Cancer During Pregnancy: Rare But Increasingly Prevalent
Kerry was diagnosed with breast cancer while pregnant at 18 weeks; Trish, with Hodgkin lymphoma at 32 weeks; and Mara, a second breast cancer at 12 weeks.
Kerry and Mara delivered healthy daughters, and Trish, a son. Their stories, highlighted on the website Hope for Two…The Pregnant with Cancer Network, Amherst, NY, tell of the shock of learning about their cancer, the fear for their unborn babies while undergoing treatment, and their delight, years later, in being able to watch their children thrive.
The chance of being diagnosed with cancer while pregnant is rare: approximately one in 1,000. Breast cancer is the most common diagnosis, seen in approximately one in 3,000 pregnancies.1
However, cancers that occur more often in younger people are those that also tend to occur during pregnancy; these include cervical and thyroid cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, and melanoma. Gestational trophoblastic tumor, albeit rare, may also be diagnosed.1 In addition, many women are becoming pregnant at older ages, and as a result, cancer incidence during pregnancy is increasing.2
One of the challenges in treating women who are diagnosed with cancer during pregnancy is its rarity. In fact, “few oncologists or obstetricians treat more than two or three patients in this situation in an entire career,” according to the Cooper University Health Care website.
To address this dearth of information, Elyce Cardonick, MD, an Ob/Gyn maternal-fetal medicine specialist at Cooper University Health Care, Camden, NJ, who is on the Hope for Two advisory board, maintains the Cancer and Pregnancy Registry, a database of all pregnant women diagnosed with cancer, which follows their children not only until birth, but ongoing annually.
“Pregnant women diagnosed with cancer find the registry helpful in learning how many other pregnant women were diagnosed and treated for the same cancer during pregnancy,” Cooper noted.
That is also the rationale behind Hope for Two, which is “dedicated to providing women diagnosed with cancer while pregnant with information, support, and hope.” The organization was founded in 1997 by three women who were diagnosed and treated for cancer while pregnant. To date, Hope for Two has counseled and supported, worldwide, more than 950 women in this predicament.
While 70% of these women have received a diagnosis of breast cancer, 28 types of cancer are represented. “Women find it important to speak with another woman who has had the same type of cancer and stage; Hope for Two provides that support,” they note.3
Interpreting the Signs of Cancer Through Pregnancy
Cancer during pregnancy may confound initial diagnosis. Many symptoms of cancer—abdominal bloating, frequent headaches, rectal bleeding—are common during pregnancy and may elude suspicion. Pregnant women with breast cancer are often diagnosed 2 to 6 months later than nonpregnant women due to enlarged breasts (making it difficult to detect small tumors) and avoidance of mammograms during pregnancy.
In some cases, routine tests or examinations conducted during a pregnancy will reveal an underlying cancer, such as cervical or ovarian. Diagnostic x-rays and CT scans are considered safe during pregnancy, with the exception of the abdomen or pelvis, which should only be radiated if necessary. MRIs, ultrasound, and biopsies are also deemed safe during pregnancy.1