Cancer in Pregnancy

Cancer is a disease that unfortunately can occur at any stage of life and pregnant women are not immune to it. Luckily, it is rare to diagnose cancer during pregnancy, and it is estimated that it can affect one in every 1,000 pregnancies.

The most common cancers are those of the cervix, breast, thyroid, melanoma, and ovary. The diagnosis of cancer in a pregnant woman is a complex situation, since the best option for the patient and the fetus must be taken into account .
Although the ultimate goal should be the complete cure of the woman without compromising the fetus , this is not always possible, so in extreme cases treatment may be at the expense of pregnancy.

Can the usual follow-up tests be done?

In general, the imaging techniques necessary for diagnosis and staging can normally be performed on a pregnant woman, prioritizing ultrasound and magnetic resonance imaging , which are safe for the fetus, trying to avoid during the first trimester the tests that involve X-rays: conventional radiology, TAC… but viable during the second and third trimesters.

Does cancer treatment vary if I am pregnant?

The fundamental principle that must be taken into account is that the priority must be to apply the treatment as if the woman were not pregnant, following the protocol indicated for that pathology.
In general, we should not associate that the diagnosis of cancer during pregnancy is equivalent to an interruption of pregnancy to carry out cancer treatment , since in many cases it may be compatible with pregnancy, or to defer diagnostic or therapeutic tests until the fetus presents the degree of maturity sufficient to make it viable.

  • Surgical treatment and anesthesia can be done normally, unless the reproductive organs are affected. In this case, whenever possible, the operation should be postponed until the fetus is viable and only put the pregnancy at risk if it is very incipient and treatment cannot be delayed .
  • The chemotherapy and radiotherapy in some cases may be administered to the mother of the second and third quarters . There are chemotherapy drugs that do not have harmful effects on the fetus.
  • Tests with ionizing radiation or radiotherapy , if the area to be treated is far from the pelvis, can be performed by protecting the abdomen with a lead screen so that the x-rays do not affect the fetus. Each case must be individualized and multidisciplinary valued between oncologist, pediatrician, obstetrician and taking into account all medical considerations, but also ethical and psychological.

Does pregnancy influence the evolution of cancer?

It does not appear that pregnancy has an influence on the evolution of the cancer . It could be thought that if the female organism allows the growth of a genetically different individual within it, its immune system may also be more benevolent with the growth of tumor cells, which also present a genetic mutation with respect to the normal cells of the patient, but that it’s not like that.
The evolution of the different malignant neoplasms does not seem to differ in pregnant or non-pregnant patients. Neither does the tumor affect the growth or evolution of the fetus except in very rare cases, and most newborns do not present any pathology that can be related to the tumor cells with which they have lived during their intrauterine life (except for rare exceptions, especially melanoma during pregnancy, which has a certain incidence of metastasis in the fetus).

Planning a pregnancy after cancer

When planning a pregnancy after the woman has suffered from cancer, the premise must prevail that the woman should be advised not to become pregnant until 5 years have passed since the diagnosis and she is free of disease . Average period that is considered in most cancers to be considered “cured”, in order to be able to carry out the appropriate treatment of a possible recurrence.
In some cases this period can be reduced to two years. The specific case of breast cancer must be taken into account , since in many cases it is hormone dependent, a pregnancy can negatively influence the prognosis of the cancer, so it must be assessed individually.
Although the subject is tough, the message to be sent is that it is possible to cure cancer during pregnancy and that cancer during pregnancy does not imply termination of pregnancy and that advances in cancer treatment should make us optimistic about cancer cases during pregnancy.
What you should know…

  • In general, we should not associate that the diagnosis of cancer during pregnancy is equivalent to an interruption of pregnancy to carry out cancer treatment, since in many cases it can be compatible with pregnancy.
  • Treatment should be the one indicated according to the protocol for that specific pathology, without being modified by the fact of pregnancy.
  • The woman should be advised not to become pregnant until five years have passed since the diagnosis and she is free of disease, the average period for most cancers to be considered “cured”, in order to be able to carry out the adequate treatment of a possible recurrence.

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