Understanding diagnosis, treatment options and specialist care to support informed decisions for the mother and developing baby.

Introduction

Cancer during pregnancy can create complex medical and emotional challenges for expectant mothers and their families. A cancer diagnosis during this period requires careful evaluation because treatment decisions must consider the mother’s health, the type and stage of cancer, and the developing baby’s wellbeing.

Although cancer during pregnancy is uncommon, it can occur and should be evaluated promptly. Depending on the diagnosis and stage of pregnancy, some investigations and treatments may be possible, while others may need to be modified, avoided or postponed. A coordinated team of oncology and pregnancy-care specialists can help assess the available options and develop an individualised treatment plan.

Understanding the diagnosis, potential risks and available treatment approaches can help patients make informed decisions in consultation with their healthcare team.

Understanding Cancer During Pregnancy

Cancer develops when abnormal cells grow uncontrollably and may invade nearby tissues or spread to other parts of the body. When cancer is diagnosed during pregnancy, doctors must consider both the usual requirements of cancer care and the medical needs associated with pregnancy.

The appropriate management depends on several factors, including:

The type of cancer and its biological characteristics.
The stage and extent of the disease.
The gestational age and stage of pregnancy.
The urgency of treatment.
The potential benefits and risks of available treatments.
The patient’s overall health and preferences.

There is no single treatment approach suitable for every pregnant patient with cancer. Individualised assessment and clear communication between the patient and the specialist team are essential.

Types of Cancer That May Occur During Pregnancy

Several types of cancer can be diagnosed during pregnancy. Their symptoms, diagnostic procedures and treatment requirements vary according to the disease.

Breast Cancer

Breast cancer can occur during pregnancy. Hormonal changes may cause breast enlargement, tenderness and other changes that sometimes make a new abnormality more difficult to recognise.

A persistent lump, unusual skin changes, nipple changes or other concerning symptoms should be assessed by a healthcare professional. Appropriate investigations can help determine whether further testing or treatment is needed.

Treatment planning depends on the cancer’s stage, tumour characteristics and pregnancy duration. Surgery, systemic treatment or other approaches may be considered according to the individual clinical situation.

Cervical Cancer

Cervical cancer may be detected during pregnancy through an examination or investigation of concerning symptoms. The recommended management depends on the stage of the cancer, the gestational age and the patient’s medical circumstances.

Specialists evaluate the potential consequences of delaying treatment against the risks of treatment during pregnancy. Care may involve gynaecological oncology and obstetric specialists.

Lymphoma

Lymphoma affects the lymphatic system and may present with enlarged lymph nodes, persistent unexplained fever, night sweats or unexplained weight loss.

These symptoms can have many causes and do not necessarily indicate cancer. When lymphoma is suspected or confirmed during pregnancy, specialists determine the necessary investigations and treatment plan according to the type and extent of the disease.

Leukaemia

Leukaemia affects blood-forming tissues and may cause persistent fatigue, recurrent infections, unusual bruising, unexplained bleeding or fever.

Because some forms of leukaemia can progress rapidly, suspected cases require prompt medical assessment. Treatment decisions depend on the specific diagnosis, disease severity and pregnancy-related considerations.

Other Cancers

Other cancers, including melanoma and certain gastrointestinal or solid tumours, may also be diagnosed during pregnancy. The recommended approach depends on the cancer type, its location, stage and urgency of treatment.

Not every cancer requires the same investigations or treatment schedule. Specialist assessment helps determine the most appropriate course of action.

Signs and Symptoms That Require Medical Evaluation

Pregnancy can cause physical changes such as fatigue, nausea, breast tenderness and changes in body weight. Many of these are normal, but persistent, unusual or concerning symptoms should not automatically be attributed to pregnancy.

Symptoms that may require medical evaluation include:

A new or persistent lump in the breast or another part of the body.
Unexplained bleeding or unusual vaginal bleeding.
A mole or skin lesion that changes in size, shape or colour.
Persistent pain without a clear explanation.
Unexplained weight loss.
Persistent swelling of lymph nodes.
Ongoing changes in bowel or bladder habits.
Unusual bruising, recurrent infections or unexplained bleeding.

These symptoms do not necessarily mean that cancer is present. A healthcare professional can assess them and determine whether further investigations are required.

Severe pain, heavy bleeding, difficulty breathing or other acute symptoms require urgent medical attention.

Diagnosing Cancer During Pregnancy

Cancer diagnosis during pregnancy requires careful consideration of the benefits and potential risks of each investigation. The diagnostic plan depends on the suspected cancer, the symptoms and the stage of pregnancy.

Medical History and Physical Examination

The doctor reviews the patient’s symptoms, medical history, family history and other relevant details. A physical examination helps identify abnormalities that may require further investigation.

Imaging Investigations

Ultrasound and MRI without gadolinium contrast may be suitable for certain clinical situations. Other imaging investigations, including those involving ionising radiation, may sometimes be medically necessary following an individual assessment of their benefits and risks.

Patients should inform their healthcare professionals that they are pregnant or may be pregnant before undergoing imaging or other medical procedures.

Biopsy and Laboratory Tests

A biopsy may be necessary to confirm a suspected cancer and identify its type. Blood tests and other laboratory investigations may also help assess the patient’s condition.

The timing and safety of these procedures should be considered by the treating team. Pregnancy should not be a reason to ignore a potentially serious medical condition.

Cancer Treatment Options During Pregnancy

Cancer treatment during pregnancy must be planned according to the diagnosis, disease stage, pregnancy duration and potential risks to the mother and developing baby.

In selected cases, treatment can begin during pregnancy. In other situations, the medical team may consider modifying the treatment plan or postponing specific treatments until after delivery if doing so is medically appropriate.

Treatment planning may involve a surgical oncologist, medical oncologist, obstetrician and other relevant specialists. A maternal-fetal medicine specialist or neonatal specialist may also be involved when needed.

Important considerations include the urgency of cancer treatment, the potential effects of delaying treatment, available alternatives and the patient’s preferences.

The benefits and risks of each option should be explained clearly so that decisions can be made through informed discussion with the treating team.

Surgery During Pregnancy

Surgery may be possible during pregnancy when it is medically necessary. Whether surgery is recommended depends on the cancer type, the procedure required, the stage of pregnancy and the risks associated with delaying treatment.

The surgical and obstetric teams consider maternal health, anaesthesia, fetal wellbeing and postoperative care when planning a procedure.

Some operations may be appropriate during pregnancy, while others may require different timing or additional precautions. Patients should discuss the urgency of surgery, alternative approaches and potential risks with their specialists.

Surgery should not automatically be considered either safe or unsafe solely because a patient is pregnant.

Chemotherapy During Pregnancy

The suitability of chemotherapy during pregnancy depends on the medicines involved, the cancer being treated and the stage of pregnancy.

Many chemotherapy medicines are avoided during the first trimester because of the risk of harm to early fetal development. Certain regimens may be considered after the first trimester in selected circumstances, while some medicines remain unsuitable throughout pregnancy. Chemotherapy is also generally avoided close to delivery because of potential complications.

The treating oncologist evaluates the benefits and risks of the proposed regimen and discusses alternatives where appropriate.

Patients should never start, stop or change cancer medicines without guidance from their treating medical team.

Radiotherapy During Pregnancy

Radiotherapy uses high-energy radiation to destroy cancer cells. Because radiation exposure can harm the developing baby, radiotherapy that would expose the fetus is generally avoided during pregnancy.

Depending on the cancer’s location and urgency, specialists may consider alternative treatments, different timing or postponement until after delivery when medically appropriate.

The decision requires an individual assessment of the potential benefits of treatment and the risks associated with delaying it. Patients should discuss available options with their oncology team.

How the Stage of Pregnancy Affects Treatment

The stage of pregnancy is an important factor when evaluating cancer treatment options. However, the trimester alone does not determine the correct treatment.

First Trimester

The first trimester is a critical period of fetal development. Some cancer treatments, particularly certain chemotherapy medicines, carry significant risks during this stage. The healthcare team carefully evaluates the urgency of treatment and available alternatives.

Second Trimester

Some treatments may be considered during the second trimester in selected circumstances. Suitability depends on the cancer diagnosis, the treatment involved and the patient’s overall health.

Third Trimester

During the third trimester, the team considers the urgency of cancer treatment, the remaining pregnancy duration, the potential risks of treatment and the timing of delivery.

The treatment plan should be individualised and coordinated between the relevant specialists.

Potential Risks to the Developing Baby

Some cancer treatments can affect fetal development, pregnancy outcomes or the timing of delivery. The degree of risk depends on the specific treatment, medicines, doses and stage of pregnancy.

The healthcare team should explain the known risks, uncertainties and potential benefits of each treatment option. Additional monitoring may be recommended depending on the patient’s medical circumstances and treatment plan.

It is important to consider both the potential risks of treatment and the consequences of delaying necessary cancer care. A balanced assessment helps patients and their specialists make informed decisions.

The Importance of Multidisciplinary Care

Cancer during pregnancy often requires collaboration between specialists with different areas of expertise. Coordinated care helps ensure that cancer treatment and pregnancy-related needs are considered together.

Depending on the diagnosis, the care team may include:

A surgical oncologist.
A medical oncologist.
An obstetrician.
A maternal-fetal medicine specialist.
A radiologist and pathologist.
A neonatal specialist.
Other healthcare professionals according to the patient’s needs.

The team reviews the diagnosis, available treatments, potential risks and timing of care. Patients should have the opportunity to ask questions and understand the reasoning behind the recommended plan.

Emotional Support During Cancer Treatment and Pregnancy

A cancer diagnosis during pregnancy can lead to anxiety, uncertainty and emotional distress. Patients may worry about their own health, their baby’s wellbeing, family responsibilities and future treatment.

Emotional support is an important part of comprehensive care. Helpful options may include discussions with the medical team, support from trusted family members, professional counselling and appropriate patient-support organisations.

Clear information about the diagnosis and treatment options can help patients feel better prepared to make decisions. Patients should feel comfortable discussing their concerns and asking for additional support whenever needed.

Frequently Asked Questions

1. Can a pregnant woman develop cancer?

Yes. Cancer can occur during pregnancy, although it is uncommon. Persistent or concerning symptoms should be evaluated by a healthcare professional.

2. Can cancer be treated during pregnancy?

In some cases, yes. The treatment plan depends on the cancer type, stage, pregnancy duration and potential risks. Some treatments may be possible during pregnancy, while others may need to be modified or postponed.

3. Is chemotherapy possible during pregnancy?

Certain chemotherapy regimens may be considered after the first trimester in selected circumstances. Many medicines are avoided during early pregnancy, and chemotherapy is generally avoided close to delivery. The decision must be made by the treating specialists.

4. Can breast cancer be diagnosed during pregnancy?

Yes. A persistent breast lump or other concerning breast changes should be assessed by a healthcare professional. Appropriate diagnostic investigations can be selected according to the clinical situation.

5. Does a cancer diagnosis always require early delivery?

No. Early delivery is not automatically necessary. The timing and mode of delivery depend on the cancer diagnosis, treatment requirements, gestational age and the health of the mother and baby.

6. Can cancer treatment harm the baby?

Some treatments can pose risks to fetal development or pregnancy outcomes. The risks vary by treatment and pregnancy stage. The medical team should explain the benefits, risks and alternatives for the individual patient.

7. Which specialists manage cancer during pregnancy?

Care may involve a surgical oncologist, medical oncologist, obstetrician, maternal-fetal medicine specialist and, when needed, a neonatal specialist. The exact team depends on the diagnosis and treatment requirements.

Conclusion

Cancer during pregnancy requires careful diagnosis, individualised treatment planning and coordinated specialist care. Although some treatments may be possible during pregnancy, others require alternative timing or approaches based on the risks and benefits for the mother and developing baby.

Understanding the diagnosis and available options can help patients make informed decisions in consultation with their healthcare team. Persistent or concerning symptoms should be assessed promptly, and recommended investigations should not be delayed without medical advice.

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Dr Priyansh Jain
Surgical Oncologist (Oncosurgeon) – Naman Cancer Clinic & Research Centre, Surat

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