Procedures that may harm the fetus may be postponed till after delivery if the cancer is detected at an early stage

Receiving a cancer diagnosis during pregnancy can be devastating. While it’s a rare occurrence, it does lead to added fear — there’s not just one, but two lives at stake. What follows is a challenging treatment cycle, where oncologists and obstetricians need to collaborate to treat the mother while protecting fetal development.

Despite a cancer diagnosis, one can have a safe and healthy pregnancy through careful planning and monitoring. Experts share some success stories where women had safe pregnancies and gave birth to healthy babies without complications.

Cancer treatment during pregnancy
The stage at which the cancer is detected determines its treatment during pregnancy. Dr Yugandhar Reddy, senior surgical oncologist, CARE Hospitals, Hitech City, Hyderabad, explains that in advanced stages, immediate intervention is required. “However, if cancer treatment is paused, the disease may progress from an earlier stage to an advanced one. This makes treating it difficult,” he says. At the same time, he explains that certain treatments, like chemotherapy, are delayed until delivery. Post childbirth, when the new mother starts a cancer treatment regimen like chemotherapy or radiation therapy, doctors usually advise against breastfeeding.

Some experts suggest hormonal therapy instead of chemotherapy during pregnancy to treat cancer. Reddy also stresses that if the cancer is aggressive, the mother may be advised to terminate the pregnancy.

Monitoring pregnancy in a mom with cancer
Many factors influence the management of cancer diagnosed during pregnancy, including its type, stage at diagnosis and the gestational age of the fetus. “After the mother delivers the baby, we continue the treatment. Else, radiation used can cross the placenta and hinder the development of the fetus,” says Dr Vidya V Bhat, obstetrician and gynaecologist, medical director, Radhakrishna Multispeciality Hospital, Bangalore. She adds that typically, mothers are not treated in the first trimester, and in the second and third trimesters, treatment is delayed if needed.

Dr Vidya recalls the case of a 32-year-old woman from Bangalore who was diagnosed with stage 1 breast cancer in her 12th week of pregnancy after discovering a lump on her breast. “We opted for an MRI rather than CT scans or mammograms, which could harm the fetus. She underwent a lumpectomy [surgical removal of the lump] during her 20th week of gestation to remove the tumour while preserving as much healthy breast tissue as possible,” she recalls. She adds that following this, chemotherapy, radiotherapy and hormonal therapy were pushed to minimize fetal development risks, chemotherapy, radiotherapy and hormonal therapy during pregnancy. “After the delivery, the woman underwent a PET scan, mammography and comprehensive evaluation to determine if the cancer had spread. She was later put on chemotherapy and radiation therapy,” she says.

Similarly, Dr Reddy recalls the case of a 29-year-old woman with a history of severe postcoital bleeding (bleeding during intercourse). “It turned out to be a case of stage 1 cervical cancer. To preserve her fertility, she underwent trachelectomy, where a portion of her cervix containing the cancerous lesion was removed, and a stitch was placed to support the remaining cervix,” he explained. After six months of close monitoring for recurrence, she was able to conceive and deliver a healthy child.

Conceiving when you have cancer: A careful approach
Dr Usha BR, consultant, obstetrics and gynecology, Fortis Hospital, Bangalore, recalls the case of a newly married woman who was planning to conceive a child in 2023. “The 28-year-old had discovered a lump in her breast in August 2022. She underwent a biopsy that showed the lump was malignant; however, a second biopsy confirmed that she had stage 1 breast cancer,” she explains.

The tissue cell was tested for hormone receptors, which is a norm in breast cancer screening. It was found to be ER/PR positive. This means the cancer cells contain receptors of estrogen (ER) and progesterone (PR), highlighting that these hormones can further aggravate cancer growth. “The ER/PR positive cancer aggravated the risk, as it could increase hormone levels during the pregnancy. There was also a chance of recurrence. Hence, this needed careful monitoring,” explains Dr Usha.

The woman eventually underwent a unilateral mastectomy, chemotherapy, and Tamoxifen hormone therapy, a treatment form used for breast cancer. “By blocking estrogen from binding to the receptors, this drug curbs cancer cell growth and recurrence,” she says.

The Tamoxifen hormone treatment was paused for the 28-year-old to conceive. However, the woman had trouble conceiving even after several months. This was a result of the side effects of chemotherapy and the temporary disruption of her hormonal balance after stopping the drug. “Her fertility expert advised her to undergo natural cycle monitoring and track her ovulation without heavy hormonal stimulation, along with oral ovulation inducers,” Dr Usha says. With this assistance, she was able to conceive in a few months. In October 2024, she gave birth via normal delivery after a closely monitored pregnancy.

Preserving fertility for the future
Cancer treatment may affect women’s ovarian reserves, making conception harder. In such cases, experts recommend fertility preservation before treating the cancer. Fertility preservation is generally advised for women with genital cancers, such as endometrial, cervical and ovarian cancer.

In this regard, Dr Vidya explains the Shanghai Protocol. “Approximately six weeks after delivery, the mother undergoes hormonal stimulation. This allows her eggs to mature during her monthly menstrual cycle. We use two methods of egg retrieval in the same menstrual cycle to collect as many eggs as possible. These can be cryopreserved [frozen and preserved at low temperatures] for future pregnancies,” she explains.

Takeaways
Factors like the type of cancer, the stage and the gestational period are considered while treating cancer during a pregnancy. While treatment can be delayed when cancer is picked up at an early stage, the mother may have to terminate the pregnancy if the cancer is aggressive or at a late stage. Experts suggest that mothers, especially those battling genital cancer, can undergo fertility preservation for future pregnancies.