Cancer Can Be Treated During PregnancyMay 31, 2012
When a pregnant woman is diagnosed with cancer, her treatment decisions are complicated by concern about how treatment may affect the baby’s health. Ideally, she can delay treatment until the baby is born, but sometimes a delay can allow the cancer to progress and make it harder to treat. The best time for beginning treatment to balance the baby’s and mother’s health needs isn’t always clear.
A series of articles published recently in The Lancet and The Lancet Oncology may make some of those treatment decisions easier. Teams of researchers from Belgium, France, and Israel found that many cases of cancer in pregnant women can be treated while the baby is carried to full term.
Chemotherapy appears safe after first trimester
One European study examined 70 children who had been exposed to chemotherapy during the second or third trimester. Researchers found that the children in the study seemed to develop just as well as children in the general population.
In fact, the researchers conclude that exposing the baby to chemotherapy in the second or third trimester may be preferable to delivering the baby early. Children who were born prematurely scored lower on IQ tests than children who were carried to full term. The researchers attribute this to the premature birth, and not the mothers’ cancer or treatment. Two-thirds of the children in the study were born early, at less than 37 weeks.
The researchers did not study chemotherapy during the first trimester, which is generally not recommended because of the risk of serious birth defects.
A separate Belgian review of breast cancer in pregnancy also concludes that delivering the baby early should be avoided if possible, and that treatment should generally be similar to that used in women who are not pregnant. But radiation is risky for the baby, and its use should be determined on an individual basis. The researchers say pregnant breast cancer patients should take the time to consult with a team of experts about the best course of treatment.
Differences among cancer types
Other reviews in the series focus on gynecological cancers and blood cancers during pregnancy.
French researchers state that as many as 1 in 1,000 pregnancies is accompanied by cancer. They say the most common types of cancer diagnosed during pregnancy are cervical cancer, breast cancer, skin cancer, leukemia, and lymphoma. They conclude that a full-term pregnancy can be the goal in most cases.
In looking at gynecological cancers, these researchers conclude that pregnancy should be preserved in patients with cervical or ovarian cancer whenever feasible. Using chemotherapy after the first trimester does not seem to harm the baby, and can help increase the chances of a healthy baby by allowing the pregnancy to continue closer to full term.
In a separate review of blood cancers during pregnancy, researchers from Israel note that Hodgkin lymphoma, non-Hodgkin lymphoma, and acute leukemia – while rare – are the most common types of blood cancer to be diagnosed in pregnant women. The researchers say these are some of the most challenging types of cancer to treat during pregnancy. A diagnosis of leukemia or lymphoma during the first trimester is the most complicated scenario because delaying treatment in these cases may be too risky for the mother, and ending the pregnancy may be needed to save the mother’s life. Chemotherapy and targeted therapies for these kinds of cancer are not safe for the baby in the first trimester. The researchers note it may be possible to treat the mother if the cancer is first diagnosed when the pregnancy is further along, but more studies need to be done to determine whether it’s safe.
Expertise is key
Regardless of the cancer type, cancer during pregnancy can be a complex situation on many levels. It may not always be a medical emergency that requires treating the cancer right away, but each case is unique. What’s most important is having a team of experts who are experienced in dealing with the many different aspects of cancer during pregnancy. This team can help make sure the mother is fully aware of her options, including their possible risks and benefits, so that she can make an informed decision about treatment.
Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study. Published online February 10, 2012 in The Lancet Oncology. First author: Frédéric Amant, PhD, Leuven Cancer Institute, Katholieke Universiteit Leuven, Belgium.
Gynaecological cancers in pregnancy. Published in the February 11, 2012 issue of The Lancet (Vol. 379). First author: Philippe Morice, MD, Institut Gustave Roussy, Villejuif, France.
Breast cancer in pregnancy. Published in the February 11, 2012 issue of The Lancet (Vol. 379). First author: Frédéric Amant, PhD, Leuven Cancer Institute, Katholieke Universiteit Leuven, Belgium.
Haematological cancers in pregnancy. Published in the February 11, 2012 issue of The Lancet (Vol. 379). First author: Benjamin Brenner, MD, Rambam Health Care Campus, Haifa, Israel.