We realise having a cancer diagnosis can be overwhelming, scary and worrying at the best of times, but when you are pregnant, you also have your unborn or new baby to consider.
This website has been set up to support you at this difficult time. You should be able to find answers to some of the questions you may have and/or places to go to find answers and support.
- Cancer during pregnancy is rare.
- Some cancer treatments are safe to use during pregnancy, while others should be avoided.
- To find out what options are available to you, it is best to talk to your doctor. They will tell you about the risks and benefits of diagnostic tests and treatment for your cancer and will consider the impact on your pregnancy/new baby during this discussion.
Being pregnant can delay a cancer diagnosis because some cancer symptoms, such as abdominal bloating, frequent headaches, breast changes or rectal bleeding, are common during pregnancy and are not considered suspicious. On the other hand, pregnancy can sometimes uncover cancer that has previously gone undetected.
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. Computed tomography (CT) scans are similar to x-rays because they use ionizing radiation. However, CT scans are much more accurate than x-rays at outlining internal organs and structures and can be very helpful in making a diagnosis of cancer or determining whether the cancer has spread. CT scans of the head or the chest are generally considered safe during pregnancy, as there is no direct radiation exposure to the fetus. When possible, women may use a lead shield that covers the abdomen (stomach) for extra protection during both x-rays and CT scans. CT scans of the abdomen or pelvis should be done only if absolutely necessary and after discussion with the medical team. Other diagnostic tests—such as magnetic resonance imaging (MRI), ultrasound, and biopsy—are also considered safe during pregnancy because they don’t use ionizing radiation.
The information above has been provided by our advisor Vanessa Hickson.
At your appointment you will have been told about your diagnosis. As the news may come as a surprise and there may be a lot of information to digest, your consultant will give you a Confirmation of Diagnosis and Summary of Discussion sheet. This will summarise the discussion about your diagnosis as well as the initial care and treatment options to manage your condition. You should also be given the opportunity to meet your Clinical Nurse Specialist and details of how you can contact them. A copy of this sheet will also be placed in your medical records.
Here are some questions you might like to ask your doctor if you are pregnant and have recently been diagnosed with cancer. It is often a good idea to have a someone accompany you to your appointments, not only for support, but so that someone else knows what has been said. Clinic appointments can be overwhelming, especially if there is a lot of information to remember.
- How much experience do you have treating pregnant women with cancer?
- How will you work with my obstetrician (a doctor who specialises in pregnancy and childbirth)?
- Do you recommend any special tests?
- What treatment plan do you recommend? Why?
- In your opinion do I need to begin treatment right away, or should I wait to start treatment?
- Could delaying treatment affect my prognosis?
- What are the short- and long-term risks of my treatment plan to me? To the baby?
- Will treatment affect my delivery? How?
- Will I be able to breastfeed?
- What support services and other resources are available to me and to my family?
- Will I be able to access donor breast milk if I am unable to breast feed?
Your local hospital and/or specialist cancer hospital will have a dedicated team to support you. These are often known as a Multidisciplinary Team (MDT)
This team may include specialist cancer nurses (e.g. breast cancer), clinical oncologist, radiologists, diagnostic radiographers, a team of pathologists, specialist surgeons including plastic surgeons, and research teams.
Dependent on the type of cancer and your condition during and after treatment, this team could also include other medical professionals such as dietician, physiotherapists, psychological support and genetic specialists.
YOU HAVE THE RIGHT TO REQUEST TO BE INVOLVED IN YOUR MDT MEETING WHERE YOUR CARE PLAN IS BEING DISCUSSED.
As each person’s cancer diagnosis and medical condition are different, we cannot give you a specific answer to this question. During this time your midwife and nurse specialist will support you. They will be able to help you understand what your cancer diagnosis and treatment means for you and your baby.
Depending on the stage of your pregnancy and any other health conditions that you and/or baby may have, chemotherapy, radiotherapy and surgery are all options that will be considered by your specialist team.
They will explain the treatment options and the risks involved. You will be part of this discussion and can ask any questions that you need. YOU ALSO HAVE THE RIGHT TO DECLINE OR ACCEPT TREATMENT OR TO ASK FOR A SECOND OPINION.
The team caring for you will decide upon your course of treatment. The stage of your pregnancy and the type of cancer will determine the recommended treatment. Chemotherapy would generally be advised only after the 1st trimester.
When making treatment recommendations for cancer during pregnancy, the doctor considers the best treatment options for the mother and the possible risks to the developing baby. The type of treatment chosen depends on many factors, including the gestational age of the fetus (stage of the pregnancy); the type, location, size, and stage of the cancer; and the wishes of the expectant mother and her family. As some cancer treatments may 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 offering an early induction of labour, where pessaries are given to encourage the body to go into labour. In some cases, such as early-stage (stage 0 or IA) cancer, doctors may wait to treat the cancer until after natural birth has occurred.
Some cancer treatments may be used during pregnancy but only after careful consideration and treatment planning to optimise the safety of both the mother and the unborn baby. These can include surgery, chemotherapy, and rarely, radiotherapy.
Surgery is the removal of the tumour and surrounding tissue during an operation. It poses little risk to the developing baby and is considered the safest cancer treatment option during pregnancy. In some cases, more extensive surgery can be done to avoid having to use chemotherapy or radiotherapy.
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy may harm the fetus, particularly if it is given during the first trimester of pregnancy when the fetus’ organs are still developing and before the placenta has fully developed.
During the second and third trimesters, some types of chemotherapy may be given without necessarily harming the fetus. The placenta acts as a barrier between the mother and the baby, and many drugs cannot pass through this barrier, or they pass through in very small amounts. If the planned chemotherapy includes a drug that is not safe during any stage of pregnancy, the doctor can sometimes substitute another drug. Sometimes a lower dose of chemotherapy may be used until your baby is delivered
Radiotherapy is the use of high-energy x-rays or other particles to destroy cancer cells. As radiation therapy can harm the fetus, particularly during the first trimester, doctors generally avoid using this treatment. Even in the second and third trimesters, the use of radiation therapy is uncommon, and the risks to the developing baby depend on the dose of radiation and the area of the body being treated.
Breastfeeding your baby will depend upon whether you are actively undergoing either chemotherapy or radiotherapy postnatally. It may also be affected if you have had recent breast surgery for breast cancer. However, it is usually perfectly possible to feed a baby from one breast if only one breast has been affected. However, both chemotherapy and radiotherapy treatments have a significant risk of passing dangerous drugs/radioactive components to the infant through the mother’s breast milk, so breast feeding would not be advised during treatments of this kind. We realise for many women this is an added complication that they did not expect to have to consider and deal with.
Please do not give up however, as depending on your individual circumstances; there may be alternative options available to you. There are options available to you dependent upon where in your treatment you are up to. Contacting the Specialist Midwife for Infant Feeding at the hospital will be useful as they will be able to assist in planning your feeding options for you and your new baby. There are a number of organisations across the UK who can provide women with donor breast milk. There are a number of milk banks across the UK and you can access these through UKAMB website who may be able to help also.
Donor breast milk is the next best option to mothers own milk and should be given consideration by both you and the team caring for you and your baby. If you are struggling to get the answers or information, a member of the team at Mummy’s star will be able to help you. We have a Lactation Consultant on our team, Helen Howard, with expertise in this area and Helen will be more than willing to have a discussion about the options available to you.
The Association for Milk Banking (UKAMB) has information on their website http://www.ukamb.org/
The team caring for you will help you to make any necessary plans for your birth. They may make suggestions based upon where you are up to in your treatment. Effective communication between the obstetric team and your oncology team are essential to ensure optimum outcomes for both you and your baby.
It is your legal right in the UK to choose where you give birth to your baby and the medical team is obliged to support you in this. There is a possibility that the doctors may suggest early induction of labour to you and if you were in agreement with this plan, then the induction and birth would usually take place on the hospital labour ward. In the event that there are any issues with your preferred plan, than you can contact a Supervisor of Midwives in your hospital who will support you to plan the care that will be acceptable for you.
Mummy’s Star is very aware of this additional challenge for a family going through cancer treatment while caring for a baby.
Some people with cancer are lucky enough to live close enough to their family and can get help from grandparents, aunts, uncles, grown up siblings etc. If you are someone who wouldn’t usually get them to help, now is the time to ask!
If you don’t have any family living close to you, why not ask your close friends? Picking up and dropping off older children at school or social activities, such as attending a friend’s birthday party or going to scouts or brownies, is something that they could do without much impact on them but the benefit to you and your family could be huge.
Other suggestions for things that family or friends can do to help – asking them to come to mind the baby while you get some well needed sleep; someone babysitting the baby and/or other children so you can get some grown-up time with a partner such as going to the cinema or out for a meal; organising some play-dates after school or at the weekend so that your children get to have some fun with their friends.
Alternatively, or in addition to help from family and friends, you might like to think about using other childcare such as breakfast and after school clubs, hiring a nanny, au pair or mother’s help and/or pre-school nurseries. If you or your partner are employed, you might like to consider tax-free Childcare Vouchers (paid as part of your salary) that can be used to pay for most types of registered childcare.
Finally, if you feel like you could do with more support (or if your friends and family are too far away or unable to help), we can contact/refer you to Home Start? It is a national charity that can support families just like yours and helps parents to build better lives for their children. Their volunteers provide support and friendship to more than 32,000 families every year. There are more than 310 local Home Starts. More information can be found at http://www.home-start.org.uk
Telling your friends and family is a very personal experience. Some people find themselves being diagnosed in an emergency situation and it seems everyone knows straight away, while others may have had a number of tests and have found out very quietly.
Here are some good articles about telling your friends and family about your cancer. We also have another section on talking to children. Please let us know your feedback on these links so we can review and amend as to what people find most helpful.
Good pages to help your family and friends
Each person is different and what they need help with will vary dependent on their local support network, such as family and friends. Here are some tips based on our experience:
- If you have friends or family nearby, now is the time to ask them for help. They will usually be only too happy to help. Try to have something specific that they can do but also be open to their suggestions.
- When friends, colleagues and family offer “Is there anything I can do to help?” try asking them for practical help such as picking up the kids from school, stacking or unloading the dishwasher, changing the beds or walking the dog. It doesn’t matter whether it is big or small – people like to help.
- Internet shopping can be a lifesaver – whether it’s grocery shopping or buying your partner’s birthday present. Or if you are staying in hospital and it might be difficult to receive a parcel at home, many stores offer an order online but deliver to store service. In addition, there are delivery drop boxes services that you can use, where mail order items can be delivered to a post-box/locker that you can access. These are often based at supermarkets or shopping malls.
- If you don’t like the idea of a friend or family helping you out, why not consider paying someone to clean your house. There are cleaning agencies and independent cleaners that can come and do a spring-clean or visit regularly to help keep the house clean.
More helpful advice can be found in the Someone Close to Me section of the website.
As each person’s condition varies, we cannot answer this question fully. We recommend that you talk to your nurse specialist and find out what going away from home would mean for you.
Before you book or plan a trip, you might like to consider the following:
- What treatment you are currently having?
Timing a trip away between chemotherapy sessions may be possible. If it is your first treatment, you might like to see how you react before attempting to go away from home. Some people feel awful for the first couple of days but then have a few good days. Other people can find that initially they can cope well with the treatment, but as the treatment continues the cumulative impact on their body can make them more unwell and recovery time after each treatment takes longer.
- Distance from home and means of travel?
Is it a couple of hours away or longer? Some people would prefer to go by car as they can stop when they want to and they have control about where and when they get there. Other people prefer the relaxation offered by going by public transport such as by train.
Travel insurance? (when travelling abroad)
Do you need it? Will it cover you? If you already have travel insurance, attached to your bank account for example, check the details carefully. It may not cover pre-existing medical conditions and failing to tell them in advance of your travel could invalidate your insurance. It might be that they will then cover everything except for cancer related problems.
You are covered by the European Health Insurance Card (EHIC). This does not replace travel insurance but means that should anything happen you should expect the same level of care as anyone else living in the country you are visiting. You need to apply for one before you travel – https://www.gov.uk/european-health-insurance-card
For more useful information, visit http://finance.macmillan.org.uk/travel-insurance/getting-travel-insurance
Some of the women on the forum have recommended these travel insurance companies:
It is currently recommended that people undergoing chemotherapy do not have ‘live’ vaccines. Talk to your doctor if you are considering any travel that requires or recommends vaccinations.
Nearest hospitals and health care centres?
If something happens while you are away, where would you need to go and how easy would it be to get there. Being prepared means that it would be less stressful if you need medical assistance. We suggest you take a thermometer and paracetamol and get some advice from your doctor how to triage any high or low body temperatures.
The emotional benefits for you and/or your family?
Having cancer changes our lives. The impact of a diagnosis and treatment of cancer can make us rethink what is important and/or we want to live life to the full. It can also be hard on our immediate family and friends and we might like to spend some quality time with them. You might like a break from the ‘cancer’ life you are living and feel like you did before you were diagnosed.
Your cancer specialist team and midwife will help you understand the new and occasionally baffling medical language. If you have ANY questions, just ask. It’s likely you’ve been given a named contact for a nurse specialist – they are often a mine of information. If they don’t know, it is very likely that they will know someone who will.
If you are ever worried or anxious, or if you have any questions, never think they are unimportant or trivial. Please ask about anything that worries you. You can contact your specialist cancer nurse, the ward where you had any operations or delivered your baby, your GP or your hospital consultant at your next appointment.
If at any point you are finding it difficult to get what you need, such as appointments on days that someone can take you, or want to complain about your care or experience, your local PALS (Patient Advice and Liaison Service can support you). Most PALS services can be contacted through your hospital switchboard and/or website.
To find out more about the organisations and websites which we trust, please visit our resources page.