Pregnancy & Maternity
Cancer during pregnancy is rare, but it does happen. The most common cancers in pregnancy are breast cancer, cervical cancer, lymphoma, and melanoma. Cancer itself rarely harms the baby, and some cancer treatments are safe during pregnancy. You and your health care provider will work together to find the best treatment. Your options will depend on how far along the pregnancy is, as well as the type, size, and stage of your cancer.
A pregnant woman with cancer is capable of giving birth to a healthy baby and some cancer treatments are safe during pregnancy.
Pregnancy does not increase the risk to develop a cancer. Breast cancer is the most common cancer in pregnant women.
Diagnosis
Being pregnant can delay a cancer diagnosis. Symptoms such as abdominal bloating, frequent headaches, or rectal bleeding might suggest ovarian, brain, or colon cancer. These symptoms are also common during pregnancy and are not considered suspicious. If these symptoms are related to cancer, diagnosis of the cancer is likely to be delayed.
Breast cancer is the most common cancer in pregnant women, affecting approximately one in 3,000 pregnancies. Pregnancy-related breast enlargement makes it difficult to detect small breast tumors, and mammograms are not regularly done during pregnancy.
If cancer is suspected during pregnancy, women and their doctors may be concerned about diagnostic tests such as x-rays. However, research has shown that the level of radiation in diagnostic x-rays is too low to harm the fetus (unborn baby). When possible, a lead shield covering the abdomen offers extra protection. Other diagnostic tests, such as magnetic resonance imaging test (MRI), ultrasound, and biopsy, are also considered safe during pregnancy because they do not use radiation.
Sometimes, pregnancy can uncover cancer that had previously gone undetected. For example, a Pap test performed as part of standard, early prenatal care can detect cervical cancer. Similarly, an ultrasound performed during pregnancy can often find ovarian cancer that might otherwise go undiagnosed.
Treatment
Treatment for cancer during pregnancy means balancing the best treatment for the mother with the possible risk to the fetus. The type of treatment given depends on many factors, including how far along the pregnancy is; the type, location, size, and stage of the cancer; and the wishes of the expectant mother and family. Because some cancer treatments can harm the fetus, especially during the first trimester (the first three months of pregnancy), treatment may be delayed until the second or third trimesters. When cancer is diagnosed later in pregnancy, doctors may wait to start treatment until after the baby is born, or they may consider inducing labor early. In some cases, such as early stage (stage 0 or IA) cervical cancer, doctors may wait to treat the cancer until after delivery.
Cancer treatments used during pregnancy may include surgery, chemotherapy, and possibly, radiation therapy, but only after careful consideration and treatment planning to optimize the safety of the mother and the unborn baby.
Breastfeeding
Although cancer cells cannot pass to the infant through breast milk, women who are being treated for cancer are generally advised not to breastfeed. Chemotherapy can be especially dangerous as it can build up in breast milk and harm the infant. Similarly, radioactive components that are taken internally, such as radioactive iodine used in treating thyroid cancer, also cross into breast milk and can harm the infant.
Elders – Oncogeriatry
Age is a risk factor for cancer due to the duration of carcinogenesis, the vulnerability of aging tissues to environmental carcinogens, and other bodily changes that favor the development and the growth of cancer. Age may also influence cancer biology. Some tumors become more aggressive and others more indolent with aging. Aging implies a reduced life expectancy and limited tolerance to stress. A comprehensive geriatric assessment (CGA) indicates which patients are more likely to benefit from cytotoxic treatment. Some physiologic changes (including reduced glomerular filtration rate, increased susceptibility to myelotoxicity, mucositis, and cardiac and neurotoxicity) are common in persons aged 65 years and older. The administration of chemotherapy to older cancer patients involves adjustment of the dose to renal function, prophylactic use of myelopoietic growth factors, maintenance of hemoglobin levels around 12 g/dL, and proper drug selection. Age is not a contraindication to cancer treatment: With appropriate caution, older individuals may benefit from cytotoxic chemotherapy to the same extent as the youngest patient.
Although more than half of all cancers occur in people above the age of 65, the good news is that elderly people can benefit from cancer treatment to the same degree as younger patients. While some treatments may have not been considered for the care of older patients formerly, things have changed. The elderly are getting healthier and living longer, and are entitled to benefit from the many life-saving medical advances new to Oncology.
A pregnant woman with cancer is capable of giving birth to a healthy baby and some cancer treatments are safe during pregnancy.
Pregnancy does not increase the risk to develop a cancer. Breast cancer is the most common cancer in pregnant women.
Diagnosis
Being pregnant can delay a cancer diagnosis. Symptoms such as abdominal bloating, frequent headaches, or rectal bleeding might suggest ovarian, brain, or colon cancer. These symptoms are also common during pregnancy and are not considered suspicious. If these symptoms are related to cancer, diagnosis of the cancer is likely to be delayed.
Breast cancer is the most common cancer in pregnant women, affecting approximately one in 3,000 pregnancies. Pregnancy-related breast enlargement makes it difficult to detect small breast tumors, and mammograms are not regularly done during pregnancy.
If cancer is suspected during pregnancy, women and their doctors may be concerned about diagnostic tests such as x-rays. However, research has shown that the level of radiation in diagnostic x-rays is too low to harm the fetus (unborn baby). When possible, a lead shield covering the abdomen offers extra protection. Other diagnostic tests, such as magnetic resonance imaging test (MRI), ultrasound, and biopsy, are also considered safe during pregnancy because they do not use radiation.
Sometimes, pregnancy can uncover cancer that had previously gone undetected. For example, a Pap test performed as part of standard, early prenatal care can detect cervical cancer. Similarly, an ultrasound performed during pregnancy can often find ovarian cancer that might otherwise go undiagnosed.
Treatment
Treatment for cancer during pregnancy means balancing the best treatment for the mother with the possible risk to the fetus. The type of treatment given depends on many factors, including how far along the pregnancy is; the type, location, size, and stage of the cancer; and the wishes of the expectant mother and family. Because some cancer treatments can harm the fetus, especially during the first trimester (the first three months of pregnancy), treatment may be delayed until the second or third trimesters. When cancer is diagnosed later in pregnancy, doctors may wait to start treatment until after the baby is born, or they may consider inducing labor early. In some cases, such as early stage (stage 0 or IA) cervical cancer, doctors may wait to treat the cancer until after delivery.
Cancer treatments used during pregnancy may include surgery, chemotherapy, and possibly, radiation therapy, but only after careful consideration and treatment planning to optimize the safety of the mother and the unborn baby.
Breastfeeding
Although cancer cells cannot pass to the infant through breast milk, women who are being treated for cancer are generally advised not to breastfeed. Chemotherapy can be especially dangerous as it can build up in breast milk and harm the infant. Similarly, radioactive components that are taken internally, such as radioactive iodine used in treating thyroid cancer, also cross into breast milk and can harm the infant.
Elders – Oncogeriatry
Age is a risk factor for cancer due to the duration of carcinogenesis, the vulnerability of aging tissues to environmental carcinogens, and other bodily changes that favor the development and the growth of cancer. Age may also influence cancer biology. Some tumors become more aggressive and others more indolent with aging. Aging implies a reduced life expectancy and limited tolerance to stress. A comprehensive geriatric assessment (CGA) indicates which patients are more likely to benefit from cytotoxic treatment. Some physiologic changes (including reduced glomerular filtration rate, increased susceptibility to myelotoxicity, mucositis, and cardiac and neurotoxicity) are common in persons aged 65 years and older. The administration of chemotherapy to older cancer patients involves adjustment of the dose to renal function, prophylactic use of myelopoietic growth factors, maintenance of hemoglobin levels around 12 g/dL, and proper drug selection. Age is not a contraindication to cancer treatment: With appropriate caution, older individuals may benefit from cytotoxic chemotherapy to the same extent as the youngest patient.
Although more than half of all cancers occur in people above the age of 65, the good news is that elderly people can benefit from cancer treatment to the same degree as younger patients. While some treatments may have not been considered for the care of older patients formerly, things have changed. The elderly are getting healthier and living longer, and are entitled to benefit from the many life-saving medical advances new to Oncology.
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