Cancer during pregnancy is uncommon. This made both doctors and women unsure how to treat cancer during pregnancy. However more   women with this disease have decided to continue with treatment during pregnancy. This has increased the information available about living or treating cancer during pregnancy.

Most women with cancer are able to deliver healthy babies because cancer  rarely affects the fetus directly. Some cancers  may spread to the placenta but do not get  to the baby. Being pregnant with cancer can be very complicated and overwhelming for both the mother and the  health care team . It is therefore important to choose a doctor who has some experience in treating pregnant women with cancer.

How is cancer diagnosed during pregnancy ?

 
Diagnosis of cancer during pregnancy is usually delayed because most of the symptoms of cancer such as abdominal bloating,  rectal bleeding and frequent headaches are also pregnancy symptoms. However, pregnancy can also uncover cancer that has gone undetected.  For example an ultrasound may be able to detect ovarian cancer and a pap smear  can detect cervical  cancer.

Cancers that usually occur during pregnancy are those common in young people such as the following :

• breast cancer
• thyroid  cancer
• cervical cancer
• melanomas
• Hodgkin lymphoma
• non Hodgkin lymphoma
• gestational trophoblastic tumor

The most common cancer during pregnancy is breast cancer. However the enlargement of breast tissues during pregnancy makes it difficult  to detect small breast tumors.  As a result pregnant women with this type of cancer are diagnosed 2 to 6 months later than women who are not pregnant.

If cancer is detected during pregnancy, doctors and pregnant women usually worry about diagnostic tests such as an  x-rays. However research have shown that the radiation in diagnostic x-rays are too low to harm the fetus. Computed tomography CT scans are similar to x-rays because they all use ionizing radiation.  . However CT scans are more accurate  in outlining internal organs and helping in detect if the cancer has spread or not. CT scans of the head and chest are considered safe because there is no direct exposure to the fetus. If there is the need to, pregnant women may be given a lead shield that covers  the abdomen for extra protection. CT scan of the abdomen or pelvis is done only if it is absolutely necessary and after discussion with a medical team. Other diagnostic tests such as ultrasound, magnetic resonance imaging MRI and are biopsy considered safe during pregnancy because they do not use ionization.

How is cancer treated during pregnancy ?

 
Doctors  choose the best treatment option for the mother and baby. They type of treatment depends on the following :

• stage of pregnancy
• type, location, size and stage of cancer
• wishes of the mother and family

 
Some cancer treatments may be harmful especially during the early stages of pregnancy. In this case, treatment may be delayed until the second or third trimester. If the cancer is detected in later pregnancy, the doctors may decide until the baby is born to start treatment or may induce labor early. If the cancer is in the early stages such as 0 or IA cervical cancer, doctors  may wait after delivery to start treatment.

Some cancer treatment may be used but only under careful consideration. These include chemotherapy, surgery and rarely radiation therapy.

Chemotherapy : This involves the use of drugs to kill the cancerous cells. It stops the cancer cell’s  ability to grow and divide. However this procedure may harm the fetus during early pregnancy. It can cause a birth defect or even miscarriage.

During the second and third trimester, chemotherapy may not necessarily harm the fetus. However chemotherapy during later pregnancy can cause anemia and malnourishment in the mother which can in turn harm the fetus indirectly. It can also cause early labor and low birth weight all of which can cause harm to the mother and baby. The mother may have trouble breastfeeding and the baby may have problems with fighting infections and gaining weight.

Surgery : This is the removal of  the tumor and surrounding tissues in an operation. This poses little risk to the unborn child and is considered the safest treatment option during  pregnancy. In some cases, extensive surgery can be done to avoid getting chemotherapy and radiation.

Radiation therapy : This uses high energy x-rays to kill cancerous cells. This treatment can affect the fetus during early pregnancy therefore doctors try as much as possible to avoid it during the first trimester. Even in the second and third trimester , the use of this treatment option is rare and the risk to the developing baby depends on the dose being used and the body part being treated.

How can pregnancy affect cancer recovery

 
The chances of recovery is almost the same as other women with the same type and stage of cancer. However, if the diagnosis and treatment is delayed during  pregnancy, the extend of the cancer can be greater. This will make overall prognosis worse.

Breastfeeding

 
Doctors usually advise women undergoing cancer treatment to avoid breastfeeding. Chemotherapy can be especially dangerous because the drug can transfer into the breast milk to the baby. Radioactive components such as iodine used in treating thyroid cancer can also get into the breastmilk and harm the baby.
 
It is important to talk to your doctor about your worries and concerns.
 
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