Cancer in Pregnancy: Diagnosis and Management Challenges

Cancer during pregnancy is rare but difficult to manage because doctors must care for both mother and baby. Many cancer symptoms look like normal pregnancy signs, which can delay diagnosis. Treatment also needs careful planning so it helps the mother without harming the fetus. That’s why early checks, specialist care, and close monitoring are important.

Why does acting early matter?

The first step is to act quickly. Because the risks are high, any unusual sign, such as a persistent lump or unexplained bleeding, should be checked without delay. Once cancer is confirmed, care must shift to a multidisciplinary team (MDT). This usually includes a perinatologist, an oncologist, a pathologist, and a counselor. Working together, they assess both pregnancy-related and cancer-related risks.

Options for safe diagnosis

Diagnosis must be adapted for pregnancy, with a focus on safe imaging and avoiding unnecessary radiation. Ultrasound and MRI are preferred throughout pregnancy. CT scans and X-rays require abdominal shielding and should be used only when essential for staging. Nuclear medicine scans are generally avoided, especially in the first trimester. After the diagnosis is established, planning centers on the safest timing and type of treatment.

Timing of chemotherapy

Chemotherapy is avoided in the first trimester because this is the highest-risk period for birth defects. It can be given in the second and third trimesters, where risks are lower, though complications like restricted fetal growth, preterm birth, and temporary myelosuppression in the newborn can still occur.

Surgery and radiotherapy

Both treatments need careful planning during pregnancy. With proper precautions, surgery is generally safe and is usually scheduled after the first trimester, when fetal monitoring and obstetric support are available. Radiotherapy is mostly avoided because shielding the fetus from scatter radiation is difficult, and the risk of harm, especially developmental or cognitive damage, is high. If radiotherapy is necessary, it’s postponed until after delivery or, in rare life-threatening situations, done in the third trimester with strict shielding and carefully controlled dosing.

Counseling and follow-up

Care relies on honest, supportive counseling and steady follow-up. Discussions include the diagnosis, when the treatment will take place, whether the mother will deliver a baby early or not, and long-term projections of both the mother and the baby. All the choices are made so that the mother and the baby are safe. It is also important to have emotional support because the situation presents a lot of stress and uncertainty.