Your Pregnancy and Cancer Questions Answered

This week "World News With Charles Gibson" reported on Linda Sanchez, a 26-year-old who is battling breast cancer during her first pregnancy.

We invited you to post your questions about pregnancy and cancer on our message boards. We sent your questions to Jennifer Litton, the breast oncologist at the M.D. Anderson Cancer Center, who was quoted on that broadcast and whose expert answers appear below.

Question: What are the chemo drugs used in pregnancy that do not cross the placenta barrier?

Dr. Jennifer Litton, breast oncologist, M.D. Anderson Cancer Center: We use a combination of 5-fluorouracil, doxorubicin and cyclophosphamide. We cannot say that it does not cross the placenta. In fact, when given in the first trimester, these drugs have been associated with birth defects that can be up to 19 percent. However, when given in the second and third trimesters, this rate drops to 1.3 percent, which is approximately the same for the general public. In the second and third trimesters, the children at birth do not appear to be having the same side effects as their mothers. More research needs be done with both the mothers and the children.

Question: My mother was diagnosed with breast cancer in 1965 while pregnant with me and is a survivor and has never had a relapse since her mastectomy. My question is, do I have a higher risk of developing cancer?

Litton: We do not have significant evidence that you have a higher risk of developing cancer because you were exposed to chemotherapy in utero. However, if your mother was diagnosed at a young age, she may want to consider talking to her medical oncologist and being seen by a genetic counselor to see if there is any concern for an inheritable genetic predisposition to cancer, such as mutations in the BRCA 1 or BRCA 2 genes. These are genes that fix mistakes in cells when they are dividing. In about 5-10 percent of breast cancers, these genes can be shut off and so cancers can develop including breast, ovarian and other cancers.

Question: What are your feelings on low doses of radiation therapy while pregnant? I am 27 weeks pregnant with Hodgkin's and have been delaying treatment until this point. My doctors think the radiation to the neck would be a better option than chemo. Just looking for more info!

Litton: There are reports of giving radiation therapy with specialized techniques for treatment of Hodgkin's Disease in the second and third trimester. I would really consider doing this at a large cancer center or seeking a second opinion with a radiation oncologist that has experience with these techniques before you make any decisions.

Question: Do you happen to know if the same applies to one with cervical cancer stage 1b1 while in 2nd trimester of pregnancy?

Litton: There are several case reports about chemotherapy during pregnancy for cervical cancer. But, like breast cancer, there are no big studies and long term follow-up of the mother and the children will be important for the medical community to address. You will have to make the decision that is best for you and you will need to discuss your questions and concerns with your gynecologic oncologist and obstetrician who need to take your specific case into account.

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