM) and oncologists (cancer specialist). You may also meet with surgeons and radiation doctors. This team will work together to come up with a plan that focuses on treating this cancer aggressively while ensuring the safety of you and your baby.
The good news is many cancers found in young healthy women are treatable, even curable. Also, many treatments can be started while you are pregnant. Many years ago it was thought that a woman would have to terminate a pregnancy if a cancer was found. That is no longer true in many cases because so many treatment options can be used even with a growing pregnancy.
However, there still are some aggressive cancers or certain therapies that are not safe while you are pregnant. Also in some situations delaying cancer treatment could be life-threatening to you. Those are difficult conversations to have, but they are important to discuss as early as you are diagnosed.
What are the treatment options for cancer?
That all depends on the type of cancer, location of the cancer, and if, and where, it has spread. It also depends on how far along you are in your pregnancy. Some treatments should be started sooner than later and some babies may need to be delivered slightly before the due date. All of those decisions are made with you and your medical care team.
Common treatment options are:
- Surgery: Some cancers are treated with surgery to remove as much of the tumors as possible. It can also be used to further evaluate and confirm the diagnosis of cancer. Surgery and anesthesia are typically very safe while pregnant. It may be recommended as soon as possible or it may be planned for after delivery of your baby depending on how far along you are in your pregnancy.
- Chemotherapy: Chemotherapy medications are used to help shrink or destroy the existing cancer cells and can be helpful to prevent the growth of new cancer cells. Some chemotherapy can be given as pills and some must be given through an IV at the hospital. Often times chemo therapy is given in “cycles” that are spaced out with a few weeks between the doses. There are some chemotherapy drugs not used while you are pregnant, and some that should be avoided in the first trimester. But there are also many chemotherapy drugs that can be used safely during your pregnancy. Many chemotherapy medications cannot get to the baby because the placenta acts as a barrier. Some must be used only in the second or third trimesters of pregnancy. The type of medication and how often you may need it is something that must be decided on for each individual patient. Chemotherapy can have side effects that can make you sick. Common side effects are loss of appetite, nausea, vomiting and increased risk of infections. Pregnant women on chemotherapy are monitored very closely for these concerns and the growth and development of your baby is watched closely too.
- Radiation: Radiation is the use of intense beams of energy to kill cancer cells. It is used less commonly in pregnancy and really depends on the location, distance of the cancer site from the uterus/baby and type of cancer. It may be suggested in some cases.
- Clinical trials: There are opportunities to be entered into a study where the latest medications, procedures and protocols are being evaluated to treat pregnant women with certain cancers. These are typically done at treatment centers or research hospitals.
Before a cancer diagnosis, your days were probably filled with excitement and happiness. You were planning for the future. You were picking nursery colors and baby names. Now you are faced with very different concerns. You may have completely different feelings about the pregnancy now.
You may no longer be excited. You might be downright angry and terrified. You have every right to feel this way. It is very important to share these thoughts and feelings with those who care about you: family, friends and your physicians.
We know a cancer diagnosis is often accompanied by depression and anxiety even when patients are not pregnant. There are many resources: counselors, support groups, survivors who are all here to help you through the emotions that you will be going through. There are also great online resources like the Hope for Two cancer network.
Typically, we recommend waiting for natural labor to deliver your baby, but there are certain reasons why planning an early delivery may be necessary or safer. Depending on the timing and type of chemotherapy you may need to plan for your labor to be induced at a certain time frame. If you are having a cesarean section, the surgery may need to be scheduled before your due date and coordinated with other surgeons who might operate at that same time to treat your cancer.
What about after pregnancy, how will this impact the postpartum period?
You may be concerned about caring for yourself and your baby after delivery. You may want to breastfeed your baby. This may still be possible. There are certain cancers and treatments that allow for safe breastfeeding. Depending on the type of chemotherapy and the time frame from the last chemo session you may be able to nurse your baby after delivery.
If you require a removal of a breast tumor you may be able to nurse from the opposite breast. Your wishes for breast feeding as well as a discussion on what’s best for you and your baby should be addressed by your health care team. If you desire to feed your baby breast milk but cannot physically, or safely, do so because of your cancer treatment, there are options such as donated breast milk banks.
Cancer treatments can cause fatigue, and caring for a new baby is always exhausting. This is another time when it will be important to communicate with your care team and support system at home. If it’s deemed safe, you may get a break in cancer therapy to allow for bonding with your new baby and healing your body. Again, treatment is so specific for each person; yours will be tailored to what is best for you.
Postpartum depression and anxiety are serious concerns that can happen to any woman, but new moms who are also dealing with cancer are at a much higher risk. It is important for you to discuss these feelings with your doctors, counselors, and all of those who love and support you so that you can have the help that you deserve.
Won’t all of this harm my baby?
As a pregnant woman, everything you do and every choice you make is focused on the safety of your growing baby. So, it is only natural for women to worry about how the cancer and the treatment of the cancer may harm your baby.
There has been new research on this very topic. The New England Journal of Medicine published a study in November 2015 that showed prenatal exposure to a maternal cancer with or without treatment did not impair the development of the child (no difference in the mental, physical, or heart development in early childhood).
Also, just because mom had a certain cancer does not put your child at any higher risk of developing the same cancer. There are some “hereditary” cancers that can be more common in families, which is why a genetic counselor will typically be part of your care team early on to discuss the risk and need for concern or not. There are some genetic tests that can be done while pregnant to evaluate if your cancer if one that may be passed on to your children.
If you have recently been diagnosed with cancer and are pregnant, please do not lose hope, do not fear the worst. Your medical team will help you navigate through these scary times and get you the treatment and help that you need.