‘When a pregnant woman hears that she has cancer, the pink cloud disappears in one fell swoop’

The book contains Roselien’s story. When she is diagnosed with breast cancer, she says: ‘This doesn’t happen to us, does it? Damn, I’m still way too young and 22 weeks pregnant with our second child. How far has the cancer gone through my body?’
“When a pregnant woman hears that she has cancer, the pink cloud disappears in one fell swoop. My experience is that the woman and her partner are completely devastated and that the cancer turns their lives upside down. They are busy decorating the baby’s room and suddenly it’s about hospitals and fear for your own life. They have many questions about the treatment and its effects on the child. The treatment and chance of cure often depend on the type of cancer and the stage of the disease. But in all cases it is a dramatic message.”

Roselien says: ‘Without us knowing anything about it, my internist-oncologist calls in the AKZ. And with success, because we get to read an extensive report covering six A4 pages. Signed by 36 doctors who have looked into my situation. I feel so supported!’
“It is good that as a treating physician you have the option to submit a case of a pregnant patient to the AKZ. I did that myself a few years ago. I then treated a woman with cervical cancer who was pregnant with twins. Only 1 in 1,000 to 1,500 pregnant women has cancer, so as a doctor you often know too little about it. The treatment of a pregnant woman with cancer is often very complex, because you are dealing with a mother and a child. That is why we as doctors are sometimes forced to make different choices. You also want to make decisions quickly, because of the chance of the cancer spreading.”

‘It gives me a lot of peace and confidence that I can be treated. And that I know hoo,’ says Roselien in the book. What do you think is a point of attention in the treatment of mother and child?
“Because cancer is so rare in pregnancy, this can lead to undertreatment. Many doctors are afraid that the treatment will have harmful consequences for the child. For example, they say: ‘I am reluctant to make a scan, because X-rays are not good for the child.’ But in the interest of the mother, a scan may be necessary to get an idea of ​​the extent of the disease. We follow the rule that also applies in obstetrics: the mother comes before the child, because without a mother there is no life. Of course, we must limit the harmful effects for the child as much as possible.”

The AKZ advises treating physicians on the most optimal treatment. Can pregnant patients with cancer be treated better than twenty years ago?
“Nowadays it is preferable that these patients receive the same treatment as non-pregnant women. We want to prevent doctors from unnecessarily deciding to terminate the pregnancy early or postpone treatment until after delivery. Through research we now know that in most cases we can safely treat women during pregnancy with chemotherapy, for example. After the first trimester of pregnancy, the placenta is mature and acts as a filter. This means that the chemotherapy does not reach the baby and the risk of congenital defects is reduced.”

‘About 1.5 years later I was declared cured’Roselien says at the end of her story. ‘I now have not one, but two healthy daughters walking around.’ What are the chances of such a happy ending for mother and child?
“The chance of recovery depends on the patient’s situation: the type of cancer, the stage of the disease, the number of weeks she is pregnant and the treatment options. The woman with cervical cancer whom I treated a few years ago had only recently been pregnant. We opted for uterus-saving surgery by removing the tumor. As a result, the pregnancy was terminated, but she retained the option for a new pregnancy. That was of course extremely sad and had a huge impact on the expectant mother and her partner.”

As you said, it is good for doctors to ask the AKZ for advice. How important is it that they also involve other care providers?
“As an oncological gynecologist, I often refer patients to a psychologist or social worker. I also see in the cases of the Cancer in Pregnancy Advisory Group that the patients experience a lot. They are often referred to the STER(k) Foundation, the patient association for women with cancer during pregnancy. For example, patients have to deal with the loss of a child, infertility, fear that the cancer will come back and what that will do to trying to become pregnant again. Relationships often come under strain due to grieving. If the cancer is defeated, they often still have a world to win.”