TMC PULSE

t m c » p u l s e | m a y 2 0 1 6 19 C ancer knows no timeline, and sometimes it can strike in the midst of the joy and possibility of a new pregnancy. In previous years, patients were advised to terminate the pregnancy for their own health. Today, there are treatment options for pregnant cancer patients that are safe for both mom and baby. Jennifer Litton, M.D., an associate professor in the Department of Breast Medical Oncology at MD Anderson, has treated women diagnosed with breast cancer after becoming pregnant. "No, you don't have to terminate a wanted pregnancy," Litton said. "There's no data that shows doing that improved outcomes." While adjustments need to be made to accom- modate pregnancy, treating a pregnant cancer patient is much like treating a non-pregnant patient. Surgery can still be performed, and many chemo- therapy drugs are safe after the first trimester, once the organs have developed. Chest X-rays and mam- mograms can also be done with fetal shielding. "The steps are what we do for our non-pregnant patients and that's really key to why patients have done so well here," Litton said, adding that, unlike many physicians, she also prefers to let patients go into labor naturally. "I know a lot of doctors take the baby super early, but for me, if I still have treatment to give, I think it's so much better if they don't have a NICU baby at 30 weeks," she said. "There's no reason because it doesn't change outcome. Our average birth week was 37 weeks, and I think that's a big part of why our kids are doing so well, too." Treating pregnant patients involves working closely with the patients' obstetricians, as it involves much more fetal monitoring than an average pregnancy. "Before chemo, I want them to see their maternal- fetal medicine specialist and have a good ultrasound so they can assess the fetus, the fluid around the fetus, the cord growth," Litton said. "Then what happens is they show up with a handwritten note or the doctor calls me and says we're good to go. They come across the street and we start the chemo that day." The same process repeats before every dose of chemotherapy. "If you give someone the regular therapy you would give a non-pregnant patient, just in the right timing," Litton said, "we've shown in studies here and in Europe that they do just as well as non- pregnant breast cancer patients." the best and safest course of action is to begin treatment immediately. But that doesn't have to mean the end of the road for cancer patients who want to start a family. "I never feel like the door is closed," Woodard said. "Unfortu- nately a lot of these procedures aren't covered by insurance, but we want women to know their dreams of motherhood don't have to be squashed. There are so many ways to build families now, and if they're open to it, they can still be a parent." After discussing with Woodard and the oncology team at MD Anderson, the Lingerfelts made several decisions prior to treat- ment. First, due in part to their age and desire to try to conceive immediately, they elected to delay tamoxifen indefinitely. Patricia tested positive for a mutation of the BRCA2 gene, putting her at higher risk for developing breast and ovarian cancer, so they have also discussed prophylactic removal of the breast tissue or ovaries within the next five years or so. Finally, they chose to begin IVF very soon after the conclusion of her cancer treatment. "I finished radiation in January 2015, and two months after that, we started the first cycle of IVF to retrieve eggs," Patricia said. Unfortunately, that first round resulted in only one embryo that was not high quality. The couple chose to wait to do another cycle, which they began in October. This time they had four embryos sent to genetic testing and were left with one to implant. "We transferred the one on Feb. 1, and two weeks later found out we were pregnant on my birthday," Patricia said. For the Lingerfelts, this preg- nancy is the realization of a dream over a decade in the making—one that quite a few times they thought might be a lost cause. Now, not only are they expecting their first child, but they also have the hope of potentially having a second. "We're super excited to see the possibility of that dream becoming a reality," Michael said. "It's taken a little while for it to sink in. To see that first ultrasound, when we saw the baby and saw the heartbeat— there was a lot of emotion in that moment." Jennifer Litton, M.D., associate professor in the Department of Breast Medical Oncology at MD Anderson. C A N C E R T R E A T M E N T D U R I N G P R E G N A N C Y

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