Lung Cancer During Pregnancy

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Lung cancer can and does occur during pregnancy at times, and since lung cancer is increasing in never smokers, especially young women, it may become an increasing problem in the future. There are a number of special challenges when lung cancer occurs during pregnancy, ranging from difficulties in making the diagnosis or choosing the best treatment options for both the mother and baby.

It's thought that lung adenocarcinoma, a type of non-small cell lung cancer, is responsible for the majority of lung cancers found in pregnant women. This is the type of lung cancer that is found most often in young people and never smokers with the disease.

Characteristics of Lung Cancer in Pregnant Women

While lung cancer may occur during pregnancy, it is not very common. The first case of lung cancer in a pregnant woman was reported in 1953, and as of 2016, there have only been an additional 70 cases reported in the literature.

A review of the literature helped reveal some characteristics of lung cancer diagnosed during pregnancy. Overall, the average age at diagnosis was 36, and the cancer was diagnosed at an average gestation of 27.3 weeks (with a range from 8 weeks to 38 weeks). Non-small cell lung cancer was the cause in 82% of cases, but unfortunately, many of the diagnoses were made when the tumor was already very advanced. The fact that 97% of tumors were diagnosed at stage 3 or stage 4 suggests that lung cancer that occurs during pregnancy follows an aggressive course. On a more optimistic note, 82% of the women gave birth to normal newborns.

The fact that lung cancer is usually diagnosed in the advanced stages in pregnant women suggests an aggressive course of the disease. A 2019 study looking at PD-L1 levels in pregnant women supports the theory that the relative suppression of the immune system during pregnancy may reduce the body's immune response to cancer.

Why Lung Cancer in Pregnant Women Is Increasing

It's thought that the main reason why lung cancer in pregnant women is increasing is that lung cancer is increasing in young people worldwide. At the same time, the age at first pregnancy is increasing in developed countries.

The mutational signature of these tumors suggests that secondhand smoke is not a major culprit, but the precise reasons have eluded us at this time. There is some concern that radon exposure in the home is increasing due to changes in home construction, but issues such as these have only recently begun to be studied.

We do know that there is a relationship between estrogen and lung cancer but aren't certain whether this may play a role in lung cancer in pregnant women. Lung cancer cells often have estrogen receptors, and the risk of lung cancer has been linked to hormone replacement therapy, oral contraceptive use, etc.

Challenge of Diagnosis

An obvious reason why diagnosing lung cancer in pregnant women can be difficult is that we usually try to avoid radiation exposure, such as lung CT scans or chest X-rays, during pregnancy. Another reason, however, has to do with the most common type of lung cancer found in pregnant women: lung adenocarcinoma.

Lung adenocarcinomas tend to grow in the periphery of the lungs and may grow quite large before they cause symptoms. Because of their location, they often cause slowly progressive shortness of breath, often first occurring only with exertion. They may also cause fatigue. Since some degree of shortness of breath and fatigue are so common with pregnancy, many women might first dismiss their lung cancer symptoms as being related to pregnancy; especially if they have never smoked.

Diagnostic Options

There are options for testing for lung cancer in pregnant women that minimize exposure of the baby to radiation. Tests such as MRI do not use radiation and are considered relatively safe in pregnancy. X-ray studies such as CT scans may be done when necessary if the baby is shielded from exposure.


Among young adults, non-smokers, and women with lung cancer, there is a much greater incidence of "actionable gene mutations." In other words, tumors in young people are more likely to have genetic changes—like EGRF mutations, ALK rearrangements, ROS! rearrangements, or BRAF mutations—for which the newer targeted therapies may be effective. For this reason, it is extremely important for women who are diagnosed during pregnancy (as well as all young adults who are diagnosed with the disease) to have molecular profiling (gene testing) done on their tumors.

Treatment Options

It's important to find an oncologist who is comfortable treating pregnant women with lung cancer. You may need to get a second opinion (or a third or a fourth). If you have a tumor with a targetable mutation (such as ALK), finding a lung oncologist who specializes in your particular molecular subtype of cancer can be very helpful.

At the same time, having an obstetrician who specializes in high-risk pregnancies is important. This physician can help you weigh the risks of prematurity with an early delivery against the risks of continuing the pregnancy and exposing the baby to the treatments you need.

  • Surgery for lung cancer offers the best option for a cure for women with early-stage lung cancer (stage 1, Stage 2, and stage 3A). Thoracic surgery can be performed on pregnant women, though special care is required for monitoring both patients. The growing abdomen can also create challenges. As with any treatment the care team including the surgeon, oncologist, and obstetrics specialist will need to work together to determine the optimal care for both mother and baby.
  • Chemotherapy is not associated with a teratogenic effect during the second or third trimester, meaning that chemotherapy is unlikely to cause birth defects. There is a risk of babies having a low birth weight as well as a small risk of intrauterine growth retardation.
  • Targeted therapies: In the past, targeted therapies (such as Tarceva for EGFR mutations) were avoided during pregnancy, but several recent case reports have discussed cases in which drugs such as Tarceva, Iressa (gefitinib), or Xalkori (crizotinib) were used, with no evidence of any effect on the baby after delivery.

In a 2015 report published in JAMA Oncology, a woman was treated successfully throughout her pregnancy. She was diagnosed (twin pregnancy) with stage 4 lung cancer with brain metastases at 10 weeks gestation, and Tarceva was started at the beginning of her second trimester (after an ethics consultation). When evaluated 13 months postpartum, the babies were both healthy and the mother was able to work as well as care for her babies. Without treatment, her expected life expectancy would have been less than one year.

Testing did show that Tarceva crossed into the placenta, but levels were much lower than the mother's blood concentration of the drug.

A Word From Verywell

Lung cancer during pregnancy is becoming more common. Though there are certainly many risks, many people have gone on to receive treatment and deliver healthy babies. Treatment of lung cancer during pregnancy depends on how far along you are (the gestational age of the baby). and many other factors such as the type and stage of your cancer, molecular profiling, and social support.

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  1. Mitrou S, Petrakis D, Fotopoulos G, et al. Lung cancer during pregnancy: A narrative review. Journal of Advanced Research. 2016. 7(4):571-574. doi:10.1016/j.jare.2015.12.004

  2. Ji Y, Schwartz J, Hartford A, et al. Successful Treatment of Non–Small Cell Lung Cancer With Erlotinib Throughout Pregnancy. JAMA Oncology. 2015. 1(6):838-840. doi:10.1001/jamaoncol.2015.1300

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