The thing Stacy Gross worried about most wasn’t the surgery she received to remove a cancerous tumor from her right breast. It is what the chemotherapy that follows might do to her unborn daughter.
Her case is rare – estimates are that breast cancer occurs in one in every 1,000 to 10,000, pregnancies, according to the American Cancer Society, though most publications cite one in every 2,000 to 3,000.
In an exam room with Dr. Mark Keaton at Augusta Oncology Associates, there is worry on the face of her mother, Jessie Gross, and Tara Jenkins, Stacy’s older sister and “junior Mom” to her.
Gross has what is often called “triple negative” breast cancer, where her cancer lacks receptors for estrogen, progesterone and the HER-2 protein, which are what more targeted treatments aim for. She will be getting three drugs – Adriamycin, Cytoxan and Taxol – with the first two starting in her third trimester.
“Those two drugs can be given while you are pregnant,” Keaton said. The major organ development and formation has already occurred in the fetus by then, he said.
“Studies show there could be some decrease in growth rate, so the babies tend to be a little bit smaller, but they haven’t really seen any major long-term birth defects or anything if the chemo is not given in the first 14 weeks or so of the pregnancy,” Keaton said. “You’re already past that point.”
There are other things to worry about, Jessie said.
“Will this make her sick?” she asked.
Keaton reassures her that the old image of violently sick chemo patients is in the past.
“We have pretty good medicine where people don’t get sick,” he said. “It is pretty uncommon that people get sick with the chemo now.”
The third drug, Taxol, will be given as soon after the birth as possible when Gross is up to it, probably within a few weeks of delivery.
Dr. Elyce Cardonick, a maternal/fetal medicine specialist at Cooper Medical School of Rowan University who runs a registry of women who battled cancer while pregnant, found in a study of more than a dozen of her patients that giving that class of drugs even during pregnancy resulted in some smaller growth
but no major problems to the baby.
When Cardonick was a fellow in 1996, doctors were so nervous about treating pregnant patients with cancer that she said she had to present her evidence about safety to the hospital ethics board.
Even with studies that show the safety, the percentage of doctors who would counsel a patient to terminate the pregnancy rather than treat has not really changed since she started, and it seems contradictory to patients until it is explained to them, Cardonick said.
“We tell our patients not to smoke cigarettes and not to take medications they don’t need, yet we say you can take chemotherapy when you’re pregnant,” she said.
THE CONCERNS Gross’ family has about her unborn child even before she starts chemotherapy are still evident in her mother and her sister as they sit in the ultrasound room watching the screen.
“She has all of her limbs, right?” Jessie asked.
“She’s had all of that checked out,” sonographer Daphne Wodford said.
Then suddenly, the baby’s scrunched face swims into view, hidden behind her hand, and they let out a collective “Awwww” and a laugh.
“I can see her little face, Stacy!” Jessie shouts.
“She’s looking at you,” Stacy said.
“She sure is,” Jessie said to the monitor. “Hey, sweetie, hey.”
It also gives big sister the chance to tease little sister.
“I think she’s got Stacy’s nose,” Jenkins said.
“I want me and her to have a little more than a nose,” Stacy said.
Everything looks good on the ultrasound and the baby is 2 pounds, 12 ounces.
“If it stays on this growth curve, it’s not going to be a big baby,” Gross’ obstetrician, Dr. Calvin Hobbs, tells her later in the exam room. “But small doesn’t necessarily mean not healthy.”
Hobbs has had one other patient who battled leukemia during her pregnancy.
“And her baby was a little small at the time of birth, a little bit over 5 pounds,” Hobbs said.
“But she was healthy?” Stacy asked.
“Did absolutely wonderfully,” Hobbs said.
AS SHE WALKED into the Augusta Oncology office on Wheeler Road for her first round of chemotherapy, Gross’ braids are gone and her hair is cut short. Her best friend, Kimberly Nujin, is with her, with her mother and her sister on the way. She eats a Twix bar and Nujin gives her a look.
“They said it’s no problem with me eating,” Gross said.
She’ll get her first treatment, return for a shot that will help boost her blood cell production and then return the next week for lab work to see how she is doing.
Gross is worried that she will have to be in isolation after the treatment.
“Your blood counts may not even get low with this shot,” Keaton reassures her. “We’ll have to see.”
As Gross and her family walk into the infusion room littered with big chairs and IV poles, a man calls out a friendly “Welcome to our world.”
Gross heads toward a corner where there is a big window and glass doors leading out to a patio.
“This is bright and sunny,” Jenkins said, as Gross settles into a chair.
Heather Evans, a registered nurse and oncology certified nurse, points out the nearby bathroom, the kitchen with snacks and the closet with blankets and pillows.
“You will be cold one moment and throwing the blankets off the next,” she tells Gross.
As Evans administers the first chemo drug, the bright red Adriamycin, Gross is worried about loss of appetite. Evans tells her it does alter the taste of food for some patients, which makes them not want to eat.
Nujin is worried about the effects on the baby.
“With all of the little kicking and stuff that she normally does, she’ll still do all of that?” she asks. Evans assures her the baby will still be active.
“She’s doing it right now,” Gross said.
EVEN WITH ALL she has going on, Gross is still finishing her master’s degree in mental health counseling through Troy University. Her last class will finish up right around the time she is due to deliver M’Kaia Dakota Manuel. With four years of active duty before her Army Reserve service, she has been applying to VA hospitals.
“I understand what some of the vets are going through,” Gross said.
When her daughter is old enough, she plans to share the full story of what they went through in her treatment. And she plans to tell her this: “If it wasn’t for you, I would not have found this lump in my breast.”