How Is Hodgkin Disease Managed During Pregnancy?

What happens if you develop Hodgkin disease when you are pregnant? How often does this happen?

Hodgkin Lymphoma in Pregnancy

Hodgkin lymphoma mainly affects young individuals in their teens and twenties - the same age when women often become pregnant. So developing Hodgkin disease during pregnancy is not that unusual. It's estimated that between 1 in 1,000 and 1 in 6,000 women have the face the question of how to manage Hodgkin lymphoma during pregnancy.

Hispanic man hugging pregnant girlfriend on sofa
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The symptoms of Hodgkin lymphoma can overlap with symptoms we associate with pregnancy. Some of these symptoms include feeling tired, having night sweats, and experiencing itchy skin. Thankfully Hodgkin's disease is very curable, and people who are diagnosed don't have to worry that they delayed their diagnosis, thinking the symptoms were due to pregnancy alone.

Does Hodgkin Lymphoma Behave Differently in Women Who Are Pregnant?

Hodgkin lymphoma behaves the same for women who are pregnant or those who are not. You may have heard rumors that pregnancy can "fuel" cancer. While that may be the case with, for example, an estrogen-dependent breast cancer, it is not the case for women with Hodgkin disease. The cancer grows and spreads the same way whether you are pregnant or not.

Tests for Pregnant Women

If you are pregnant, your doctor will likely order different tests to diagnose and stage your disease than if you weren't pregnant. X-rays, CT scans, and PET scans are generally avoided during pregnancy to prevent radiation exposure to the fetus. MRI scans are used instead; they are equally good while being harmless during pregnancy. The other tests are similar and so are the stages of Hodgkin lymphoma.

Is an Abortion Necessary?

It is rarely necessary to terminate a pregnancy when someone is diagnosed with Hodgkin lymphoma. Most often treatment can be delayed or modified until the baby is mature enough to be delivered relatively safely. Only if the disease is so advanced that it threatens the life of the mother, or makes a viable delivery impossible, is abortion considered.

Treatment During Pregnancy

There are no fixed rules on the treatment of lymphoma during pregnancy. The stage of lymphoma, the time of pregnancy and the wishes of the mother are all considered when making the treatment decision. Treatment is often delayed or modified so that the best balance can be obtained between disease control and the safety of the unborn child.

The first trimester of pregnancy: If Hodgkin is diagnosed during the first trimester of pregnancy, the intention is to delay the treatment if possible to prevent any damage to the fetus. The baby is most prone to harm from cancer treatments during the first three months when its organs are being formed - especially during the time span from 2 weeks to 8 weeks after conception. Chemotherapy is harmful at this stage and must be avoided. Radiation is harmful too if it reaches the womb. But it may be delivered to areas far away from the womb (like the neck or the upper chest) with careful shielding of the abdomen from the rays if it becomes necessary to start treatment. In most young women diagnosed in an early stage, it is possible to delay treatment until you reach your second trimester, or even until your baby is delivered.

The second and third trimester of pregnancy: Managing lymphoma in the latter half of pregnancy is easier because more choices are available. Waiting until the baby’s lungs mature (and it becomes suitable for delivery) is easier and steroids are given to hurry this process work quite well. If starting treatment becomes necessary, some chemotherapy drugs may be started without a high risk of damage to the fetus. In fact, a few studies show that the standard combination of chemo drugs like ABVD may be given safely during the last few months of pregnancy. Radiation may also be delivered to some select areas of the body if the abdomen can be carefully shielded.

Outcomes of Treatment

Results from a study that followed patients up for 20 years after treatment showed that the results of treating pregnant women with Hodgkin were no different from those who did not have the disease. Survival rates are the same. Hodgkin lymphoma is one of few cancers where the chances of cure are high in all stages. A few months of treatment delay during pregnancy does not alter treatment results too much. Keeping your baby is a definite option and few expectant mothers will let that pass.

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