Pregnancy and Cancer

Part 1 of 2

When a pregnant woman is diagnosed with cancer, her 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.

Diagnosis

Cancer during pregnancy is rare, occurring in approximately one out of every 1,000 pregnancies, and little research is available to guide women and doctors.  Breast cancer is the most common cancer in pregnant women; affecting approximately one in 3,500 pregnancies. The other common cancers in pregnancy are cervical cancer, lymphoma, and melanoma. A pregnant woman with cancer is capable of giving birth to a healthy baby, and some cancer treatments are safe during pregnancy. Cancer rarely affects the fetus directly.

If cancer is suspected during pregnancy, women may be concerned about diagnostic tests such as x-rays. However, research has shown that the level of radiation in diagnostic x-rays is too low to harm the fetus. When possible, women may use a lead shield that covers the abdomen for extra protection. Other diagnostic tests, such as magnetic resonance imaging (MRI), ultrasound, and biopsy, are also considered safe during pregnancy because they don’t use ionizing radiation.

Some diagnostic tests use liquid radioactive iodine to help stage cancer (figure out whether the cancer has spread to other parts of the body). Radioactive iodine cannot be used during pregnancy because it can damage or destroy the fetus’ thyroid gland.

Treatment

When making treatment decisions for cancer during pregnancy, the doctor considers the best treatment options for the mother and the possible risks to the fetus.

The type of treatment given will depend on the following:

  • The trimester of your pregnancy
  • The type, location, size and stage of the cancer
  • What the woman prefers

Because some cancer treatments can harm the fetus, especially during the first trimester (the first three months of pregnancy), treatment may be delayed until the second or third trimesters. When cancer is diagnosed later in pregnancy, doctors may wait to start treatment until after the baby is born, or they may consider inducing labor early.

Some cancer treatments may be used during pregnancy but only after careful consideration to optimize the safety of the mother and the unborn baby. These include surgery and chemotherapy.  Radiation is generally not utilized during pregnancy.  After evaluation your doctor will develop a treatment plan based on individual circumstances.

Read part 2.

Resources

U-M Women’s Health

American Cancer Society: Gestational Trophoblastic Disease

 

Understanding Childhood Cancers and How Genetics Could be Involved

Due to advances in research and collaborative studies, the National Cancer Institute reports that the long-term survival for children with cancer has increased from less than 10% to almost 80% in the past 50 years.

In general, cancer in children and adolescents is rare, with particular cancers occurring more often:

  • leukemia
  • lymphoma
  • brain and central nervous system tumor
  • tumors of developing tissues such as neuroblastoma, bone and soft tissue sarcomas
  • other cancers

While most cancers in children occur by chance, a small portion can be linked to an inherited genetic syndrome. One study of 1,100 pediatric cancer patients evaluated by genetic specialists confirmed an inherited cancer susceptibility syndrome in 3.9% and a suspected syndrome in another 3.3%*.

Though your child may already be seeing a number of specialists, referral to a geneticist or a genetic counselor can be another important piece which may provide a better understanding of why your child developed cancer and what this diagnosis means for siblings and other family members.

If other family members have been diagnosed with cancers, this could indicate an inherited syndrome that increases risks for cancer. Some of the pediatric cancers that may suggest an inherited predisposition to cancer and warrant a referral to a genetics clinic include:

  • medullary thyroid cancer
  • adrenal cortical carcinoma
  • retinoblastoma
  • sarcoma

Physicians and genetic counselors in the Cancer Genetics Clinic at the University of Michigan meet with patients and families to review your family history and determine if genetic testing may help clarify risks for additional cancers in the family. Targeted screenings and other risk reduction efforts can be taken in an effort to prevent cancer in the future.  The Cancer Genetics Clinic welcomes patients of all ages who may have questions about the risk of a genetic predisposition in their family.

Continue learning about cancer and genetic risk

*(Merks et al, Am J Med Genet. 2005 Apr 15; 134A(2):132-43)

Leukemia and Lymphoma – The “Liquid Tumors”

Health professionals often refer to leukemia and lymphoma as “liquid tumors”.   Also called blood cancers, these cancers can affect the bone marrow, the blood cells and the lymphatic system.

Every 4 minutes, 1 person in the United States is diagnosed with a blood cancer, according to the Leukemia and Lymphoma Society.   Leukemia and lymphoma are often grouped together and considered related cancers because they probably all result from acquired mutations to the DNA of a single lymph- or blood-forming stem cell.

Continue reading

U-M Experts Featured On PBS

Guest blogger Betsy de Parry posts today about how she came to produce a weekly PBS television segment that regularly features experts from the University of Michigan Comprehensive Cancer Center. Watch the show, A Wider World, tonight at 5:30 p.m., on WTVS in Detroit.

Guest blogger Betsy de Parry

Guest blogger Betsy de Parry

By Betsy de Parry

 

When I was diagnosed with non-Hodgkin lymphoma nearly 10 years ago and successfully treated at University of Michigan Comprehensive Cancer Center,  I could never have dreamed that I would have the chance to produce reports about cancer for a PBS show.

The opportunity came as a complete surprise early this year when Peggy Shriver, executive director of the Michigan Chapter of the Leukemia and Lymphoma Society, introduced me to Elizabeth Kelly, executive producer of the half-hour weekly PBS show A Wider World. On the air since 2000, A Wider World has been the only regularly scheduled TV show about disabilities, but its focus is on abilities. Each week, the show introduces viewers to others who have overcome obstacles and misconceptions and delivers information designed to improve the lives of those who face challenges.

Elizabeth wanted to devote a part of each show to those facing cancer. Would I be willing, she asked, to produce them?  I was not only willing, but eager!

To determine what people most wanted to know, I created a survey with two dozen potential topics and asked people in a couple of online support groups to answer. The response was overwhelming.  Respondents wanted to learn more about everything from survivorship to pathology, medical imaging to pain management, clinical trials to parenting and children’s issues.

There was no question about whom I would ask to address the topics: experts at my “cancer alma mater.” I wanted to give viewers a glimpse of what I know so well: that U- M is truly extraordinary, made so by dedicated, remarkable people. Continue reading

After cancer diagnosis, U-M doctor gains new understanding for patients


Samuel Silver, M.D., Ph.D., a professor of internal medicine and an oncologist at the University of Michigan Comprehensive Cancer Center, talks about his bout with lymphoma and how it changed his understanding for patients with new cancer diagnoses. The video was produced by the National Comprehensive Cancer Network, a consortium of 21 leading cancer institutes dedicated to improving the quality and effectiveness of care provided to patients with cancer. The U-M Comprehensive Cancer Center is a founding member of the NCCN.