Pregnancy is usually a time of joy and hope; the diagnosis of cancer can be devastating. When pregnancy and cancer occur at the same time, they present special challenges for patients and physicians. Fortunately, these challenges can usually be overcome by a multidisciplinary treatment approach.
“Cancer treatment is not incompatible with pregnancy,” said Dr. Andrea Milbourne, director of the Section of General Gynecology and assistant professor in the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center at the University of Texas. “The old idea that a pregnant patient has to choose between terminating the pregnancy and untreated is not true in most cases.”
Diagnosis and Evaluation
Dr. Theriault said the majority of pregnant patients suffering from breast cancer concurrently learn they are pregnant before receiving a diagnosis of cancer. Although women are sensitive to changes in your breasts during pregnancy and probably warn new packages, these packages are sometimes confused with clogged milk ducts or swelling, which may delay the correct diagnosis.
“The standard of care is the same for the pregnant woman for the woman who is not pregnant,” said Dr. Theriault. “Whenever there is an abnormality in the breast with a stay longer than 2 weeks, it is necessary to subject the patient to an imaging of some sort.” He said this usually includes diagnostic mammography and breast ultrasound. Although the radiation dose of mammography is negligible, usually a shield is provided to protect the fetus.
If the imaging indicates that a mass may be cancer, then a core needle biopsy is performed. If the initial ultrasound indicates that the lymph nodes are involved, a biopsy by fine needle aspiration of lymph nodes will also be held. Both procedures can be performed safely in pregnant women.
“In our population of pregnant women, between 65% and 70% had committed the lymph nodes at the time of diagnosis,” said Dr. Theriault. “If the lymph nodes are involved or if there is reason to suspect that metastasis, examine other organ systems that might also be involved-especially in women with symptoms such as back pain or stomach.”
Commonly areas where metastases develop breast cancer are the same in pregnant women than nonpregnant women: lungs, liver and bones. Chest radiography is used to review the metastasis of breast cancer in the lungs; As with mammography, this procedure does not expose the fetus to dangerous levels of radiation, and can provide protection. Ultrasound is used to check liver metastases. The imaging unenhanced MRI of the thoracic and lumbar vertebrae is used to check bone metastases. Dr. Theriault said been shown to accuracy of this imaging modality is equivalent to bone scintigraphy, which is avoided in pregnant women because irradiates the fetus.