By: Maayan S. Heller for Fibroids1
Only until very recently, pregnant women diagnosed with cancer faced a grim choice: Abort their babies or risk their lives.
Most women confronted with this scenario were advised to end their pregnancies or else be forced to delay treatment for months, possibly at the expense of their own survival. But new research seems to have found a third possibility for parents-to-be facing this ominous and unbelievable reality that could save both mother and child.
|Be sure to have the appropriate cancer screening tests:|
Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.
Clinical breast exams should be part of a periodic health exam, about every three years for women in their 20s and 30s and every year for women 40 and over.
All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test.
The American Cancer Society recommends that all women should be informed about the risks and symptoms of endometrial cancer, and strongly encouraged to report any unexpected bleeding or spotting to their doctors. For women with or at high risk for hereditary nonpolyposis colon cancer (HNPCC), annual screening should be offered for endometrial cancer with endometrial biopsy beginning at age 35.
Nevertheless, it’s not that simple and the subject remains both sensitive and complicated, because many elements are in the balance, and especially because two lives are in jeopardy.
Cancer for expectant mothers is actually reasonably uncommon, according to Living With Cancer (a web site of the American Society for Clinical Oncology), occurring only in about one of every 1,000 pregnancies. Furthermore, the cancers that tend to occur during pregnancy are those that are more common in younger people, such as breast cancer, cervical cancer, Hodgkins lymphoma, thyroid cancer and malignant melanoma.
However, since age is the biggest risk factor for cancer, and more women are waiting longer to have children, many doctors expect the rate of cancer during pregnancy to rise.
Early detection of cancer in pregnant women has historically been challenging, because many of the first signs of cancer, such as abdominal bloating, frequent headaches or rectal bleeding are also common symptoms in early pregnancy, at which point they would not be cause for suspicion. Unfortunately, the similarity of the symptoms often results in delayed diagnosis.
With breast cancer, changes in breast size and sensation associated with pregnancy make it particularly hard to detect tumors. Plus, mammograms are not routine during pregnancy.
In fact, common diagnostic tests and treatments – like mammograms, x-rays and chemotherapy – have been traditionally avoided altogether during pregnancy, since most doctors are reluctant to order them for fear of harming the baby.
Though the cancer itself will not generally affect the fetus (though any condition weakening a mother’s immune system can influence the baby), many professionals emphasize that treatments and diagnostics can have an effect on the fetus.
Factors such as the fetus’ gestational age can contribute to the extent of the effects, but each case will be different. Higher doses of radiation can also potentially lead to miscarriage, stillbirth, birth defects or cancer later in life. So the survival of the mother has conventionally been the top priority.
Doctors at the University of Texas M.D. Anderson Cancer Center recently completed a 15-year research study on treatment of pregnant women with breast cancer. The study, which will be published later this year, focused on breast cancer because it is the most common cancer in pregnant women, affecting approximately one in 3,000 pregnancies.
“The first thing that has been recommended to them is that they terminate the pregnancy,” Dr. Richard L. Theriault, one of the lead researchers in the study acknowledged in the January, 2004 issue of OncoLog, the hospital’s published report to physicians.
As Monique Webb, an expectant mother – and now a patient at M.D. Anderson – told People Magazine in the October 10, 2005 issue: “My [first] doctor’s basic message was that my health was more important.”
Dr. Theriault’s colleague and another lead researcher in the study, Dr. Karin Gwyn, added that depending on both the stage of the cancer and a woman’s medical health, ending the pregnancy may be the most appropriate option – “but it is not always necessary,” she said.
According to their findings, women can undergo biopsies and even be treated with chemotherapy during pregnancy. In fact, many of their patients were given multiple courses of chemo and still successfully carried their babies to term.
These women technically have a choice, but for many the maternal instinct makes it impossible to pick herself over her child.
Lisa Landrum, an M.D. Anderson patient who was treated and gave birth to a healthy boy, said that for her, there wouldn’t have been any options. “I’ve lived 38 years,” she told People, “but this baby hasn’t even had a chance to live at all.”
Another M.D. Anderson success, Jennifer Finder, 33, told People that though she chose to be treated, she still felt as though she were “walking a tightrope” between life and death, and that she constantly worried about the baby’s survival.
This study clearly offers a new option for parents confronting these most difficult circumstances as well as for the medical professionals who advise and treat them.
Of the 57 births during the course of the study, only one baby suffered from a genetic disorder, Down’s syndrome, which the doctors feel was unconnected to the chemo.
That is hope.
Where once there was little research to guide patients and doctors, there are now strong signs that in certain cases a pregnant woman with cancer can safely go through treatment and give birth to a healthy baby.