Breast Cancer During Pregnancy

You can be diagnosed with cancer at any point in your life, even when you are pregnant. Breast cancer during pregnancy has to be dealt with extra care as you have to be given the best treatment to eradicate cancer while also protecting your baby from the side-effects of any such treatment.

What Causes Breast Cancer in Pregnancy

While all the natural causes of cancer could be the reason for the occurrence of the disease, there are certain factors related to pregnancy that could cause breast cancer. Here are a few causes of the disease

• Pregnancy is associated with a spike in hormones like oestrogen and progesterone. These hormones enable the cancer cells to grow and multiply to other tissues.
• Some women have a genetic predisposition for breast cancer and pregnancy that gets triggered during pregnancy when the reproductive organs are at their peak.
• It has been observed that instances of cancer usually accompany late pregnancies.
• A family history of cancer.

Possible Breast Cancer Signs & Symptoms

The signs of breast cancer can be easily mistaken for other symptoms that are common during pregnancy. You can ask your doctor to keep an eye out for the following signs that could be indicative of breast cancer.

• Lumps or thickening of the flesh below the underarm or breast.
• Changes in the shape of the breast.
• The skin on the breast could exhibit signs of puckering or dimpling.
• Inverted nipple
• Any discharge from the nipple mainly if it has blood in it.
• If the skin on the breast, nipple or areola displays red, scaly or swollen tissue.
• The dimples on the skin resemble that of an orange peel. This condition is known as peau d’orange.

Is It Difficult To Diagnose Breast Cancer in Early Pregnancy?

In most cases, cancer is not detected in the early stages of the pregnancy as the various hormonal changes in pregnancy will cause the breast to look different in any case. As the body prepares itself for the pregnancy, the tissue in the breast becomes denser. This makes it harder to detect and diagnose any small tumours.

Doctors are usually aware of a problem only when the cancerous tissue becomes big enough to notice. A regular mammogram is not recommended as the radiation could cause harm to the developing foetus. Only after the mother-to-be crosses the first trimester is a diagnostic mammogram allowed along with a shield to protect the baby.

How to Check for Breast Cancer When Pregnant?

You might be wondering what you can do to catch the onset of cancer early enough to give you a good chance of beating cancer without endangering the health of your baby.

The best approach is to check your breasts and surrounding regions, particularly the underarms, daily. You can do this yourself or ask your partner to help you with hard-to-reach areas. If you see any signs of lumps in the tissue, then do not hesitate to bring it to your doctor’s attention.

Diagnosis

If your doctor finds that there is reason enough or signs of breast cancer, then he/she will either recommend a mammogram based on how far your pregnancy has progressed or suggest other imaging tests. Once the lump has been located, it then has to be identified as a benign or malignant one.

• One of the first things that will be done is that a sample of the tissue from the lump will be sent for a biopsy. This can be done in two ways – an inpatient procedure where the sample is taken through a simple surgical incision or an outpatient procedure where the sample is taken via a needle.
• Do not be worried about this procedure as the area around the lump will be adequately anesthetised and you will feel almost no pain.
• The biopsy is conducted to determine the nature of the lump. Most of the time, these lumps are tumours that are either benign, that is non-cancerous, or malignant, which means that it is cancerous.

Understanding the Stages of Breast Cancer

If the lump is deemed cancerous then knowing what stage of breast cancer you have will affect the method or line of treatment greatly. One of the major factors in determining what stage the cancer is in is how far the cancerous cells have spread to the lymph if at all. The other factors include the size of the tumour, if the cancer is invasive or not, and if cancer has spread beyond the breast.

• Stage 0: This stage is usually used to describe cancer where the cancerous cells haven’t broken away to invade or spread to tissues outside of the breast. This is known as non-invasive breast cancer.
• Stage 1: This is an invasive type of cancer where the cancerous cells are invading only normal breast tissue. The tumour measures up to 2 centimetres or absence of a singular large tumour but a collection of small cancer cells that range between the sizes of 0.2mm and 2mm. This small collection of cancerous cells could also be found in the lymph nodes.
• Stage 2: Here the cancerous cells will either have affected up to three lymph nodes, or the tumour is larger than 5 centimetres, or both.
• Stage 3: Here the cancerous cells would’ve spread up to 9 auxiliary lymph nodes or will be larger than 5 centimetres and swelling, or an ulcer might be observed, or it could have spread to the areas around the breast such as the chest wall or skin of the breast.
• Stage 4: In this stage, cancer would’ve spread beyond the breasts and will affect the other organs of the body such as the lungs, skin, bones, or even the brain.

Is Surgery The Best Option?

If the breast cancer is diagnosed at an early stage, the first option most oncologists will recommend is surgery, whether the patient is pregnant or not. This surgery poses no risk to the developing baby, though if the surgery is planned in the last trimester, then the OB/GYN will be present to monitor the health of the baby.

Please note that surgery is only recommended if the cancer is detected in its early stages and is located within the breast or the lymph nodes in the underarm.

Is Anaesthesia Safe For Breast Cancer Treatment In Pregnancy?

Anaesthesia has been known to cross the placenta and to the foetus. This does not appear to cause any birth defects to the baby or any other type of pregnancy issues. You can discuss this concern with your surgeon and gynaecologist to allay any other fears you might have. Since you are pregnant, the surgeons will move quickly on the operating table to ensure that you and your baby are not under anaesthesia for too long.

Treatment

The treatment for breast cancer will depend entirely upon the stage of cancer you have been diagnosed with. Usually, if the cancer is detected early enough, the first line of treatment is surgery.

• Surgery: Here the cancerous tissue from the breast and surrounding areas is removed surgically. There are two types of surgical options in this case – BCS, or breast-conserving surgery or mastectomy. In the former, only the cancerous tissue is removed from the body. The latter involves the removal of the entire breast that has cancer. BCS requires further radiation, and this is not recommended to pregnant women as it could harm the developing baby.
• Chemotherapy: This treatment will most likely be recommended to you based on the spread and stage of cancer and the stage of pregnancy. It is not recommended to women in their first trimester as it could affect the development of the baby. The radiation is also not recommended after the 35^th week of pregnancy and up to 3 weeks after delivery as it lowers the mother’s blood count.

Sometimes the best treatment plan for the mother might not be the healthiest option for the foetus. Since there are many variable factors with such a medical condition, you will need the expert advice of your gynaecologist, surgeon, medical oncologist and radiation oncologist to zero in on a treatment plan that will help you the most.

Does Breast Cancer Affect The Unborn Baby?

One of the most worrisome concerns most mothers-to-be with breast cancer have is that the breast cancer and pregnancy could affect one another; specifically, that cancer could harm the baby adversely. There has been no known instance of breast cancer spreading to the developing baby. However, in some rare cases, the cancer cells could spread to the placenta as well.

While a pregnancy on its own can be fraught with anxieties and worries, a pregnancy with breast cancer (pregnancy breast cancer) can make things much more complicated. Remember to check yourself for lumps and tell your doctor about your concerns, so that you can work together to come up with a treatment plan that keeps the stage of cancer, stage of pregnancy, and your personal medical history in mind.