Lung Cancer During Pregnancy

While rare, the incidence may be increasing

Table of Contents
View All
Table of Contents

Lung cancer can occur during pregnancy. When it does, it is usually diagnosed in the advanced stages of the disease and is more difficult to treat, due to the risks to both the mother and baby. Lung adenocarcinoma, a type of non-small cell lung cancer, is the most common type of lung cancer found in pregnant women (as is the case with young people and never-smokers with the disease).

Though other cancers are more commonly seen during pregnancy, including breast cancer, cervical cancer, lymphoma, and leukemia, studies suggest that the incidence of lung cancer may soon increase, as smoking rates among women in the United States are fast approaching those of men (13.6% versus 17.6%, respectively).

Doctor reviews records with pregnant woman
M_a_y_a / Getty Images


It is estimated that one of every 1,000 women will get some form of cancer while pregnant. Of the many forms, lung cancer is one of the least likely. The first case was documented back in 1953 and, as of 2016, there have only been an additional 70 cases reported in the medical literature.

A 2016 review in the Journal of Advanced Research looked into these cases and found certain commonalities.

  • Average age: The average age at diagnosis was 36.
  • Trimester: The diagnosis was usually made closer toward the beginning of the third trimester (an average of 27.3 weeks of gestation).
  • Cancer type: Non-small cell lung cancer was the cause in 82% of cases.
  • Cancer stage: 97% were stage 3 or stage 4 at the time of diagnosis.
  • Delivery status: 82% of the women gave birth to healthy newborns.


The reasons for these findings are not entirely clear, but it is believed that changes to a woman's immune system play a central role. This is actually a normal process in which the implantation of the embryo in the uterus alters the immune response so that the fetus is not regarded as a threat to the mother.

However, if there is pre-existing cancer, these changes to the immune system can leave the body less able to respond to the disease.

According to a 2019 study in Frontiers in Immunology, lung cancer can blunt the body's immune defenses during pregnancy as evidenced by increases in a protein called programmed death-ligand 1 (PD-L1).

PD-L1 is found on cancer cells and can bind to T-cells (a type of white blood cell) and neutralize them. Without T-cells to defend the body, tumors can grow unchecked and at far greater speeds. When this occurs during pregnancy, a tumor can be far more aggressive and dangerous.

The most common type of lung cancer encountered during pregnancy is adenocarcinoma.


Diagnosing lung cancer in pregnant women can be challenging, since lung adenocarcinomas tend to develop in the periphery of the lungs and only cause symptoms when they are quite large.

Even if symptoms develop, such as shortness of breath and fatigue⁠, they are easily mistaken for symptoms of pregnancy.

It is for this reason that lung cancer is usually not recognized in pregnant women until advanced stages, when there may be wheezing, swollen cervical (neck) lymph nodes, hemoptysis (coughing up blood), and unexplained weight loss.

If lung cancer is suspected, a healthcare provider can use the following tests to help diagnose the disease during pregnancy:

  • Chest X-rays and computed tomography (CT) scans, both of which use ionizing radiation to create images, can be used safely if a lead apron is worn to protect the baby from radiation.
  • Sputum cytology involves the coughing up of phlegm so that it can be examined under a microscope for cancer cells.

If any of these initial tests suggest cancer, a biopsy (such as fine needle aspiration) would be performed to collect a sample of cells for examination in the lab. This can provide a definitive diagnosis of cancer.

Bronchoscopy, sometimes used to diagnose lung cancer from within the airways, is contraindicated during pregnancy due to the use of anesthesia.

There are no blood tests that can diagnose lung cancer.

Molecular Profiling

There is a greater incidence of "actionable gene mutations" in women with lung cancer. These mutations—like EGRF mutations or BRAF mutations—cause physical changes in a cancer cell. This creates specific receptors on the surface of the cells onto which a targeted drug can latch.

These mutations can be identified with a battery of genetic tests called molecular profiling. Women diagnosed with lung cancer during pregnancy will usually undergo molecular profiling to see if they are candidates for newer targeted therapies.


If you are pregnant and have been diagnosed with lung cancer, it is important to find an oncologist experienced in treating pregnant patients. The cancer specialist should also work collaboratively with an obstetrician specializing in high-risk pregnancies.

Together, these healthcare providers can help you weigh the risks of continuing the pregnancy (including premature delivery) and exposing your baby to cancer treatments.

The treatment options during pregnancy are not as extensive as those for non-pregnant women. They include the following.

  • Surgery: Surgery for lung cancer offers the best chance for a cure for women with early-stage lung cancer (stage 1, stage 2, and stage 3A). It requires extensive preoperative imaging, such as MRI scans, and a surgical oncologist familiar with the nuances of maternal physiology.
  • Chemotherapy and targeted therapy: These treatments can pose risks for the fetus, and you will need to speak with your doctor to discuss the potential risks and benefits for your specific situation.

Radiation therapy is contraindicated during pregnancy. Immunotherapy drugs like Opdivo (nivolumab) and Keytruda (pembrolizumab) are also avoided due to the risk of fetal harm, although they may be used after the delivery.

A Word From Verywell

Lung cancer during pregnancy is uncommon. If you are or are planning to become pregnant, let your practitioner know if you've ever been a smoker and how many pack-years you smoked.

By knowing your smoking history from the start, your healthcare provider will be aware of your risk and better able to spot any early signs of lung cancer, while it is still highly treatable.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  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. National Institute on Drug Abuse. Are there gender differences in tobacco smoking?.

  3. Prabhudas M, Bonney E, Caron K, et al. Immune mechanisms at the maternal-fetal interface: perspectives and challenges. Nat Immunol. 2015;16(4):328-34. doi:10.1038/ni.3131

  4. Okuyama M, Mezawa H, Kawai T, Urashima M. Elevated soluble PD-L1 in pregnant women's serum suppresses the immune reactionFrontiers Immunol. 2019;10:86. doi:10.3389/fimmu.2019.00086

  5. Dagogo-Jack I, Gainor JF, Porter RL, et al. Clinicopathologic features of NSCLC diagnosed during pregnancy or the peripartum period in the era of molecular genotyping. J Thorac Oncol. 2016g;11(9):1522-8. doi:10.1016/j.jtho.2016.05.031

  6. Hepner A, Negrini D, Hase EA, et al. Cancer during pregnancy: The oncologist overview. World J Oncol. 2019;10(1):28-34. doi:10.14740/wjon1177

  7. Whang B. Thoracic Surgery in the pregnant patient. Thorac Surg Clin. 2018;28(1):1-7. doi:10.1016/j.thorsurg.2017.08.002

  8. Johnson DB, Sullivan RJ, Menzies AM. Immune checkpoint inhibitors in challenging populations. Cancer. 2017 Jun 1;123(11):1904-11. doi:10.1002/cncr.30642

By Lynne Eldridge, MD
 Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."