Cancer Diagnosis During Pregnancy or Postpartum

This page is for anyone diagnosed with cancer while pregnant or soon after giving birth. It explains who should be on your team, how treatment can work at each stage of pregnancy, and when to get help right away.

You may have been told that cancer in pregnancy means choosing between your treatment and your pregnancy. NCI's guidance on breast cancer during pregnancy says ending a pregnancy does not necessarily improve a woman's chance of survival. That depends on the cancer type and stage. ACS says treatment options depend on the type of cancer, its size and location, whether it has spread, how far along you are, your health, and your own wishes. ACS also says laws about ending a pregnancy differ by state, and that this should be part of the talk with your team.

NCI says about 1 in 1,000 pregnant women is diagnosed with cancer. That is uncommon enough that your local team may not have managed it before. NCI also says newer treatments, such as immunotherapy and targeted drugs, have not been evaluated in this group.

You need a team, not a single doctor. ACS says care should be coordinated between your cancer care team and your obstetrician and, or, a high-risk pregnancy doctor called a maternal-fetal medicine (MFM) specialist. If nobody has mentioned one, ask for the referral by name. If your center is unfamiliar with cancer in pregnancy, it is reasonable to ask for a second opinion at a center that manages it regularly.

First trimester. ACS says chemotherapy is generally not given in the first trimester, because a lot of fetal development happens then and the safety of some drugs has not been studied. ACS says surgery is generally safe during pregnancy. It is typically believed to be safest in the second or early third trimester, but it can be done at any time, depending on the situation.

Second and third trimesters. NCI says that after the first 3 months, certain types of chemotherapy may be given. It says this does not usually harm the fetus but may cause early labor or low birth weight. ACS says it might raise the risk of early delivery, and that it is not clear whether these children have long-term effects. NCI reported that a 2015 study from the International Network on Cancer, Infertility and Pregnancy found that chemotherapy in the womb did not raise the risk of developmental or cognitive problems.

Not every drug qualifies. Your team should choose the regimen.

Anesthesia. ACS says surgery for cancer outside the belly and pelvis generally carries little risk to the fetus. But there are times in pregnancy when anesthesia may be risky. Your surgeon, anesthesiologist and OB or MFM specialist decide the best timing.

Radiation is usually not used during pregnancy. ACS says high doses, especially to the belly and pelvis, can harm the fetus at any time. For imaging, ACS says CT scans are usually not used if ultrasound or an MRI can be done instead.

NCI says chemotherapy should be avoided 3 to 4 weeks before delivery, because it can cause delivery complications for both mother and baby. ACS says chemotherapy is generally not recommended after 35 weeks or within 3 weeks of delivery, because it can lower blood counts. Your oncologist and MFM specialist will plan delivery timing with you.

NCI says women receiving chemotherapy should not breastfeed. Many chemotherapy drugs may be found in high levels in breast milk and could harm the nursing baby. NCI also says that if surgery is planned and a woman has already given birth, breastfeeding should be stopped. If breastfeeding matters to you, raise it before treatment starts.

You are recovering from birth, sleeping badly, and caring for a newborn while starting treatment. Practical help here is not a luxury. Ask the hospital social worker what exists locally. Let people do specific tasks rather than waiting for you to ask.

Ask what your specific cancer, stage and stage of pregnancy make possible. Ask for a maternal-fetal medicine specialist. And get a second opinion if the first conversation started with an ultimatum.

CDC says to seek medical care immediately for any urgent maternal warning sign, during pregnancy and in the year after delivery. Tell them you are pregnant or were pregnant in the last year, and that you are being treated for cancer.

• Call 911 or go to an emergency department if you have the worst headache of your life or a headache that will not go away, vision changes such as flashes or blind spots, chest pain, a fast or pounding heartbeat with dizziness, sudden trouble breathing, fainting, or you are suddenly confused or very hard to wake. Do not drive yourself.
• Call 911 or go to an emergency department if you have heavy bleeding, such as soaking through a pad in an hour, or passing clots bigger than an egg. Also go if you vomit blood or material that looks like coffee grounds, or have black, tarry stool.
• Call your care team and your obstetric team right away if you have vaginal bleeding that is more than spotting, fluid leaking, vaginal discharge that smells bad, severe belly pain that does not go away, extreme swelling of your hands or face, or the baby moves less or stops moving. CDC lists all of these as warning signs to act on immediately.
• Call your care team and your obstetric team right away if one leg or arm becomes swollen, red, painful or tender. CDC lists this as a warning sign during pregnancy and up to 6 weeks after birth.
• If you are on chemotherapy or have low white cells, call your care team right away, day or night, if your temperature is 100.4°F (38°C) or higher. CDC's advice is to call your doctor immediately, because fever may be the only sign of an infection that could be life-threatening during chemotherapy. Also call right away for chills, a sore throat, mouth sores, burning when you urinate, redness at a catheter site, or any other sign of infection, even without a fever. A normal temperature is not permission to wait. If you cannot reach them quickly, go to an emergency department. Say that you are pregnant or recently pregnant and on chemotherapy.
• Call your care team the same day if you are very tired and weak in a way that is not normal for you, or you are severely sick to your stomach and cannot keep fluids down.

If you have thoughts of harming yourself or your baby, tell someone today. In the US you can call or text 988 at any hour.

• CDC: Urgent Maternal Warning Signs (Hear Her).
• CDC: Fever During Cancer Treatment.
• NCI: Breast Cancer Treatment During Pregnancy (PDQ).
• NCI Cancer Currents: Treating Cancer during Pregnancy: New Drugs, Old Questions.
• American Cancer Society: Cancer During Pregnancy.