Things were going well for young mother Alana. With a doting husband, an adorable two-year-old son and a baby on the way, she couldn’t be any happier. But unbeknownst to her, a storm was brewing on the horizon.
Recalling the day when her life took a 180° turn, she says, “I was in midst of reading a story to my son when I noticed a lump in my breast. I hoped that it was one of those things which normally occur during pregnancy but I had a bad feeling about it.” Acting on her gut instinct, she decided to get herself checked.
“Initially, the doctor didn’t think it could be serious but he suggested that I undergo an ultrasound scan, followed by a biopsy just to be sure.” Nothing could prepare her for the results that came back: she was diagnosed with stage 3 breast cancer. “I was stunned. It seemed so impossible. I was too young to have cancer,” she says. After the initial shock, came panic. What was going to happen to her unborn child? “I was terrified. I kept wondering if I would be able to keep my baby.”
Pregnant with cancer
Someone once said, “Pregnancy and motherhood are the most beautiful and significantly life-altering events that I’ve ever experienced.” And it really should be for mothers everywhere. But while pregnancy is a joyous occasion for many, it can be a difficult journey for those who have been diagnosed with cancer. To find out about this predicament and what it entails for both mother and child, we speak to an expert on the matter: Consultant oncologist Dr Mastura Md Yusof.
When asked how common this predicament is in Malaysia, Dr Mastura says, “We don’t have specific statistics but I would say that cancer during pregnancy is something that may be on the rise. An increasing number of women are postponing childbearing to a later age; more women have picked up smoking; obesity is a growing problem among women – all these factors can play a role.”
In Alana’s case, it was a lump in her breast that set off alarm bells. What other symptoms should pregnant women look out for? “The symptoms depend on the type of cancer and its stage of presentation,” she replies. Will these tell-tale signs differ between someone who is expecting and someone who isn’t? “No, the symptoms are often similar. In the case of breast cancer, women will typically have a breast lump or nipple discharge whereas for those with cervical cancer, they are likely to experience abnormal per vaginal bleeding. Always remember, if in doubt, see your doctor. Don’t wait,” she emphasizes.
‘Will my baby be safe?’
As with other chronic diseases, diagnostic tests are necessary to confirm if patients do indeed have cancer – pregnant women included. “It’s popular belief that diagnostic tests will harm the pregnancy but it’s actually not true. Biopsy is a simple procedure which entails taking an extremely tiny amount of tissue from the tumour area. This is so we can examine the tissue under the microscope for any presence of cancer. It doesn’t involve radiation of any kind so it won’t harm the foetus. It’s also safe for expecting mothers to undergo biopsies under anaesthesia,” Dr Mastura assures.
Listing down other forms of diagnostic methods, she says, “Other tests that are considered safe include ultrasound, magnetic resonance imaging (MRI), blood tests and lumbar puncture.” What about things like chest x-rays and mammograms? “They can be safe as long as an abdominal shield is utilized to protect the foetus from exposure to radiation,” she clarifies.
Diagnostic tests may be safe for pregnancies but now it begets the question: can pregnancies compromise the diagnosis process? “In breast cancer, pregnancy does cause the breasts to enlarge. Therefore, it may be difficult to feel for the lump upon examination – both by the patient and the doctor. But other than that, pregnancy generally won’t affect the process.”
‘What are my options?’
Like many things in life, there is no one-size-fits-all strategy when it comes to cancer treatment. “The treatment options that are available to a patient depend on various factors,” Dr Mastura explains. These factors include:
“Firstly, it depends on the patient herself. Does she have any pre-existing medical conditions? How is her physical fitness and organ function? Is this pregnancy her first? Does she have any other kids? How far along is she?”
Type of cancer
“Another factor we take into consideration is the type and stage of cancer she has. Once those details have been confirmed, we can look into the treatment (eg, surgery, chemotherapy, etc) that is indicated for her exact condition. Surgery can be performed at any time during the pregnancy while most chemotherapy drugs can be administered during the 2nd and 3rd trimesters. Patients who undergo chemotherapy aren’t allowed to breastfeed. Instead, they will be given medications to halt breast milk production. Radiotherapy, on the other hand is not given during pregnancy.”
‘Can I keep my baby?’
The few first questions to cross every patient’s mind are likely to be ‘Can I keep my child? Can I undergo treatment while pregnant? Will treatment jeopardize my pregnancy? Must I abort my baby?’ However, Dr Mastura has encouraging words to offer.
“Abortion is only considered if the patient’s cancer is advanced, treatment has to be given acutely or she is still in her 1st trimester whereby treatment like chemotherapy will put the baby at risk,” she says.
“Battling cancer whilst pregnant can be terrifying but it’s not a dead end. It is a treatable condition. If a patient is managed in a multidisciplinary setting by a team of specialists (eg, oncologists, surgeons, radiologists, pathologists, anaesthetists, neonatologists, etc) all the way, the outlook is usually good. Additionally, an obstetrician will regularly review her at the antenatal clinic every two weeks or so until delivery to ensure the foetal progress is good. We’ve had many women opting to continue with their pregnancies – and they have gone on to give birth to healthy babies. In fact, some actively share their experiences with the hopes of allaying the fears that new patients have. So, don’t lose hope!”
Is it preventable?
When asked if early screening can help lower the risk of cancer during pregnancy, Dr Mastura says, “As of now, there’s no evidence that screening before conception can either reduce that risk or improve a cancer patient’s survival. What women should actually do is firstly check their family’s medical history for any types of cancer. Then of course, they must live healthily – meaning no smoking, no alcohol, be physically active, eat a well-balanced diet, have a healthy weight, etc. Having kids before turning 30 plays a significant role too.”
Health at Iowa. Available at www.medcom.uiowa.edu