In general, when a pregnant woman has lung cancer, there are no specific manifestations, and most still have respiratory symptoms such as coughing and difficulty breathing. However, some pregnancy reactions are difficult to distinguish from lung cancer symptoms, so other means are needed to really diagnose lung cancer.
How is it diagnosed?
Lung cancer can’t be diagnosed without imaging. As a pregnant mother, you may be concerned about whether there is radiation from the test and whether it will affect your baby’s development. In fact, with proper protection, most imaging tests are safe, including:
- Chest radiographs. The radiation dose from a chest x-ray is very low, and studies have confirmed that such a low dose of x-rays is not enough to affect your baby’s development. However, for insurance purposes, a lead plate can be used to protect the abdomen and below.
- CT. CT scans provide more information and are more accurate than chest radiographs and are now almost routine in the diagnosis of lung cancer in clinical practice. However, the same lead plates can be used to protect the abdomen and below during the exam.
- Magnetic resonance imaging. This is generally used for scans of the head and bones. It has no radiation exposure and you can be assured of a safe exam.
- Tissue biopsy. Young, nonsmoking women with lung cancer are more likely to have a gene that can be “targeted. That’s why it’s so important to take the tumor tissue to determine the type of pathology and do genetic testing. This is a minor “procedure” and the damage to your body is minimal, so you can tolerate it under normal circumstances.
CT.
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How is it treated?
Pregnant women have a unique body function.
Pregnant women have unique body functions, and treatment needs to take into account the impact on the baby.
After diagnosis, you may also have the ambivalence of wanting to have a safe and healthy full-term delivery, and wanting to have your baby born early enough to receive treatment and control the progression of your disease. It is recommended that you consult with an experienced oncologist, as well as an obstetrician who has experience with high-risk births, who will help you weigh the pros and cons of early versus full-term delivery for your baby and work with you to develop the most appropriate delivery and treatment plan. For example, you may be concerned about the possibility of tumor cells metastasizing to your baby. One study found that the likelihood of tumor metastasis to the fetus during pregnancy was 26%, so your obstetrician may recommend early delivery to reduce the risk of metastasis.
Currently, common treatment options that can be adopted by pregnant women include:
- Surgery. For patients in stages I, II, and IIIA. Although there are risks, with proper preoperative preparation and intraoperative monitoring, surgery is instead the relatively safest of all treatment modalities.
- Chemotherapy. Chemotherapy is risky in the first trimester of pregnancy. The placenta is not fully developed, and chemotherapy drugs (such as platinum) can cross the placenta and affect the baby, even increasing the risk of miscarriage. After this trimester, when the placenta is fully developed, chemotherapy drugs cannot penetrate the placenta and the baby is able to avoid the direct effects of the drugs. At this point, the effects of chemotherapy on the baby are indirect. For example, pregnant women may have adverse reactions after chemotherapy, such as infections and anemia, which may have an impact on the baby’s development, such as developmental delays and eventually being born as a low birth weight baby. A study found that eight pregnant women who received chemotherapy had no metastasis of tumor cells to the fetus. This suggests that chemotherapy is like a double-edged sword for the baby, with both benefits and drawbacks.
- Radiotherapy. Pregnant women should avoid radiation therapy because the process produces high-energy X-rays that can have a greater impact on the baby.
- Targeted therapy.
- Targeted therapy. There are no clinical trials of any targeted drugs that include pregnant patients, so it is not clear whether targeted therapy is safe for pregnant women, and therefore it is not recommended for pregnant women. However, a very few studies have found that pregnant women have given birth to healthy babies with erlotinib, gefitinib, and crizotinib. However, your doctor still recommends that you take tissue for genetic testing after your lung cancer diagnosis, and after delivery, your doctor will use the results of the genetic report to develop the next step in your treatment plan.
To summarize: there are many treatment options for lung cancer, but not all of them are applicable to pregnant women. Your age, tumor location, type, and stage are all factors that your doctor will need to consider. Of course, the most important thing is what you and your family want.
Pregnant women have one disease and two risks. We hope that as lung cancer research continues to advance and expand, the future of pregnant lung cancer patients will have more and better treatment options.
Co-authors: Dr. Bai Xiaoyan, Guangdong Provincial People’s Hospital, Guangdong Lung Cancer Institute Dr. Zheng Meimei