Cancer treatment safe during pregnancy

Cancer patients who are pregnant often face pressure to end their pregnancy early, but this may not be necessary. Elyce Cardonick, a maternal fetal medicine physician and founder of the Cancer and Pregnancy Registry, has seen this firsthand. Early in her career, she met two pregnant women with ovarian cancer, one of whom was expecting twins.

These women were introduced to each other as a support network during and after their pregnancies. The mother of twins is still alive today, while the other woman did not survive beyond her child’s second birthday. When Cardonick spoke with the surviving woman, she was distraught about her friend’s death, and Cardonick thought that the difference in their treatment may have been a factor.

The woman who lived was treated as if she were not pregnant, undergoing a CT scan and workup of her ovarian cyst, and even receiving chemotherapy while pregnant. Her twins are now 28 years old, and all are thriving.

Treatment During Pregnancy

In contrast, the woman who died had her treatment delayed until her third trimester. Cardonick believes that earlier treatment could have made a difference in her case. Patients diagnosed with cancer are often advised to terminate their pregnancies without discussing the option of treating cancer during pregnancy.

This is despite the fact that chemotherapy can be safely administered during pregnancy, and the infant can be delivered at term. Cardonick recalls a patient diagnosed with Hodgkin lymphoma during pregnancy, who was told by another physician to terminate her pregnancy because she already had two kids.

However, research has shown that pregnant women with cancer have similar survival rates to non-pregnant women with the same cancer. There is no evidence to suggest that ending a pregnancy improves the mother’s outcome. In fact, children exposed to chemotherapy during pregnancy perform as well on standardized tests as unexposed children.

As Cardonick notes, giving chemotherapy to a woman during pregnancy may seem dangerous, but the research backs up this approach. The key is to balance the risks and benefits of treatment, rather than delaying or withholding treatment altogether. Cardonick has worked to develop guidelines for physicians to handle this medical dilemma, including the safety of performing MRIs and CT scans during pregnancy.

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The Cancer and Pregnancy Registry has collected data on over 650 cases, and Cardonick continues to ask the same questions she asked when she first encountered a pregnant cancer patient: how would the cancer be treated if the patient were not pregnant, and how long can treatment be safely delayed without compromising the prognosis.

Cardonick has worked with the Society of Maternal Fetal Medicine and the American Society of Clinical Oncology to publish guidelines to help other physicians handle this medical dilemma. These guidelines address avoiding delays in pregnant women and discuss the safety of performing MRIs without contrast and CT scans with contrast. They also discuss performing necessary surgeries at any gestational age in pregnancy when this would be the clinical solution if the patient were not pregnant. And they lay out how to give chemotherapy during the second and third trimesters and time treatment for safe delivery for mother and child.

Supporting Mothers and Babies

The Cancer and Pregnancy Registry has collected data on over 650 cases, and this research has helped to inform the development of guidelines and best practices for treating cancer during pregnancy.

One of the main challenges in treating cancer during pregnancy is the delay in diagnosis. Cancer is often diagnosed later in pregnant women, partly due to common symptoms between certain types of cancer and pregnancy.

Delayed Diagnosis

The reluctance to perform imaging during pregnancy can also delay biopsies and management. This is a complex issue, and one that Cardonick has grappled with throughout her career. By pooling data from scattered cases into a central database, Cardonick has been able to track the outcomes of women and their babies, and to identify areas for improvement.

No options in such cases are without risk: an elective preterm birth to avoid cancer treatment, delaying cancer treatment until after delivery, or starting chemotherapy during pregnancy so the fetus can develop longer in utero and reach term. As any treatment in medicine, it is a balance between risks and benefits.

She has spent nearly three decades caring for women diagnosed with cancer during pregnancy and advocating for mothers and their babies.