How cancer is addressed during a patient’s pregnancy
Cancer during pregnancy is uncommon. But when it does occur, it can be complicated for the mother and the healthcare team. Cancer itself rarely affects the growing baby directly. But a doctor must be selective about how they diagnose and treat pregnant women with cancer. Cancers during pregnancy
Breast cancer is the most common cancer diagnosed during pregnancy. In the USA alone, it affects about one in 3,000 women who are pregnant. Other cancers that tend to occur during pregnancy are also more common in younger people. These include cervical cancer, thyroid cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, melanoma, gestational trophoblastic tumour.
Being pregnant may delay a cancer diagnosis. This is because some cancer symptoms, such as bloating, headaches, breast changes or rectal bleeding are also common during pregnancy. On the other hand, pregnancy can sometimes uncover cancer.
Some diagnostic tests for cancer are safe for pregnant women and the fetus, like magnetic resonance imaging, ultrasound and biopsy. Others, however, could be harmful, like X-ray, CT scans or PET-CT scans. Treatment during pregnancy
Planning a cancer treatment during pregnancy requires a multidisciplinary team of doctors working together. This includes cancer doctors (oncologists) and high-risk obstetricians.
Oncologists and obstetricians do the following:
> Compare the best cancer treatment options for the woman with the lowest possible risks for the growing baby.
> Consider a number of factors, including the stage of the pregnancy; type, location, size and stage of the cancer; and wishes of the woman and her family. > Closely monitor the woman during the treatment and make sure the baby is healthy. Sometimes, doctors choose to delay or avoid certain treatments for pregnant women with cancer.
Some treatment adjustments include: > During the first three months of pregnancy, some cancer treatments are more likely to harm the fetus; so the healthcare team may delay the treatment until the second or third trimester. > When the cancer is diagnosed later in the pregnancy, healthcare providers may put the treatment on hold until after the baby is born.
> In other cases, such as earlystage cervical cancer, the team may wait until after delivery before starting treatment. > Some treatments, like radiation therapy, can harm the fetus in all trimesters, and healthcare providers generally avoid using these methods during pregnancy.
Some cancer treatments that can be done during a pregnancy are:
> Surgery: It is considered the safest cancer treatment during all stages of pregnancy.
> Chemotherapy: The health- care team may choose to use this treatment only during certain periods in the pregnancy.
During the first three months, chemotherapy carries the risk of birth defects or pregnancy loss. This is when the fetus’ organs are still growing.
During the second and third trimesters, doctors can give several types of chemotherapy without apparent risk to the fetus. The placenta acts as a barrier between the woman and the baby, so some drugs would not be able to pass through.
Some healthcare providers may discuss inducing labor early to protect the baby from the cancer treatment. However, it is preferred to continue the pregnancy until natural labour and delivery occurs.
Women who are receiving chemotherapy after a pregnancy should not breastfeed, as chemotherapy drugs can be transferred to the infant through the breast milk.
Both pregnancy and cancer can give lots of stress to patients and their families. Members of the healthcare team, including the oncologist, obstetrician, counsellor, psychologist or psychiatrist, can help reduce their stress and other psychological issues.
Does pregnancy affect risks?
Pregnancy itself does not appear to affect how well the cancer treatment works. Similarly, it does not affect the risk of cancer development. Often, pregnancy after cancer treatment is safe for both the mother and the baby.
Pregnancy also does not seem to raise the risk of the cancer coming back. Still, some women may be told to wait a number of years before trying to have a baby, and the waiting period depends on several factors such as cancer type and stage, type of treatment and a woman’s age. This may range from six months to a few years.