For Jo Powell, the joy that came with discovering she had finally become pregnant was short-lived. Mere days after learning of her pregnancy, the British administrator made another discovery: she had cancer.
Her doctors recommended that she terminate the pregnancy and begin treatment immediately, but Powell was determined to have the child, reports the Daily Mail. She refused treatment, instead opting to wait five months to begin chemotherapy. Two years later, Powell has amazed doctors by giving birth to a perfectly healthy boy and completely recovering from her disease.
"I just couldn't believe what they were saying to me. It was like I was in a living nightmare. Richard and I had been trying for a baby for years and we were convinced it wasn't going to happen for us, so Jake was so special," Powell told the Daily Mail.
When she discovered the lump in her breast, doctors warned her that the cancer could be aggravated by the hormones brought on by pregnancy. Despite the dangers, she convinced her doctors to delay chemotherapy treatment, but did insist on surgically removing her lymph nodes when she was 10 weeks along. She would not begin small doses of chemotherapy until she was nearly six months along. As soon as her son was born, Powell underwent intensive treatment that threatened her life, but she has now made a full recovery and recently learned that the cancer will not return.
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Powell's dilemma is not unique. According to Cancer.net, about 1 in 1000 pregnant women will fight cancer during their pregnancy. The well-respected cancer information site also says that while the disease rarely affects the fetus directly, various treatment options do have the potential to harm the unborn child.
One of the most common treatments, and the one that Powell decided to delay, is chemotherapy. It is considered risky in the first trimester, but recent studies published over the past year in the medical journal The Lancet have found almost no risk of harm to the fetus of mothers who had chemotherapy in their second and third trimesters.
Commenting on one of these studies, two French researchers stated that "Treatment of malignancy [cancer] in pregnancy is still associated with unacceptable errors: eg, the sometimes unjustified termination of pregnancies or the choice of an inadequate strategy for treatment of a tumour with the risk of compromised survival." In other words, these studies have the potential to change the way cancer in pregnancy is treated, encouraging pregnant women to terminate less and treat with chemotherapy earlier and more aggressively.
"It's an unusual situation because you're looking after two patients at once," says Dr. Mark Clemons, a medical oncologist at the Ottawa Regional Cancer Centre. He says that it's always a case of balancing the health of the mother and the health of the baby. Clemons says that while the Lancet studies are reassuring, every case is individual, and because cancer in pregnancy is relatively rare, it's hard for studies to be definitive.
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"These findings are reassuring of what we're already doing in standard clinical practice," says Clemons, " and the days of routinely advising abortion in these types of cases are fortunately long gone in the vast majority of cases."
The Motherrisk Program, which conducts research and provides information on maternal and fetal health through the Hospital for Sick Children in Toronto, identifies cancer as the second leading cause of death in Canadian women during the reproductive years. On their website, they detail the risks surrounding another common cancer treatment: radiation.
According to Motherrisk, the effect on the fetus depends on the radiation dose and the proximity of the treatment area to the unborn child. If the cancer being treated is more than 30cm away from the fetus, radiation can be safe. This means many areas, like the head, neck, breasts and extremities can sometimes be safely treated with radiation. Lead shielding, a lower dose, and using a smaller radiation field can also reduce the exposure to the fetus.
Ultimately, each woman's case is unique, and her decision should be made in consultation with the physicians that know her case. For Powell, taking control of that choice has lead to the best possible outcome: a healthy mother and child. "'He is so bright and cheery" Powell said of her son Jake in an interview with the Daily Mail. "I look at him now and I know the hell we went through for him was worth it."