Background: Cancer occurs during pregnancy at a rate of approximately 1 out of 1,000 pregnancies. Due to recent trends of postponed childbearing this rate may actually be increasing as age is a notable risk factor for many types of cancer. A cancer diagnosis may be delayed because symptoms of cancer may mimic normal changes of pregnancy. Cancer is perceived as an assault to the well being of both the woman and her unborn child.  Despite differing circumstances associated with this diagnosis, there are many commonalities related to the moral, psychosocial and ethical issues of treatment.

Case:  Mrs. S was diagnosed with recurrent glioblastoma multiforme at seventeen weeks gestation. Her treatment consisted of surgery to debulk the tumor, chemotherapy, physical therapy, cesarean delivery at thirty weeks gestation and palliative care after delivery.  Despite a grim diagnosis she continued postpartum chemotherapy hoping for a cure. She died three months after the delivery of her child.

Mrs. J.  was diagnosed at thirty weeks gestation with a neuroendocrine neoplasm of the pancreas with metastasis to the liver.  Mrs. J's symptoms were masked by her pregnancy causing a delay in diagnosis. Her treatment consisted of a liver biopsy to confirm the diagnosis, stent placement, amniocentesis for fetal lung maturity and cesarean delivery. Her cesarean section was coordinated with surgical oncology for visual inspection of her liver to determine progression of the cancer. Postoperatively she began chemotherapy and was able to successfully breastfeed her baby during treatment. She continues outpatient chemotherapy treatment and is doing well.

Conclusion: Despite the traumatic experience of diagnosis and treatment of cancer during pregnancy a favorable outcome may be achieved with the delivery of a healthy newborn. There are many complexities to be navigated during the treatment of cancer in pregnancy. Making treatment decisions is a collaborative effort between the patient, oncologist, surgeon, nurse and obstetrician. Careful planning optimizes safety for both the woman and her unborn child.

Keywords: Pregnancy, cancer, chemotherapy