When cancer strikes
Cathryn Marsala is excited about the arrival of her second child. She entered the first trimester of her pregnancy with some queasiness and increased fatigue—all normal symptoms for an expecting mom.
Upon entering her second trimester, her sister Ashley, 27, was diagnosed with Stage 2 thyroid cancer. Marsala knew there was a risk of such cancer in her family tree, as her younger brother Philip was diagnosed two years ago with Stage 1 thyroid cancer. To be safe, Marsala consulted her OB/GYN, John Eichenlaub and her father, Philip Bayliss, who happens to be an OB/GYN with maternal fetal medicine at Lancaster General Women and Babies Hospital. An ultrasound of Marsala’s neck was immediately ordered.
“Prior to the ultrasound, I really wasn't too worried about any issues. I was feeling healthy, my pregnancy was going great, and after all, what are the odds that both my siblings and I would have thyroid cancer,” she said. But the ultrasound showed “suspicious” nodules on her thyroid and a biopsy was ordered. The results were positive for thyroid cancer. “Many thoughts went through my head,” the 31-year-old admitted.
“What will happen to my baby?”
Hearing the words, “It’s cancer,” is daunting for any patient. Hearing those words when you are pregnant is overwhelming. The first thought for the new mom may be “What will happen to my baby?” She may also ask herself, “How will I take care of my baby if I have cancer?”
In most cases, doctors say the baby is not directly affected if mom has cancer. Only melanoma, a skin cancer, can cross into the placenta, according to John R. Mantione, MD, OB/GYN with Woodward & Associates in Middletown, and Chair of Obstetrics and Gynecology at PinnacleHealth.
It was evident based on the test results that like her sister and brother before her, Marsala needed to have her thyroid removed. “Most thyroid cancer is not aggressive,” Bayliss said, “and the primary treatment is to remove the thyroid.” It was decided in Marsala’s case that the thyroid would not need to be removed until a month after delivery so that she can bond with her newborn, a girl she and her husband plan to name Maggie. Marsala would also receive iodine radiation after the thyroid is removed.
She will be able to breastfeed her newborn daughter for a few weeks until she has her surgery.
A family history
While Marsala’s diagnosis is rare, there are ways for women with a family history of some cancers to be prepared in advance for such a diagnosis. Dr. Serdar Ural, chief of Maternal-Fetal Medicine with Penn State Milton Hershey Medical Center, noted genetic testing can be done for women with breast cancer in their family, and pap smears may be required more often for women with history of cervical cancers in their family.
Ural recommends women continue to do self-breast exams during pregnancy and cautions women to consider the fact that most expecting women have lumpy breast tissue. “Many times women will find a lump and almost every time it is benign,” Ural said, adding women should always tell their doctor if they feel something out of the ordinary.
Cancer in a child-bearing woman is rare because the women are younger, their cancer risk is low, Mantione said.
Ural pointed to a study that concluded one in every 1,000 pregnant mothers have cancer. “You would think that’s low,” said Ural, who has seen moms with leukemia and blood-related cancers, “and others say it is not.”
Problems during a cancer pregnancy are varied because much is to be considered.
“It depends on the gestational age of the baby when the mother is diagnosed,” Mantione said, and also if there are aggressive tumors involved.
Most women hold off on treatment for themselves until after the baby is born, much like Marsala.
Dr. Faith Daggs, OB/GYN at Holy Spirit Hospital said chemotherapy, if necessary, can be safely administered during the second and part of the third trimester of pregnancy and will not harm the baby.
Daggs also pointed out the recurrence rate of cancer in pregnant women is no different than a woman who is not pregnant. It is important to take the matter one day at a time and stay focused on the health of mom and baby during the pregnancy.
Holy Spirit Hospital offers a support program called “Mom’s Place,” designed for pregnant women and mothers who “feel alone, afraid, overwhelmed, sad or worried. The program is coordinated through the department of Behavioral Health and is offered from 6 to 7:30 p.m. every Tuesday at 20 Erford Road, Suite 11, Lemoyne.
Family support has played an important role in Marsala’s situation as husband Jamie and 3 year-old-son Jack give hugs and the support she needs.
Bayliss is not only Marsala’s father, but he is familiar with this scenario as dealing with pregnant moms in high risk pregnancies is his job. He said doctors are examining Marsala regularly and have also diagnosed her with hypothyroidism, which both Ashley and Philip had encountered with their cancer. She is now on a medication that will keep her thyroid levels ups and there has been no influence on the baby during these treatments. “All of my physicians are fantastic and are keeping an eye on both me and the baby. Up to this point, Maggie is as healthy as she can be and is doing great,” she said.
Tabitha Goodling is a freelance writer and mother of four daughters (including triplets!) from Juniata County.