A cancer diagnosis during pregnancy requires careful consideration for both the parent and the developing fetus. While uncommon, this situation can be managed effectively with modern medical approaches. The primary goal is to create a treatment plan that addresses the cancer while safeguarding the health of both individuals. With coordinated care, it is possible to treat cancer during gestation without harming the unborn baby, leading to positive outcomes for both.
Diagnosing Cancer in Pregnant Individuals
Identifying cancer during pregnancy can be complex because many of its symptoms mimic the normal physiological changes of gestation. Signs such as fatigue, breast tenderness or lumps, bloating, and mild anemia are common in pregnancy but can also be indicators of malignancy. This overlap can lead to delays in diagnosis, as the symptoms may be attributed to the pregnancy itself. Consequently, persistent or unusual symptoms warrant thorough investigation.
Specific imaging and testing methods are preferred for a safe diagnosis. Ultrasounds and magnetic resonance imaging (MRI) are considered safe for the fetus and are excellent tools for diagnosis and staging. Biopsies, which involve taking a small tissue sample for analysis, can also be performed safely depending on the location of the suspected tumor. A simple, ultrasound-guided biopsy, for instance, can be safely performed even during the first trimester.
While some imaging techniques that use radiation, such as X-rays and computed tomography (CT) scans, are generally avoided, they may be used in certain situations. When necessary, these tests are performed with protective lead shielding over the abdomen to minimize radiation exposure to the fetus. The most common cancers diagnosed during pregnancy include:
- Breast cancer
- Cervical cancer
- Lymphoma
- Melanoma
- Leukemia
Treatment Approaches During Pregnancy
The management of cancer during pregnancy requires a collaborative effort from a multidisciplinary team, typically including an oncologist, a high-risk obstetrician, and a perinatologist. This team develops a treatment strategy tailored to the specific type and stage of the cancer, the gestational age of the fetus, and the overall health of the pregnant individual.
Surgery is often considered a safe treatment option at any stage of pregnancy. For certain cancers, such as early-stage breast cancer, surgical removal of a tumor and nearby lymph nodes can be performed with minimal risk to the fetus. However, the feasibility of surgery depends on the cancer’s location; for instance, a procedure involving the uterus would not be safe for the baby. When possible, surgeons may opt for regional over general anesthesia and take special care to minimize handling of the uterus.
Chemotherapy administration is highly dependent on timing. It is generally avoided during the first trimester, the period of organogenesis when the fetus is most vulnerable to developmental harm. However, during the second and third trimesters, certain chemotherapy drugs can often be administered safely. The placenta acts as a partial barrier, preventing some of these drugs from reaching the fetus. Chemotherapy is typically paused between 33 and 35 weeks of gestation to avoid complications during labor, such as low blood counts in the mother.
Radiation therapy is generally avoided during pregnancy due to the risk of harming the developing fetus. In rare cases, if the cancer is located far from the uterus, radiation may be considered with extensive shielding to protect the abdomen. Any decision to use radiation is made after a careful evaluation of the potential benefits for the mother versus the risks to the fetus.
Impact on the Fetus and Newborn
The cancer itself very rarely spreads from the mother to the fetus. The placenta serves as an effective barrier, protecting the developing baby from the mother’s cancer cells.
The more significant considerations are the potential indirect effects of cancer treatments on the fetus, as some risks are unavoidable. One of the most common outcomes is a higher likelihood of premature birth, which may be a planned medical decision to allow the mother to begin more intensive treatment. Low birth weight is another potential risk associated with cancer treatment during pregnancy.
Despite these potential risks, many children whose mothers underwent cancer treatment during pregnancy are born healthy. Long-term follow-up studies on children exposed to chemotherapy in utero have not shown an increased risk of congenital abnormalities or developmental delays. Careful monitoring by a high-risk obstetrician throughout the pregnancy helps to manage and mitigate potential complications, ensuring the best possible outcome for the newborn.
Postpartum Considerations and Breastfeeding
After the baby is born, the focus of the mother’s cancer care can shift. Treatment plans that were modified or delayed during pregnancy may be initiated or intensified. This could involve starting radiation therapy, changing chemotherapy regimens, or undergoing additional surgeries that were not safe to perform while pregnant.
One of the questions for new mothers who have undergone cancer treatment is whether they can breastfeed. The answer depends on the specific treatments being received. Breastfeeding is generally not recommended for individuals undergoing active chemotherapy or receiving certain other medications, as these drugs can be passed to the infant through breast milk and could be harmful.
For those who had treatments like surgery that have since concluded, breastfeeding may be possible. The new mother should have a detailed discussion with her oncology team and obstetrician to understand the specific recommendations for her situation. This period also involves continued follow-up care for both the mother, to monitor her cancer status, and the baby, to ensure they are meeting developmental milestones.