Pregnant with cancer: Why a 2nd opinion is critical

Published: Jun. 27, 2018 at 4:41 PM EDT
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One young mom was told to end her pregnancy when she was diagnosed with cancer. But a second opinion changed everything.

Leigh Ingram’s story is a graphic illustration of evolving cancer treatment and the importance of a second opinion.

She was diagnosed with tonsil cancer when she was 16 weeks pregnant. Three doctors recommended she end her pregnancy and start treatment immediately. Instead, she asked one more doctor what he thought.

Leigh and Mike Ingram treasure every day with 1-year-old Layne. But at one point, they were close to never having her.

“Even though three people had told me that we should terminate, I felt like we needed to go to another institution and make sure we were really doing the right thing,” Leigh said.

They went for a second opinion at UCLA and a third at UC San Diego. Dr. Parag Sanghvi and colleagues came up with a plan that let Leigh keep her baby.

"Why don’t we do some surgery up front and see what the pathology shows?" Sanghvi said. "And then, if this is what we expect it to be, we'll follow her closely and then plan to do any additional treatment that's needed after she delivered her baby.”

“We really didn't think we would hear anything different, so it was just this ray of light to hear that we could keep the baby and that there was another option,” Leigh said.

Doctor’s at UCLA removed Leigh’s right tumor and 12 lymph nodes. Six months later, Layne arrived. The next day, doctors found a growth in Leigh’s other tonsil. That meant another surgery and six weeks of radiation.

Now, she says life is blessedly normal. She and Sanghvi say that with cancer treatment changing so fast, a second opinion can be critical.

“So, if there’s ever a time where you feel like yes, something’s just not right here, get that second opinion, find somebody who may be a better fit for you," Sanghvi said. "And I think Leigh’s case really illustrates that.”

“I can’t tell you how close we were to not having the baby," Leigh said. "It just – I just thank God every day for her.”

Sanghvi says Leigh also benefited from being treated at an institution that has experts from many fields. Her care required oncologists, radiologists, maternal fetal care specialists and the neonatal intensive care unit.



REPORT #2540

BACKGROUND: Cancer during pregnancy is uncommon. For many years, health care providers and women were often unsure about how to deal with cancer during pregnancy. Now, more women with cancer are starting or continuing treatment during pregnancy. Cancer itself rarely affects the growing baby directly. But having cancer while pregnant can be complicated for both the mother and the health care team. Therefore, it is important to find a health care provider who has experience treating pregnant women with cancer. The cancers that tend to occur during pregnancy are also more common in younger people. They include cervical cancer, breast cancer, thyroid cancer, Hodgkin lymphoma, Non-Hodgkin lymphoma, melanoma, and gestational trophoblastic tumor. Breast cancer is the most common cancer diagnosed during pregnancy. It affects about 1 in 3,000 women who are pregnant. Because breasts typically enlarge and change texture during pregnancy, changes from cancer may be difficult to detect. Or they may not appear to be abnormal. As a result, pregnant women with breast cancer may be diagnosed later than non-pregnant women.


TREATMENTS AND RISKS: When making treatment decisions for cancer during pregnancy, it is important to compare the best options for the pregnant woman against the possible risks to the growing baby. Treatment recommendations are based on many factors like stage of the pregnancy, type, location, size, and stage of the cancer. In general, treatment during pregnancy requires close teamwork with cancer doctors and high-risk obstetricians. These professionals can closely monitor the woman during treatment and make sure the baby is healthy. Some cancer treatments are more likely to harm the fetus during the first 3 months of pregnancy. So the health care provider may delay treatment until the second or third trimesters. When cancer is diagnosed later in pregnancy, health care providers may wait to start treatment until after the baby is born. In some cases, such as early-stage (stage 0 or IA) cervical cancer, health care providers may wait to treat the cancer until after delivery. Some treatments, such as radiation therapy, can harm the fetus in all trimesters. Radiation therapy uses high-energy x-rays to destroy cancer cells. The risks to the developing baby depend on the radiation dose and the area of the body being treated.


STUDY SUGGESTS TREATMENT DOESN’T HARM BABY: A new study of 129 children suggests that babies whose mothers have cancer during pregnancy, and seek treatment, are not at put at a greater risk for development problems. In the study, published in the New England Journal of Medicine, researchers looked at a group of children whose mothers had cancer during pregnancy. Ninety-six of the children were exposed to chemotherapy, 11 were exposed to radiotherapy, 13 were exposed to surgery, two were exposed to drug treatments and 14 had mothers who did not undergo treatment while pregnant. The mothers underwent treatment in the last two trimesters of pregnancy and the researchers followed up on the babies over a year after birth. Babies who were exposed to moms with cancer with or without treatment did not have impaired cardiac, cognitive or general development in early childhood, the study authors conclude. There was a higher prevalence of preterm births, but the researchers note the children had normal development at 22 months.