Myassa Kjaerem
Senior Global Medical Advisor, MD. PhD.
Cancer treatment during pregnancy poses unique challenges and requires careful consideration to balance the health of the mother and the developing foetus. The approach to treatment can vary significantly based on the type and stage of cancer, as well as the timing of the pregnancy.
For women diagnosed with cancer who are planning to conceive, it's critical to consult healthcare providers about the impact of cancer treatments on fertility and take an active decision on how to proceed in order not to impair the possibility to become pregnant if it is wished after treatment completion. Options such as egg or embryo freezing before treatment offer a possibility for future pregnancy. Additionally, patients should discuss the potential risks of cancer recurrence and the optimal timing of conception post-treatment, ensuring that the patient has adequately recovered and that a potential planned pregnancy is not compromised.
Cancer diagnosis during pregnancy is rare but presents a complex situation. Treatment decisions depend on the cancer type, stage, and gestational age. In the first trimester, chemotherapy is generally avoided due to the high risk of foetal malformations and the precise gestational age at which chemotherapy can be initiated safely remains unclear in the first 12 weeks of gestation. However, some treatments may be considered during the second and third trimesters when foetal development is less susceptible to teratogenic exposure. Surgery is often the preferred option if feasible, as it carries fewer risks compared to chemotherapy or radiation. Careful monitoring and a multidisciplinary approach involving oncologists, obstetricians, and paediatricians are essential.
Even though bladder cancer incidence among young women in childbearing age is rare, its occurrence requires a thorough management plan and a careful treatment choice weighing treatment efficacy and foetus safety. Chemotherapies are not recommended during the first trimester of gestation.
Postpartum, the treatment plan can be more aggressive. Chemotherapy, radiation, and other cancer therapies that might pose risks during pregnancy can be fully administered. In this case breastfeeding interruption is often recommended as some treatments can pass into breast milk and may not be safe for the infant. Women who have undergone cancer treatment and are considering future pregnancies are recommended to seek genetic counselling and fertility evaluations. Also, a recent Danish study showed that school performance and educational achievement in children are not affected by exposure to maternal cancer in utero underlining independently to when the cancer is diagnosed.
Overall, the treatment of cancer during pregnancy requires a delicate balance, prioritizing both the health of the mother and the safety of the unborn child. Advances in medicine and a multidisciplinary approach have improved the outcomes for both mothers and their babies.