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Cancer During Pregnancy

By Lara A. Friel, MD, PhD, Assistant Professor, Maternal-Fetal Medicine Division, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Medical School at Houston, McGovern Medical School

Because cancer tends to be life threatening and because delays in treatment may reduce the likelihood of successful treatment, cancer is usually treated the same way whether the woman is pregnant or not. Some of the usual treatments (surgery, chemotherapy drugs, and radiation therapy) may harm the fetus. Thus, some women may consider abortion. However, treatments can sometimes be timed so that risk to the fetus is reduced.

In some cancers, treatment may be modified during pregnancy.

Rectal cancer

Removal of the uterus (hysterectomy) may be required to be sure that all the cancer is removed. In such cases, cesarean delivery may be done as early as 28 weeks of pregnancy so that hysterectomy can be done and aggressive cancer treatment can be started.

Cervical cancer

If pregnant women have an abnormal Papanicolaou (Pap) test, doctors examine the cervix with a binocular magnifying lens (colposcopy) and take a sample of any abnormal tissue (biopsy). These procedures do not harm the fetus.

If cervical cancer is in a very early stage, treatment is usually postponed until after delivery. If more advanced cervical cancer is detected early in pregnancy, it is usually treated immediately as needed. If it is diagnosed late in pregnancy, doctors explain the risk of postponing treatment so that women can decide whether to postpone treatment until after the fetus is mature enough to be delivered. If cancer is advanced, cesarean delivery is done, followed by hysterectomy.

Other gynecologic cancers

Cancer of the ovaries is hard to detect during pregnancy. It may require immediate treatment (removal of both ovaries).

Cancer of the uterus (endometrial cancer) or fallopian tubes rarely occurs during pregnancy.

Breast cancer

Breast cancer is hard to detect during pregnancy because the breasts enlarge. If any lump is detected, doctors evaluate it.

Usually, breast cancer should be treated immediately.

Leukemia and Hodgkin lymphoma

Leukemia and Hodgkin lymphoma are uncommon during pregnancy. The anticancer drugs typically used to treat these cancers increase risk of miscarriage and birth defects.

Because leukemias can become fatal rapidly, women are treated as soon as possible, without waiting to allow the fetus to mature.

If Hodgkin lymphoma is present only in areas above the diaphragm (the muscle that separates the chest from the abdomen), radiation therapy may be used, and the abdomen is shielded to protect the fetus from radiation. If lymphoma is present in areas below the diaphragm, doctors may recommend abortion.