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Pregnant patient battles breast cancer

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When Stacy Gross found a hard lump high up on her right breast, it wasn’t a moment of panic. After all, she was four months pregnant and milk was starting to fill into her breasts, which can sometimes cause minor problems.

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Stacy Gross listens to Oncologist Mark Keaton (right) explain how the chemotherapy will not hurt her unborn baby.  SARA CALDWELL/STAFF
SARA CALDWELL/STAFF
Stacy Gross listens to Oncologist Mark Keaton (right) explain how the chemotherapy will not hurt her unborn baby.

“It happens,” said Stacy’s best friend, Kimberly Nujin, a mother of two. “You get knots in your breasts because of the milk forming and they hurt. It actually feels like a ball. I told her put a warm compress on it and massage it. We were just thinking it was clogged up milk.”

Her obstetrician’s nurse told her the same thing. But the knot didn’t go away. In fact, it got a little bigger. Her obstetrician, Dr. Calvin Hobbs, did an ultrasound at University Hospital and then sent her upstairs the same day to surgeon Randy Cooper, who did another ultrasound.

“(He said) I’m 99 percent sure this is breast cancer,” Stacy said. “I’m kind of in blackout mode when he said that.”

It is rare and estimates range widely about just how rare – breast cancer occurs in approximately one in every 1,000 to 10,000 pregnancies, according to the American Cancer Society, while others estimate one in every 2,000-3,000. But most agree it is increasing in part because women are waiting longer to have children and increasing maternal age is the biggest risk factor, said Dr. Elyce Cardonick, a maternal and fetal medicine specialist with Cooper Medical School of Rowan University in Camden, N.J., who runs a registry for pregnant women battling cancer.

“Our population is either completing their families later or starting their families later and cancer is being diagnosed earlier and earlier,” she said. “And the two populations, the pregnant population and the cancer patients, are crisscrossing more than they did when women would finish their childbearing by their 30s.”

What most people and even many doctors don’t realize is that cancer can be treated, even with chemotherapy, while the patient is still pregnant, depending on the stage of the pregnancy.

“People do get nervous when it comes to pregnant patients,” Cardonick said. “ ‘She has a mole on her leg, I can’t remove it, I can’t do surgery because she is pregnant.’ Yes, you can. ‘I can’t give her anesthesia or painkillers because she is pregnant.’ Yes, you can.”

In Stacy’s case, it is propofol that she gets during her lumpectomy. Her case will only be complicated by the fact that during the sentinel lymph node biopsy, when ordinarily Cooper would inject a blue dye to help him find the draining lymph nodes, the dye can’t be used in pregnant patients.

“It’s almost like he is going in somewhat blind,” Stacy said.

Not that it, or anything else, seems to slow down Dr. Cooper in the operating room at University. He draws a diamond around the three-centimeter rock-hard lump that sits close to her armpit. In five minutes of quick cutting, it is out and he is working on taking out the margins around it.

He spends about 15 minutes digging out seven lymph nodes before he is done and begins closing her up. On a fingernail on her right hand, Stacy sports a tiny pink ribbon.

In the waiting room, Cooper is giving Stacy’s mother, Jessie, the good news.

“It could not have gone any easier,” he tells her.

Still, her eyes are filled with tears.

“I prayed about it, put it in God’s hands and I feel so much better about it now,” Jessie said.

Though Stacy is 31 and a staff sergeant in the Army Reserve, Jessie still calls her “my baby.” And though she has three grandchildren already, this little girl will be special.

“I’m going to call her my little miracle baby,” Jessie said.

COMING MONDAY

What worried Stacy Gross most wasn’t the surgery she received to removed a tumor from her breast. It is what the chemotherapy that follows might do to her unborn daughter.

COMING IN METRO

TREATMENT OPTIONS FOR PREGNANT WOMEN

According to a review article published in June in the Journal of Thoracic Disease, pregnant women with breast cancer have some options when it comes to cancer treatment.

 • Surgery: A modified radical mastectomy where the whole breast is removed is the standard of care but a lumpectomy where just the tumor and associated tissue is removed is also a possibility. However, lumpectomy usually needs to be followed by radiation and radiation is not recommended during pregnancy.

• Radiation: The general consensus is to delay radiation therapy until after delivery because it can cause mutations in the fetus. In cases of urgent clinical need, it can be given if adequate shielding is provided and the area being treated is far away from the fetus.

• Chemotherapy: This method is generally not recommended during the first trimester because it might interfere with organ development but can be given safely during the second and third trimester. The risk of a defect in the fetus is around 10-20 percent in the first trimester but only 1.3 percent in the third trimester. The most common drugs used to treat breast cancer are anthracyclines and they have been shown to be safe during pregnancy. There is less study on a class called taxanes although a study out of Cooper Medical School of Rowan University found that with more than a dozen pregnant patients who received that class of drugs lower birth weight was the only major side effect for the baby.

• Hormonal therapy: Tamoxifen has been shown to cause defects in 20 percent of the fetuses exposed to it and is generally not recommended during pregnancy.


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