Cancer Diagnosis during Pregnancy: Here’s What You Should Know

Introduction

Cancer diagnosis during pregnancy is considered a rare event with different prevalence rates reported by different studies. The prevalence rate of cancer during pregnancy is 25–27 per 100,000 pregnancies and 17 per 100,000 live births. Cancer incidence during pregnancy is increasing due to postponing childbirth to a later stage.

Types of cancer during pregnancy

Pregnant women do not have an increased risk of cancer due to pregnancy. Breast cancer is the most common cancer diagnosed during pregnancy, affecting almost 1 in 3000 pregnant women. Other common cancers diagnosed during pregnancy are cervical cancer, ovarian cancer, thyroid cancer, Hodgkin lymphoma, colorectal cancer, melanoma, skin cancer, non-Hodgkin lymphoma, and leukemia.

Rarely, cancer may also develop due to molar pregnancies. It is a gestational trophoblastic disease involving abnormal uterine cell growth. Although the symptoms of molar pregnancy are similar to pregnancy symptoms, a fetus is not formed from molar pregnancy.

Delayed diagnosis

Physiological changes during pregnancy may overlap and mask the signs and symptoms of cancer. It results in delayed cancer diagnosis as the patient, and the caregivers consider cancer symptoms to be pregnancy. Even if the symptoms indicate the possibility of cancer, the healthcare providers do not immediately evaluate due to the potential risk of diagnostic techniques on the fetus. Further, even if the evaluation is performed, the risk of false negatives or misdiagnosis is high as pregnancy may interfere with the specificity of the diagnostic methods. If the woman has cancer symptoms, she should consult with the gynecologic oncologist in Nashik.

Diagnosis of cancer during pregnancy

Some of the techniques used for diagnosing cancer during pregnancy are:

• X-ray: During x-ray, low dose radiation is used to obtain images of the internal body organs. It has been found that the radiation dose during the x-rays does not harm the fetus. However, the woman should have a lead shield on the abdomen to protect the child whenever possible.
• CT scan: It involves using rotating x-ray machines and computers to obtain cross-sectional images. Chest and head CT scans are considered safe during pregnancy. However, the abdomen CT scan should only be done if the benefits exceed the risk. In any case, a lead shield should be used on the abdomen during a CT scan.
• Ultrasound: It involves using sound waves to create images of the internal organs. Ultrasound is considered safe during pregnancy.
• Magnetic resonance imaging: MRI uses the magnetic field and computer to create high-quality images of the internal organs. As it does not involve the use of ionizing radiations, it is considered safe during pregnancy.
• Biopsy: It is considered safe during pregnancy. During the procedure, the doctor obtains a sample of abnormal tissue and sends it to the laboratory for further examination.
• Other tests: The other tests may also diagnose the specific type of cancer. For instance, the Pap smear test may diagnose cervical cancer.

Treatment of cancer during pregnancy

Pregnant women diagnosed with cancer should receive the best gynecologic treatment in Nashik. Some of the treatment options available to oncologists in cancer during pregnancy are:

• Surgery: Several studies have indicated the safety of surgery and anesthesia in pregnant women. Though there is no increased risk of birth defects, a slight elevation in the risk of miscarriage is reported. Therapeutic surgery should be performed, if recommended, during pregnancy. However, aesthetic surgery may be delayed and can be done after the postpartum period.
• Radiation therapy: The doses used during radiotherapy are significantly higher than those used in diagnostic tests. It may harm the fetus. Thus, radiation therapy should be performed during pregnancy only if necessary and delaying it may lead to fatal consequences.
• Chemotherapy: The doctor during chemotherapy administers drugs that are toxic to cells. These drugs may cause miscarriage or birth defects, especially in the first trimester. Different drugs have different potentials to harm the fetus.
• Hormonal treatment: Endocrine treatment for cancer during pregnancy is contraindicated due to its potential to harm the fetus.
• Targeted therapy: Some drugs used in targeted therapy are safe to be administered in pregnant women. The oncologists should use the therapy after considering the benefits against the risks.

Effects of cancer on pregnancy

With the advancement in treatment options, there is no need to terminate the pregnancy in most cases. However, in some cases, women may be required to deliver the baby before completing the gestation period. The patient should follow the instructions of the oncologists and should not miss any follow-up visits.

Effects of cancer on lactation

It is not known how cancer affects the fetus. In rare cases, such as melanoma or leukemia, cancer may spread to the fetus. The doctor comprehensively examines the baby for any signs of cancer. The cancer treatment may also harm the fetus.

Delaying treatment

If possible, the doctor may advise the patient to delay the treatment until delivery. It may be the case when the cancer is diagnosed at a later stage of pregnancy or if the cancer is at an early stage. The doctor may also opt for early delivery if required.

Prognosis

Diagnosis of cancer during pregnancy has little or no effect on the overall prognosis compared to non-pregnant women. However, there may be an effect on the outcome due to delayed diagnosis or delayed treatment due to pregnancy.