Pregnancy and surgery

Some operations in pregnancy may be done with a local anaesthetic, but most involve a general anaesthetic. Your cancer doctor and pregnancy doctor will explain the best timing for surgery. They explain the operation, its risks, and complications and how they monitor the baby. You may also see an anaesthetist.

Women with breast cancer can have surgery to remove only the area of the cancer or sometimes the whole breast (mastectomy). If you need radiotherapy, you have it after the baby is born.

Women with very early cancer of the cervix may be able to have it monitored and then have a hysterectomy after the birth. Occasionally, it may be possible to do surgery to remove most of the cervix and upper part of the vagina (trachelectomy). If the cancer is not at the earliest stage you can have chemotherapy to control it and then have a hysterectomy after the birth.

Women with melanoma are often cured with surgery which can be done safely during pregnancy. It is important not to delay surgery for melanoma because of pregnancy.

Pregnancy and surgery

Most operations can be done safely during pregnancy. Some can be done under local anaesthetic, but others involve having a general anaesthetic.

Your cancer doctor and pregnancy doctor (obstetrician) will work together to decide the best timing for surgery. They may delay it until you are in your second trimester. This is because surgery (under general anaesthetic) during the first trimester may slightly increase the risk of miscarriage.

You will see your obstetrician and an anaesthetist to discuss the operation. They will explain how they keep a close check on you and the baby during surgery. Your obstetrician may want to monitor the baby’s heart rate before and after surgery.

Possible complications

The risks and complications depend on the type of operation you are having. Your surgeon will talk to you about these. Surgery to your tummy area (abdomen) or to your pelvis may have more risk of complications. This is because the area is so close to the womb and baby. There is more risk if you are more than 25 weeks pregnant.

If you need this type of surgery, you and the baby will be very closely monitored during the operation. If you are later in your pregnancy, the obstetrician may be there. This is to make sure there is expert help available if there are any problems with the baby during surgery.

Blood clots

Pregnancy and surgery both increase the risk of a blood clot. Cancer itself can also increase the risk of a blood clot. Your surgeon and nurse will give you advice about ways to reduce this risk.

They may ask you to wear compression stockings before your operation and for a few weeks after it. You will also be encouraged to get up and walk around soon after your operation. Some women may be given injections under the skin to help reduce the risk of getting a clot.

A clot can cause:

  • pain, redness and swelling in your leg or arm
  • breathlessness
  • pain in your chest.

Contact your doctor straightaway if you have any of these symptoms. A blood clot is serious, but doctors can treat it with drugs that thin the blood.

After the operation I felt groggy and sore. But all that seemed irrelevant when the doctor arrived to check the baby’s heartbeat. It was such a relief to hear.

Polly


Different cancers and surgery

You can find out more about surgery in our information on the type of cancer you have. Call us on 0808 808 00 00 to order our free information booklets.


Breast cancer

Pregnant women with breast cancer are usually given a choice of operation. This is the same as for women who are not pregnant. You may have surgery to remove lymph nodes under your arm at the same time as breast surgery.

Your surgeon and breast care nurse will talk to you about your options for surgery. They may ask you to decide between having only the area of the cancer removed or having your whole breast removed (mastectomy). They will talk to you about the best timing for surgery.

Removing only the cancer

Women who have only the area of the cancer removed need radiotherapy to the breast afterwards (breast conserving treatment). Radiotherapy reduces the risk of the cancer coming back in the breast.

You will not usually have radiotherapy during pregnancy. Your doctor will advise you if the delay between having surgery and radiotherapy is safe for you. This depends on how far along your pregnancy is. But if chemotherapy is part of your treatment plan, you will have it before radiotherapy.

Removing a breast

Sometimes the surgeon may advise having the whole breast removed (mastectomy). This may be because the lump is too large or there is cancer in different parts of the breast.

A mastectomy can be done safely during pregnancy. You can have breast reconstruction after the baby is born and when treatment is over.

Some women may have chemotherapy before surgery to shrink a cancer. This means you may be able to avoid having a mastectomy. If this happens, surgery to remove only the cancer (breast-conserving surgery) may be done after the baby is born.

Sentinel lymph node biopsy (SLNB)

Some women have a sentinel lymph node biopsy done during their operation. Your surgeon will explain if it is suitable for you.

SLNB checks 1 to 3 lymph nodes in the armpit to see whether they contain cancer cells. If there are no cancer cells, you will not need further surgery to remove more lymph nodes.

For the test, a small amount of radioactive liquid is injected into your breast. There is no evidence that this is harmful for the baby. Usually with a SLNB you also have a blue dye injected into the breast to stain the lymph nodes. This is not usually given when you are pregnant.

Cancer of the cervix

One of the main treatments for cancer of the cervix is removing the womb (hysterectomy). If you continue with your pregnancy, surgery is done after the baby is born. Your doctor cannot be certain how delaying surgery may affect your outlook. They will explain the possible risks in your situation.

If you are diagnosed in early pregnancy, your doctor may think the delay in having surgery is too long. They may advise you to end the pregnancy so you can have a hysterectomy. This is a very distressing situation, especially as it means you can no longer get pregnant. It is important to talk to your doctor about concerns about your fertility.

If the cancer is very early-stage, it may be possible to delay surgery and monitor the cancer until the baby is born.

If the cancer is not at the earliest stage, or if it starts to grow, you can have chemotherapy to control it. You can then have surgery after the baby is born.

Removing the pelvic lymph nodes

Depending on how far along your pregnancy is, you may have surgery to remove the lymph nodes in your pelvis. This is to check if they contain any cancer cells. Your surgeon may advise this so they can be certain the cancer is still early-stage. You can only have this done if you are under 18 to 22 weeks pregnant.

The operation is done under a general anaesthetic using keyhole surgery (laparoscopically). The risk of complications or bleeding from this operation may be slightly higher in pregnant women. Your doctors and nurses will monitor you closely. If any complications develop, they can be treated quickly.

If there are cancer cells in the lymph nodes, your doctor may advise you to end the pregnancy. This is so you can have a hysterectomy straightaway. Your doctors and nurses will talk this over with you carefully and give you a lot of support. If you decide to continue with the pregnancy, you will be given chemotherapy. You can have a hysterectomy after the baby is born.

Trachelectomy

A trachelectomy operation removes most of the cervix and the upper part of the vagina. If the tumour is very small and early-stage, it may be possible to do it during pregnancy. But there is also a risk of bleeding and of losing the baby after the operation.

Very few women have had a trachelectomy during pregnancy. But some of these women have successfully given birth to healthy babies. This type of surgery is very specialised. It is only done in certain hospitals by surgeons who are experts in this area.

Hysterectomy after the birth

If you need a hysterectomy after the birth, it may be done at the same time as a Caesarean section (C-section) to deliver your baby. Your pregnancy doctor (obstetrician) will deliver your baby. 

They will talk this over with you very carefully to prepare you. You have a C-section through a cut made in your tummy. A gynaecological cancer surgeon will do the operation to remove your womb.

Melanoma

Surgery is the main treatment for melanoma and it can be done safely in pregnancy. Most early-stage melanomas are cured with surgery. So it is important that your operation is not delayed because you are pregnant. You may be able to have the melanoma removed using a local anaesthetic.

Lymph nodes

Sometimes your specialist may offer you a test called a sentinel lymph node biopsy (SLNB). This is to check whether any cancer cells have spread to the lymph nodes (glands) closest to the melanoma (sentinel nodes). It is a small operation that is done under a general anaesthetic.

You have it done in the same way as usual, except without the injection of blue dye. It is not usually given in pregnancy. We have more information about sentinel lymph node biopsies lymph node assessment and treatment.

A SLNB can tell your doctors more about your situation but it is not a treatment. It is important to talk to your specialist about how helpful it may be for you.

If the results show cancer cells, any surgery to remove the rest of the lymph nodes is usually done after the baby is born.

We have more information about surgery to remove the lymph nodes. It explains the benefits and disadvantages of surgery to remove the lymph nodes.

If melanoma has spread to organs inside the body, the specialist may ask you to think about having the baby delivered early. This is because the immunotherapy drugs used to help control advanced melanoma are not safe for the baby.