Cancer During Pregnancy: Diagnosis & Care

This page is for people diagnosed with cancer while pregnant, and for their partners and families. It explains how diagnosis, treatment, and delivery planning usually work.

Being diagnosed with cancer while pregnant is frightening. Many people assume treatment is impossible. That is not always true. NCI says women can be treated for breast cancer during pregnancy. The type of treatment and its timing may be changed by the pregnancy.

The decisions are complicated. And they belong to the pregnant person.

Pregnancy can make cancer harder to spot. Normal breast changes, such as larger, tender and lumpy breasts, can hide small lumps. Because of this, breast cancer is often found at a later stage in pregnancy. If you notice a change that worries you, talk to your doctor right away. Pregnancy is not a reason to skip a workup.

Imaging is possible, with care. For breast cancer, the first test for a lump is usually an ultrasound, which uses no radiation. Mammograms use only a small amount of radiation and can be used safely. Ultrasound and MRI with limited use of dye can be used for staging. CT or PET-CT scans may be dangerous for the baby. When scans are used, steps such as shielding the belly keep the baby's exposure as low as possible.

Ask what each test would change. Ask whether a lower-exposure test answers the same question.

Care during pregnancy is shared between your cancer team and your pregnancy care team. Ask who is coordinating between them.

Treatment options depend on the stage of the cancer and the trimester. For some cancers, the choice to continue or end a pregnancy comes up. NCI notes that the ability to end a pregnancy because of advanced cancer may vary by state. For breast cancer, NCI says ending a pregnancy does not necessarily improve survival. Whatever you decide, you are entitled to a clear explanation of what each choice would mean.

Questions worth asking the whole team together, in one room:

• Can this cancer be treated well without delaying treatment, and what does waiting cost?
• Which specific drugs are being proposed, and what is known about each in pregnancy?
• Is delivery timing being driven by my treatment, by the baby's development, or both?
• Who is coordinating between oncology and obstetrics, and who do I call first with a problem?
• What follow-up will the baby have after birth?

Our general list of questions to ask before treatment begins can be adapted for this conversation.

The details depend on the type of cancer and the stage of pregnancy.

Surgery can be done during pregnancy for some cancers. For example, most pregnant women with breast cancer have surgery to remove the cancer or the breast.

Chemotherapy is a different question in the first trimester than later. NCI says chemotherapy is not safe for the fetus in the first trimester. Given in the second or third trimester, it does not usually harm the fetus. It may cause early labor and low birth weight. Radiation therapy is harmful throughout fetal development.

For breast cancer, NCI says hormone therapy, targeted therapy and immunotherapy are usually not given during pregnancy, because they can harm the baby.

Delivery timing becomes part of the treatment plan. For breast cancer, chemotherapy should be avoided 3 to 4 weeks before delivery. For some cervical cancers, the team may suggest an early delivery by C-section so other treatment can start. NCI says women getting chemotherapy should not breastfeed, because many of these drugs pass into breast milk. Ask about this in advance.

This can be a lonely diagnosis. NCI says one-on-one counseling and in-person or online support groups can help you cope. Hope for Two, also known as the Pregnant with Cancer Network, connects people who have been through cancer during pregnancy with those going through it now. Our support page has other starting points.

The team in front of you has your full history and your stated priorities. They are a better guide than confident opinions from people who have never faced this.

You now have two sets of warning signs running at once. Agree in advance who you call first for what, and keep both numbers together. When something happens, say up front that you are pregnant and receiving cancer treatment.

The CDC says to get medical care right away for these urgent warning signs during pregnancy (CDC).

• Call 911 or go to the ER if you have heavy vaginal bleeding, severe belly pain that does not go away, severe chest, shoulder or back pain, trouble breathing, or you faint or pass out. Do not drive yourself.
• Get care right away, at any hour, if your baby has stopped moving or is moving less than before, or you have any vaginal bleeding that is more than spotting or fluid leaking.
• Call your doctor right away, at any hour, if your temperature is 100.4°F (38°C) or higher after chemotherapy. CDC classes a fever on chemotherapy as a medical emergency, and pregnancy does not change that (CDC). This is not a message to leave for the clinic. If you cannot reach them, go to the ER and say you are pregnant and on chemotherapy.
• Get care right away if you cannot keep water or other fluids down, or one leg or arm becomes swollen, painful or tender.
• Call your care team right away if the wound from cancer surgery turns red, hot or starts leaking. For emergencies call 911 or go to the ER.

• CDC — Urgent Maternal Warning Signs
• CDC — Watch Out for Fever
• National Cancer Institute — Cervical Cancer Treatment during Pregnancy
• National Cancer Institute — Breast Cancer During Pregnancy
• National Cancer Institute — Cancer Staging