When you have surgery for cancer during pregnancy

Most operations are safe during pregnancy. The surgery you have will depend on the type of cancer you have. Some operations are done under local anaesthetic. Others may use a general anaesthetic. Depending on the type of operation you need, you may have a regional anaesthetic (such as an epidural), which numbs an area of the body. You may have this instead of a general anaesthetic.

Your cancer doctor and pregnancy doctor (obstetrician) will decide the best time for you to have surgery.

If you need a general anaesthetic, they may recommend delaying it until you are in your second trimester (over 14 weeks pregnant). This is because having a general anaesthetic in the first trimester, can slightly increase the risk of miscarriage.

If you have surgery during the third trimester (from 28 weeks), your doctors will give you drugs to stop you going into labour.

Your obstetrician and an anaesthetist will talk to you about the operation. They will explain the checks they will do on you and the baby during surgery. Your obstetrician may want to check the baby’s heart rate before and after surgery.

Possible complications

The risks and complications depend on the type of surgery you are having. Your surgeon will explain these to you.

Surgery to your tummy area (abdomen) or your pelvis may have a higher risk of complications. This is because the area is so close to the womb and baby. There is more risk if you are further than 25 weeks pregnant.

If you need this type of surgery, you and the baby will be checked very closely during surgery. If you are later in your pregnancy, the obstetrician may be there to provide expert help if there are any problems with the baby.

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 specialist 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. They will also encourage you to get up and walk about soon after your operation. Your nurse may give you injections under the skin to reduce the risk of a blood clot.

A clot can cause:

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

Contact your doctor straight away if you have any of these symptoms.

Breast cancer and surgery during pregnancy

If you have breast cancer, you are usually given a choice of operations. This is the same 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. They may ask you to decide whether you want only the area of the cancer removed, or your whole breast (mastectomy). They will talk to you about the best timing for surgery.

Removing only the cancer

You may have surgery to remove only the area of the cancer. This is called breast conserving surgery. You will need radiotherapy to the breast afterwards. Radiotherapy reduces the risk of the cancer coming back in the breast.

You will not have radiotherapy while you are pregnant. Your doctor will tell you if having a delay between surgery and radiotherapy is safe for you. This depends on how many weeks pregnant you are. If chemotherapy is part of your treatment plan, you will have this before radiotherapy.

Removing a breast

Sometimes the surgeon may recommend having the whole breast removed. This is called having a mastectomy.

It is safe to have a mastectomy during pregnancy. If you want breast reconstruction, you can usually have this after the baby is born and when treatment has finished.

Some women may have chemotherapy before surgery to shrink a cancer. This means you may not need to have a mastectomy. You may have breast-conserving surgery after the baby is born.

Sentinel lymph node biopsy (SLNB)

Some women have an SLNB during their breast operation. Your surgeon will explain if it is suitable for you.

An SLNB usually checks about 1 to 3 lymph nodes in the armpit to see if 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 you would also have a blue dye injected into the breast to stain the nearby lymph nodes. But this dye is not usually given during pregnancy.

Cancer of the cervix and surgery during pregnancy

One of the main treatments for cancer of the cervix is removing the womb (hysterectomy). Your treatment in pregnancy depends on the stage of the cancer, how many weeks pregnant you are and your choices.

Your specialist doctor will explain the risks of continuing with the pregnancy in your situation.

Monitoring early stage cancer of the cervix

If the cancer is very early-stage, it may be possible to delay surgery and monitor the cancer until the baby is born. If there are signs the cancer is growing, your doctors can give you chemotherapy. Many cervical cancers diagnosed in pregnancy are at an early stage.

Delaying surgery

If you are still in early pregnancy, your doctor cannot be sure how a delay in surgery may affect your outlook. Sometimes they may advise ending the pregnancy so you can have a hysterectomy. This is a hard situation, especially as the surgery means you can no longer get pregnant. Your doctors and nurses will give you a lot of support. It is important to talk to your doctor about any fertility worries you may have.

If you continue with your pregnancy, or are diagnosed later in pregnancy, your doctor may recommend chemotherapy. You can have this if you are more than 14 weeks pregnant. You can have surgery after the baby is born, or at the same time as a Caesarean section. Some women may need more chemotherapy and sometimes radiotherapy after the birth.

Surgery to remove the pelvic lymph nodes

If you are under 18 to 22 weeks pregnant, your doctor may recommend surgery to remove the lymph nodes (glands) in your pelvis. This is to check if the nodes contain any cancer cells. Your surgeon may advise this so they can be certain the cancer is still early-stage.

If there are cancer cells in the lymph nodes, doctors usually recommend you end the pregnancy. This is so you can have a hysterectomy straight away. Your doctors and nurses will talk about this with you and give you a lot of support.

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

If you decide to continue with the pregnancy, you will have chemotherapy. You can then have a hysterectomy after the baby is born.

Trachelectomy

A trachelectomy 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 the surgery during pregnancy. This may happen if the cancer diagnosis is early in the pregnancy and you want to continue with the pregnancy. You usually have the pelvic lymph nodes removed first, to make sure the cancer is early stage.

With a trachelectomy there is a risk of bleeding and of losing the baby after the operation. Doctors will talk to you to make sure you fully understand the risks involved and any other options.

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

Hysterectomy after the birth

You may need a hysterectomy after the birth. This may be at the same time as the Caesarean section (C-section) to deliver your baby. Doctors do not advise a normal delivery as there are possible risks of bleeding from the cancer.

A gynaecological cancer surgeon will do the hysterectomy. An obstetrician will deliver your baby through a cut made in your tummy (C-section).

Your doctors and nurses will talk with you before surgery so you understand what will happen.

Melanoma and surgery during pregnancy

Surgery is the main treatment for melanoma. Early-stage melanomas are usually cured with surgery. This surgery is safe during pregnancy. It is important not to delay surgery because you are pregnant. Usually you can have the melanoma removed using a local anaesthetic.

Sentinel lymph node biopsy (SLNB)

Sometimes your specialist may offer you a test called a sentinel lymph node biopsy (SLNB). It checks if any melanoma cells have spread to the lymph nodes (glands) closest to the melanoma. It can tell your doctor more about the stage of the melanoma and if you need further treatment.

An SLNB removes the first lymph node or nodes called the sentinel nodes. You need a general anaesthetic to have it done. The doctor injects a small amount of radioactive liquid close to the lymph nodes. There is no evidence that this is harmful for the baby. Usually, they inject a blue dye to stain the nearby lymph nodes but this dye is not usually used during pregnancy.

Adjuvant treatment

If the melanoma has spread to the lymph nodes nearby, your doctor may talk to you about further treatment to reduce the risk of the melanoma coming back. This is called adjuvant treatment. This may involve immunotherapy and targeted therapy drugs which you cannot have during pregnancy.

Adjuvant treatment must start within a set time after SNLB. This means you will only have an SNLB in your third trimester (28 weeks onwards) of your pregnancy.

Advanced melanoma

If melanoma has spread to other parts of the body, your specialist may ask you to think about having the baby delivered early. This means you can start treatment with targeted therapy and immunotherapy drugs.