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The story of a young pregnant woman who has been diagnosed with terminal cancer recently hit the headlines.  Laura King, a 29-year-old expectant mum from Surrey was 17 weeks pregnant when she received the devastating news.

Last year Laura had extensive surgery and treatment to fight off an aggressive breast cancer. After receiving the all-clear, she and her husband Drew decided to start a family. She successfully conceived and everything was progressing well- but just a few months into her pregnancy, she developed severe pain in her arm, which were shown to be caused by secondary cancers in the bones. Mrs King said ‘’For a long time I thought it was muscular. It wasn’t until I started to experience increasing and constant pain. My strength and range of movement was starting to deteriorate rapidly too which made me really think something wasn’t right and pushed me to request an X-ray.’

Secondary tumours develop where cancer cells have travelled to another part of the body. This is known as metastatic disease and it’s often more aggressive and more difficult to treat than the primary cancer. Laura has been told that her cancer is incurable, however she has had targeted therapy on the area affected. Some forms of chemotherapy, clinical trials and experimental treatments cannot be used because they could harm her unborn child. Her friends, family and a GoFundMe page have raised money to support Laura while she is unable to work and to help fund further treatment once the baby is born. Laura said:

‘I have had the most amazing support from my incredible husband, family, friends and work. Including words of support, visits for when I’ve had to be off work, flowers, biscuits, sweets and pamper care packages.’

I wish Laura, Drew and the family all the very best with the birth of their baby and the battle with cancer. Being diagnosed with a serious disease is difficult at the best of times and when you’re pregnant it can be particularly frightening and upsetting. I thought I’d share some of the facts, features and challenges of dealing with cancer in pregnancy.

Pregnancy and Cancer-Risk

Cancer in pregnancy is thankfully rare, in line with the rates in all young women. Cancer can affect around 1 in every 1,000 pregnancies[1]. The most common types are those that tend to affect women who are of reproductive age, which includes cervical cancer, the skin cancer malignant melanoma, Hodgkin’s, leukaemia and breast cancer like Laura.

We know that women’s immune systems change during pregnancy. However, the scientific studies, to date, show that being pregnant doesn’t appear to make cancers grow faster. The other good news is that pregnant women can usually be treated just as effectively as women who are not expecting. The right combination of treatments will depend on the type of cancer, the stage of the disease and how soon you are expecting your baby.

Cancer Treatments

Some treatments are not safe in pregnancy and may need to be postponed, if possible, until after the birth:

Chemotherapy drugs act to stop cancer cells growing and dividing. But they can have the same effect on the cells in your baby, so chemotherapy in the first few months could lead to miscarriage or defects in the developing baby, later many of the drugs may be given more safely because the placenta provides an effective barrier.

Surgery can be one of the safest treatments. An operation to remove the tumour usually provides little risk to the baby. In contrast the high levels of radiation can harm the fetus, so the benefits of treatment will be balanced against this danger. The location of the cancer and the potential of highly localised therapy will also be considered.

The outcome of treatment and the disease’s effect on the wellbeing of mother and baby will depend on the type of cancer and the extent of the disease. One thing we do know for sure is that prompt diagnosis and the timely management of the cancer is better for the health of both mum and baby[2].

Cancer in Pregnancy

Signs of Cancer

Your body changes so much in pregnancy, it can be difficult to tell what’s normal and what’s definitely not. Tiredness, sickness, breathlessness, vaginal bleeding, skin and breast changes could all indicate cancer but could also be part and parcel of a healthy pregnancy. I’d always recommend caution and seeking medical advice if you’re concerned. But a quick list to keep an eye out for includes:

  • Breast changes: The breasts grow and become tender in pregnancy. However, any new lumps, dimpling of the breast, blood from the nipple or a newly inverted nipple should be checked.
  • Mole changes:Moles often get biggeror darker during pregnancy. However, a mole that is irregular in size or colouration, or one that itches or bleeds should always be investigate.
  • Bleeding: Bleeding in pregnancy should always be checked. Cervical cancer can classically cause bleeding after sex. But always get checked, your doctor will also make sure you’ve had a recent smear test.
  • Tiredness: Yes, pregnancy is exhausting but severe malaise could indicate anaemia or other problems.
  • Breathlessness: Lots of pregnant women puff and pant. But if you’re struggling to catch your breath, you have pain on breathing, you have a stubborn cough or you’ve coughed up blood, get help.
  • New lumps and bumps: There’s one big new bump developing inside but any other lumps in the neck, armpit or elsewhere should be investigated.

Coping with Cancer and Pregnancy

Dealing with the dual challenges of pregnancy and cancer can be overwhelming.

You and your family will be coping with physical and emotional difficulties and it can be tricky to know where to turn. You are not alone. Your GP, midwife and hospital team should be a source of support and can I also recommend the charity Mummy’s Star? They offer guidance for pregnant women with a cancer diagnosis. They provide information, links and a forum that can get you in touch with other parents who are going through the same thing.

Treatment Decisions

It can be hard to make choices about cancer treatment, because you are considering the health and wellbeing of your baby as well as yourself. Your healthcare team will try to balance the safety of your baby with your own health and cancer therapy.

The decisions won’t always be easy. Sometimes, if the pregnancy is in the very early stages and the cancer is aggressive, it may be suggested that you should consider termination. Later, a slightly earlier delivery may be advised so that further treatment can be initiated.  Alternatively, a potentially harmful therapy may be essential for your own survival. Throughout this, your team should give you all the information available, so that you can make an informed choice.

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