Making cancer treatment decisions during pregnancy
Your doctors and nurses will explain the risks and benefits of cancer treatment when you are pregnant.
Making treatment decisions
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT). This will include a cancer doctor and nurse and your obstetrician and midwife will also be part of the MDT.
After the MDT meeting, your doctors and nurses will explain your treatment options in more detail. It can help to have a partner, family member or close friend with you when you meet your doctor and nurse.
You and your doctors and nurses will need to talk things over carefully. As much as possible, doctors will try to give the same treatment as they would if you were not pregnant. Sometimes certain treatments are delayed because they are not safe for the baby.
You may have different treatment options. It is important to fully understand the risks and benefits of each option before you decide. This may involve several appointments with your cancer team. Your cancer team understand that you need to think through your options. You should make sure you take enough time to think about and understand the information they give you.
You may be making hard decisions that affect your own life and your pregnancy. You may also have other children to think about. You may need support from people that you are close to as well as your healthcare teams.
Unless you have a fast-growing cancer, you do not usually need to decide straight away. You can take time to think about how you feel and consider which options feel right for you. Your doctors and nurses will give you advice and help you with decisions. It may also help to see a psychologist or counsellor to talk things over.
If you need emotional support, practical advice or simply someone to listen, you can contact the Macmillan Support Line for free on 0808 808 00 00, 7 days a week, 8am to 8pm.
What treatment depends on
Your doctors consider many things before recommending the best treatment options for you. These are:
- how many weeks pregnant you are
- the type of cancer
- the stage of cancer – for example, how far it has grown or if it has spread
- if you have had treatment for cancer before
- how slowly or quickly the cancer is growing
- whether the aim of treatment is to cure the cancer or to control it.
The type and stage of cancer
Doctors will try to give you the same treatment as they would give to someone with the same type of cancer who is not pregnant.
Depending on the treatment you need, doctors may recommend delaying or changing treatment to help protect the baby.
Your doctors will talk to you before you make any decisions about your pregnancy and treatment. They also look at the stage of the cancer. If the cancer is bigger, doctors may advise starting treatment as soon as possible. They also look to see whether the cancer is a type that is likely to grow slowly or more quickly.
Slow-growing cancer
Doctors may be able to monitor a cancer that is growing slowly during pregnancy. If the cancer starts to grow more quickly, they usually recommend you start treatment. If you are diagnosed at a later stage of pregnancy, your doctor may advise delaying treatment until after the baby is born.
Fast-growing cancer
For fast-growing cancers, doctors usually recommend you start treatment straight away. If your pregnancy is at an early stage, they will usually talk to you about ending the pregnancy. This is because the cancer is a serious risk to your health. They can then give you the best possible treatment for your situation. You will be given lots of support to help you cope with this distressing situation.
If you are diagnosed in your third trimester, doctors may advise that the baby is delivered early. This is usually if you have a certain type of leukaemia or lymphoma. You start intensive chemotherapy straight after the baby is born.
How many weeks pregnant you are
How far along you are in your pregnancy is important when deciding about treatment. It affects the timing of different treatments, particularly chemotherapy.
A pregnancy usually lasts for about 40 weeks. It is divided into periods of around 3 months, called trimesters. During each trimester, the baby goes through different stages of development.
First trimester - week 0 to week 13 (month 0 to month 3)
The baby is developing, and its organs and limbs are forming. Doctors usually avoid giving chemotherapy during this time. Some types of surgery may need to be delayed.
Second trimester - week 14 to week 27 (month 4 to month 6)
The baby is growing quickly, and the lungs and other organs are developing. You can have chemotherapy any time from 14 weeks onwards. You can also have some types of surgery. At 24 weeks, the baby has a chance of surviving if it is born.
Third trimester - week 28 onwards (month 7 to month 9)
This is the final stage of growth, when the baby moves into position for birth. If you are diagnosed with cancer during this time, it may be possible to:
- delay treatment until after the baby is born, depending on the type of cancer
- have treatment to control the cancer until the baby is born
- have the baby delivered early, if neonatal doctors think the baby can cope with this, and then start cancer treatment.
Monitoring the cancer
If you have a very early-stage or slow-growing cancer, your cancer doctor may advise checking (monitoring) the cancer during your pregnancy, rather than having treatment. After the baby is born, you can start treatment. Doctors may suggest this if the cancer is not likely to change much during the rest of your pregnancy. It depends on the type of cancer you have and how many weeks pregnant you are.
Monitoring may be an option if you have:
- low-grade lymphoma or early Hodgkin lymphoma
- stage 1 cervical cancer
- chronic lymphocytic leukaemia (CLL).
If monitoring is an option, your cancer doctor and nurse will talk about it with you. They will explain the type of checks you will have.
Future fertility
Even though you are already pregnant, you may worry about the effects of cancer treatment on your future fertility. If you are worried about this, talk to your cancer doctor before treatment starts. Some ways of protecting fertility will not be possible during pregnancy. But there may be other things your doctors can think about, such as the type of chemotherapy drugs you have.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our pregnancy and cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
de Haan J, Verheecke M, et al. Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncology. 2018. Vol 19 [accessed October 2023]
Public Health England, Cancer before, during and after pregnancy, National Cancer Registration and Analysis Service 2018 [accessed October 2023]
Silverstein J, Post AL, Chien AJ, Olin R, Tsai KK, Ngo Z, Van Loon K. Multidisciplinary management of cancer during pregnancy. JCO Oncol Pract. 2020 Sep;16(9):545-557. doi: 10.1200/OP.20.00077. PMID: 32910882. [accessed September 2023]
Wolters V, Heimovaara J, Maggen C, et al. Management of pregnancy in cancer Int J Gynecol Cancer 2021;31:314–322.
Reviewer
Consultant Medical Oncologist & Honorary Associate Professor
Date reviewed
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