Lymphoma is now the fourth most diagnosed malignancy during pregnancy, occurring in approximately 1:6000 deliveries.  With the delay in childbearing and the increase in primiparous maternal age it can be expected that cancer will become diagnosed more frequently in pregnant women. Since Non-Hodgkin’s lymphomas (NHL) occur in an older patient population than Hodgkin lymphomas, this may account for fewer reports of NHL patients with coexisting pregnancy. When a diagnosis is made, issues surrounding decisions regarding the approach to treatment options are extremely complex and must include the medical and obstetrical health of both the mother and fetus.

Case:

 B. B. was a gravida one, para zero, 25 year old married patient. She had multiple encounters with the healthcare system during her first and second trimester until being diagnosed with Non-Hodgkin’s Lymphoma at 27-28 weeks. An interdisciplinary team was formed and invites went out to Perinatology, Oncology, Obstetrics, Spiritual Services, Palliative Care and Social Services. The patient’s initial plan was to start the first round of chemotherapy to help with her pain and reduce the nodules in her neck. It was essential to the team that a clear plan with ongoing communication needed to be determined.  

Less than two weeks later the patient was readmitted for intractable head pain. A lumbar puncture confirmed cancer cells in her Cerebral Spinal Fluid. She would now need to be treated with chemotherapy in her brain through placement of an Ommaya Reservoir, a device surgically implanted under the scalp used to carry medicine to the brain and spinal cord. Her delivery was scheduled and would be complicated by her extremely low platelet and white blood cell counts.

The most critical and challenging issues for the team involved managing the patient’s pain, treating her cancer and keeping an obstetric eye on maternal well being and fetal development. B.B.’s care was complicated by her physical location in the hospital, family dynamics and need for prenatal education and rest. She delivered a female infant vaginally at 30+6 weeks.

Conclusion:

The diagnosis of cancer during pregnancy is rare, but may increase in the future. Through an interdisciplinary team effort that includes the obstetrical nurse we can accept the challenges that accompany the pregnant oncology patient and promote evidenced based best practice to provide continuity through physical, psychological and spiritual care for optimal outcomes.

Keywords:

Non-Hodgkins Lymphoma in pregnancy, Interdisciplinary teams for best outcomes