Cancer in pregnancy

The simultaneous occurrence of cancer and pregnancy is rare with a reported incidence of 0.07% to 0.1%. When it does so, it may be necessary to perform surgery or to prescribe chemotherapy or radiotherapy. Surgery can, and frequently is, performed without undue difficulty on a pregnant women. Excluding caesarean sections, about 50,000 pregnant women per year in the USA will undergo a surgical procedure. This treatment is never withheld from expectant mothers who need it.

Pregnant women with cancer are treated the same way as non-pregnant women with the same conditions. Numerous studies have shown over and over again that the outcome for pregnant women with cancer is no different than that of women who are not pregnant, when matched for age, stage and cancer type.

Effects on the unborn child

Some women will ask to delay some treatments until such a time as the baby is unlikely to be adversely affected by such treatment. The unborn child has developed all its organs and limbs by the 12th week of pregnancy. Hence chemotherapy can be given to a woman in the second and third trimester without causing any abnormality in the unborn child. With judicious selection of chemotherapeutic agents pregnant women can be treated even in the first trimester. Some drugs cannot cross the placental barrier, some others appear not to cause malformations. If the folic acid antagonists are excluded the incidence of congenital malformation is 6% for single agents. Fortunately, methotrexate, the principal folic acid antagonist used, is not part of any curative regimen for which a therapeutically equivalent substitute is lacking.

To optimise the efficacy of radiotherapy for cancer patents who are pregnant, the following factors must be considered: the potential effects of the therapy on the unborn child, the stage and prognosis of the mother's disease and the possible risks to the patient of restricting cancer treatment. The risk to the unborn is negligible if the foetal exposure does not exceed 0.1Gy.

Where cure is a realistic goal, therapy should not be modified in such a way as to compromise its achievement. If there is no hope for cure or even significant palliation, the primary goal may become the protection of the foetus from any harmful effects of anticancer therapy and the delivery of a healthy infant. Therapy should be individualised for each patient and patient choice must be respected.

Cancer of the womb

In the rare case of cervical cancer in pregnancy, it is usually necessary to immediately perform a hysterectomy to remove the cancerous womb of the mother. This hysterectomy is not, and has never been considered by medicine or by the law, as an abortion.

Abortion could do nothing to treat the diseased womb. The desired effect is the removal of the diseased organ; the undesired side effect is the early removal of the baby. The same treatment would be given to a non-pregnant woman with a cancerous womb.

Abortion and cancer

A cancer specialist Prof. James Fennelly, stated (Irish Times, 29/6/1992) that "there is no evidence that pregnancy makes cancer worse. There is no evidence that termination of pregnancy makes cancer better. All the necessary treatment can be given under specialised management." He quotes in detail which anti-cancer drugs can be used in different types of cancer (including breast cancer, leukaemia, melanoma and brain tumours) without the risk of producing a deformed baby. There is a possibility that the disease or treatment may cause a miscarriage or lead to an underweight baby, but this is very different from killing the child through abortion.