Pregnancy and Cancer

Abstract

Cancer is the second most common cause of death in women of reproductive age, with the incidence of cancer in pregnancy ranging from 0.07 to 0.1% [1]. As cancer therapy is becoming more efficacious and women are waiting later to begin childbearing, cancer in pregnancy as well as pregnancy in cancer survivors are both increasing in prevalence. With the increasing survival of cancer patients, issues regarding the quality of life in cancer survivors are becoming progressively more important. Unfortunately, many of the successful treatment options for cancer lead to infertility. In a time of tragedy, while facing the new diagnosis of cancer, it is very difficult for patients to think about the implications of their therapies. As a healthcare provider, one must weigh a variety of considerations in such circumstances including but not limited to the clinical, biological, ethical, legal and psychosocial issues surrounding cancer and pregnancy.

My partner and I agreed we wanted a big family so as soon as we agreed we were going to be a couple we wanted to get started on that family. I was thrilled when I got pregnant right away and relieved that the morning sickness wasn’t too bad. Except for the odd looking mole I had developed on my growing belly, I felt great and people told me I looked healthy. My OB/GYN said the mole was probably nothing but suggested I see a dermatologist. I made the appointment more out of vanity than real concern and so it didn’t occur to me to bring anyone with me to the dermatologist. My partner and my sister had come to every OB/GYN apt with me but I thought I was going to just run in for a quick appointment and the doctor would tell me this mole would go away after pregnancy. But, it didn’t happen that way. I was by myself when the dermatologist told me she was concerned and suspected melanoma. My head was spinning as I thought about who to call first – my sister? My partner? My OB-GYN? A priest? So I just sat there in the office not calling anyone and rationalized to myself that everything was fine and there must be a mistake. Hours later I was on the Internet trying to find out what the odds were of getting cancer while pregnant. Whatever those odds were, they had found me. A week later it was confirmed – I had advanced melanoma and I was 5 months pregnant.

I was told I could have surgery right away with no harm to my baby, but the additional treatment I was likely to need could not be administered safely while I was pregnant. My doctor said my chances of long-term survival would be significantly improved if I had chemo right away, but I couldn’t do it while I was pregnant. My sister said she just wanted me alive – whatever it took. My partner said he didn’t even see what the quandary was because if I didn’t survive there would be no baby and no mother to raise the baby.

I wanted this baby as much as I wanted to live, and I didn’t want one more or less than the other. I asked my sister if she would promise to raise this baby if anything happened to me and although she said she couldn’t bear to think about it, she agreed. That was the tipping point for me. I decided to eschew the medical advice and go on with the pregnancy and delay treatment.

My son was born healthy 3 months later although I eventually agreed to an early inducement so I could begin treatment. My partner thought I was crazy and ended our relationship but I am hopeful he will continue to see his son. I have good days and bad days now. The treatment has been exhausting and my oncologist says he is not seeing the progress he had hoped. I don’t regret my decision. Today my son took his first steps and that was such a joy to witness. Will I be here to see him run or go to school or learn to drive? I don’t know, and really none of us knows. I may die tomorrow from cancer and you may die in a car accident. What matters is today and for today, my son smiling and laughing and learning how to walk. I just take it one day at a time.

Debbie, Adult Cancer Patient