In Spain, one in every thousand women are diagnosed with cancer during pregnancy or during the year after childbirth. As to why, Dr. Isabel Calvo, of the Breast Tumor Section of the Medical Oncology Service at MD Anderson Cancer Center Madrid, believes that it may be caused by two factors - the delay in the age at which women are having their first child and Increased awareness of women about cancer, which makes them consult a health professional at the first sign of any symptoms, which, says the specialist, "contributes greatly to early diagnosis".
Among the most frequent tumors diagnosed in these women, is breast cancer, followed by cervical cancer, because "these are common tumors in women, regardless of pregnancy", explains Dr. Calvo. However, pregnancy can play a protective role against ovarian cancer because "ovulations, micro tears in the ovarian capsule, do not occur during pregnancy".
Surgery and chemotheraoy versus radiotherapy and hormone therapy
On the subject of cancer treatments during pregnancy, Dr. Calvo explains that, although there is no cancer therapy that does not involve risks, the most important thing in these cases is to "assess the risk / benefit of treatments and diagnostic or surgical procedures with respect to both the mother and the fetus to be able to use those that are essential and least harmful to both”.
In general terms, surgery does not usually pose a risk, although "the time under anesthesia does", emphasizes the doctor, who also points out that radiotherapy and hormone therapy are contraindicated during pregnancy. In the case of chemotherapy, she stresses the importance of evaluating each individual case and "administer chemotherapy only when necessary, starting in the second trimester and with as few cycles as possible". In addition, it is important to know which chemotherapy drugs can be used and which not, according to pharmacological guidelines.
A multidisciplinary approach to a complex treatment process
These patients follow a complex treatment process that requires a multidisciplinary approach as for any type of cancer (surgical oncologist, medical oncologist, nursing, pathology, radiology, nuclear medicine, psycho-oncology ...), but to which a specialist in obstetrics must also be added to monitor the condition of the fetus at all times. Dr. Calvo further points out that the center where the patient finally gives birth must have a pediatric intensive care unit in case it were necessary since it is a high risk pregnancy.
Furthermore, in addition to the physical problems the disease entails, we must also add the psychological aspects. "The presence of a psycho-oncologist is fundamental, given that the mother usually has mixed feelings about her being treated and cured and the damage the treatments can cause the fetus", says Dr. Calvo, who also points out concerns such as the preservation of fertility and lactation, since it must be borne in mind that most drugs can pass through the breast milk to the baby.