Rarely, a young woman is diagnosed with cancer during her pregnancy. The increase in cancer cases requires women to take precautions. Especially the mothers who have cancer patients in their family history can have a more peaceful pregnancy by having their controls done during the period they are planning pregnancy. Medical Oncology and Internal Medicine Specialist from Anadolu Medical Center Dr. Dr. Haluk Onat and Gynecology and Obstetrics Specialist Assoc. Dr. Contact Fatih directlyanswered our questions about cancer treatment during pregnancy.
What types of cancer are most common during pregnancy?
The probability of cancer in a woman of conception age varies from one to three thousand to one in ten thousand. Breast cancer is most common in pregnancy. Then comes lymph cancer, blood cancers, cervical cancer and thyroid cancers. Gastric, intestinal and lung cancers that are common in the society are rare in pregnancy because they are cancers of older ages.
Does the type of cancer make a risk difference to the health of the mother and the baby?
No, but the decision is whether the pregnancy can continue and when the treatment can be done. In terms of the course of these types of cancer, there is no difference between pregnant women and non-pregnant women, ie pregnancy does not add to the course of the disease. Malignant melanoma, which is not included in the frequency list, that is, skin cancer, is progressing unfortunately during pregnancy. Pregnancy accelerates the development of this cancer which occurs in the form of cancer of the moles on the skin. In skin cancer, pregnancy should be terminated if possible, and treatment should be started immediately in the later stages of pregnancy.
What diagnostic methods can be used when cancer is suspected?
Ultrasonography, which is the least harmful method in breast cancer, is not always sufficient. If necessary, mammography and limited MRI can also be used. Computed tomography (CT), nuclear bone scintigraphy and PET CT are the methods that are strictly avoided during pregnancy. However, since these diagnostic methods are not used, it may be difficult to understand the prevalence. Biopsy to make a definite diagnosis is no problem.
When can cancer be treated in a pregnant woman?
When deciding the treatment, the diagnosis, stage and stage of pregnancy are important. According to this information, it is decided whether pregnancy should be terminated. Drug treatment cannot be applied to the mother in the first trimester of pregnancy. Because these drugs can cause anomalies in the baby. Drug treatment can be performed after the first trimester of pregnancy. Drug treatment during pregnancy increases the possibility of preterm birth and low-weight birth. It is necessary to know these risks and take precautions and to plan the birth accordingly.
Are there any situations where pregnancy should be terminated?
If the disease is encountered in the first three months, it is necessary to decide whether the pregnancy will continue. This decision is made with the family. Pregnancy can continue in early cancers. However, in cases of blood cancer, lymph cancer (Hodgkin's disease and lymphoma) or the disease is common, pregnancy must be terminated and treatment should begin immediately.
If possible, radiotherapy is not applied at all during pregnancy or under special conditions during pregnancy. In addition, breast cancer in the early stage of the disease is usually caught in the protection of the breast is preferred. However, since radiotherapy is required after breast-conserving surgery, this becomes an impractical option and it is necessary to remove the breast completely. If the diagnosis is made in the first or second trimester of pregnancy, treatment starts while the pregnancy continues. Surgical treatment can also be applied during thyroid cancer.
Is it possible for a mother who is being treated for cancer to breastfeed?
If the cancer drug treatment continues, it is not possible for the mother to breastfeed her baby.
Which examinations do you recommend for expectant mothers before pregnancy?
Women who are at risk for familial breast cancer should start screening for breast cancer 10 years before the youngest breast cancer in the family. In addition, all women, with or without familial risk, need to perform breast examinations themselves after menstruation. Women aged 35 and older should also undergo breast examination, breast ultrasound and, if necessary, mammography by a specialist physician. Among gynecological cancers during pregnancy, cervical cancer is the most common, and secondly, ovarian tumors. Pregnancy smear test and gynecological examination are required for screening cervical cancer and precursor lesions of this cancer. If a serious lesion is observed during the examination, it is possible to perform a biopsy immediately. Gynecological examination and ultrasonography for the diagnosis of ovarian tumors is also important.
What needs to be paid attention during pregnancy?
Because of the hormonal changes experienced during pregnancy, breast tissue is handled differently in breast examination. If necessary, breast ultrasonography or even mammography or breast MRI can be performed in patients with advanced clinical suspicion. If smear test has not been performed in the last year before pregnancy, smear test should be taken within the first three months of pregnancy. It is important not to forget the possibility of a cancer that may have settled in the cervix during the bleeding during pregnancy. During pregnancy examinations, especially during the first three months, ovaries should be evaluated. Because in later periods, due to the growth of pregnancy ovaries may not be difficult or possible to evaluate.
Which expectant mothers should be more careful?
We recommend smear test to all mothers before pregnancy. Every woman needs to know and do breast self-examination.