Cancer during pregnancy

Some cancer treatments are safe to use during pregnancy, or at certain times during pregnancy. Some are not safe for babies at all. Most cancers don’t spread from one woman to another. Modern treatments and better monitoring have made it safer for women who are pregnant with cancer. The chances of a successful delivery are higher. You can still have a healthy baby even if you’re pregnant or living with cancer.

Types and stages of cancer

Being pregnant doesn’t cause cancer.

These are the most common types of cancers that are diagnosed in pregnancy.

• breast (the commonest)
• cervical
• Hodgkin lymphoma
• non-Hodgkin lymphoma
• ovarian
• melanoma skin cancer
• leukaemia
• thyroid
• colorectal

Rarely, cancer can develop from a molar pregnancy. A type of gestational tumoroblastic disease is called molar pregnancies. Instead, the abnormal growth of the uterus is caused by the tissue that would normally become a fetus. Molar pregnancy can have the same symptoms as a pregnancy but is not normal. A molar pregnancy does not result in a fetus.

Learn more about gestational trophoblastic disorder.

Diagnosing cancer during pregnancy

Pregnancy can bring on many symptoms, including nausea, vomiting and abdominal bloating. Sometimes, symptoms may be associated with a particular type of cancer. Talk to your doctor if you have symptoms that persist or occur during pregnancy, even if it is not considered normal.

Sometimes, cancer can be detected in pregnancy earlier than expected. A routine Pap test during pregnancy, for example, can detect cervical cancer. Ovarian cancer may be detected by an ultrasound performed during pregnancy.

You may be concerned about the potential harm to your baby if you suspect that there is cancer. You may be concerned about radiation exposure from x-rays, CT scans, or nuclear medicine tests. Some of these tests are safe to use during pregnancy. This will give your doctor more information to help you treat cancer.

Xrays and CT scan

The number of x-rays taken and the radiation dose used will determine if the tests are harmful to the baby. For extra protection during CT scans or x-rays, a lead shield is used to cover the mother’s abdomen.

Studies have shown that the radiation dose in x-rays used to diagnose cancer can cause harm to babies if there is adequate shielding.

CT scans are more accurate than regular x-rays in showing internal structures and organs. They also use a higher dose of radiation than standard x-rays. These scans can be used to diagnose and track the spread of cancer. The CT scans of the chest and head are generally safe. However, CT scans of the abdomen and pelvis are not recommended unless you need to plan your treatment.

MRI and ultrasound

Because they don’t use radiation, MRIs or ultrasounds can be used safely during pregnancy. Many biopsies and physical exams are safe tools for diagnosing cancer. Talk to your doctor if you have concerns about any particular test.

Cancer treatment during pregnancy

It is difficult to treat cancer in pregnancy. Your pregnancy doctor (also called an obstetrician), will evaluate the baby’s age, maturity, and delivery date. This information will help you plan your treatment and ensure that the baby is growing normally.

Your healthcare team will evaluate your options and balance them against possible risks to your baby. The options for cancer treatment are the same for pregnant women as those who are not, but the timing and manner of treatment may differ.

Treatment type and timing depend on many factors, including

• The location of cancer
• The type of cancer
• The stage of cancer
• The baby’s age (how long you have been a mother)
• How urgently is treatment needed
• What do you want or prefer

Your treatment is customized to your needs. Treatments for cancer during pregnancy can include chemotherapy, surgery and radiation therapy. These treatments should be used only after careful planning and thought to improve your health as well as the health of your baby.

A baby can be affected by certain cancer treatments, particularly in the first three months of pregnancy, also known as the first trimester. This is the time when the baby’s body and organs develop. Sometimes, cancer treatment can be delayed until later in pregnancy, usually during the second or the third trimester.

It may be possible to delay starting treatment until after the birth of a baby if cancer is discovered later in pregnancy. A doctor might also suggest inducing or bringing on labor early.

It may be possible to prolong the pregnancy until the baby is born, but it might not be possible to treat some early-stage cancers. Minor surgery can be performed to treat early-stage cancers without causing harm to the baby.

You and your doctor might need to talk about whether you want to continue the pregnancy in certain situations. If you have been diagnosed with advanced or aggressive cancer early in your pregnancy, it may be safer to start treatment immediately.

Surgery

Surgery is generally considered to be the best option for certain cancers, particularly after the first trimester. It is possible to reduce the risks for you and your baby with improvements in surgery and attentive monitoring.

Drug therapies and Chemotherapy

Chemotherapy refers to the treatment of cancer with anticancer drugs. It is a systemic treatment. It is a systemic therapy, meaning that the drug travels through the bloodstream to destroy and find cancer cells. The toxic effects of chemotherapy and other drugs to treat cancer can cause harm to babies, particularly if given in the first trimester, when baby’s organs are still developing.

Sometimes doctors will delay the administration of chemotherapy in order to minimize the impact on the baby. It depends on the stage of cancer and how rapidly it developed.

Congenital disabilities, low birth weights and miscarriages can be caused by chemotherapy in the first trimester. There are different types of chemotherapy that can increase the risk of congenital disability.

Some chemotherapy drugs administered during the second or third trimesters can cause low birth weight, stillbirth, and death. However, many other drugs and chemotherapy may be administered during these trimesters. The placenta provides a lot of protection. The placenta is formed during pregnancy and links the blood supply of mother and baby. It supplies nutrients and eliminates waste products. It acts as a barrier between mother and baby so that chemotherapy drugs can’t pass through.

After 35 weeks of pregnancy, chemotherapy is not recommended. This is because it can lower the blood cell count which can lead to bleeding and an increased risk of infection during childbirth. This is a good time to stop chemotherapy. It will allow you to recover any bone marrow you have lost from treatment. This may allow the placenta to remove any drugs from the baby’s system and give you time to get your blood count back to normal.

There are some unknown effects that chemotherapy and other drug therapies can have on babies, particularly for newer therapies like targeted or biological therapies. Health problems like anaemia, nausea, vomiting, and infection can be caused by chemotherapy and other drug therapies. These issues can also indirectly affect a baby.

Radiation therapy

Radiation therapy uses high energy x-rays and particles to shrink tumours and destroy cancer cells. Radiation therapy is not recommended during pregnancy, as it can cause harm to a baby’s nervous system and organs. Radiation therapy can be used in either the second or third trimester depending on the radiation dose and the treatment area. Guidelines for radiation exposure during pregnancy have been developed by the International Commission on Radiological Protection.

Radiation therapy can be done if there is a possibility of cancer spreading to the baby’s pelvis. To reduce radiation exposure for the baby, lead blocks or shields are used. Breast cancer treatment can be delayed until after birth.

Radiation therapy cannot treat pelvic cancers without serious consequences for the baby, regardless of stage. This can lead to miscarriage and congenital disabilities as well as slow growth and abnormal brain function. The doctor may recommend that the baby be terminated if the pregnancy is more than 26 weeks. Treatment can be delayed until after delivery if the cancer is discovered later in pregnancy.

Breastfeeding

Breast milk cannot transmit cancer cells to infants. However, chemotherapy and other drugs can be passed to babies and cause harm. Radioactive substances, such as radioactive iodine to treat thyroid cancer, can be ingested as a pill or drink and cause harm to the baby. If you are undergoing chemotherapy or other systemic therapies, you might be asked to stop breastfeeding.

Always check with your healthcare team to make sure you are safe to breastfeed.

Prognosis

The prognosis (estimated outcome), for pregnant women with cancer is often the exact same as that for women of the same age and who have the same type and stage.