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When Pregnancy and Non-Hodgkin Lymphoma Collide

When Pregnancy and Non-Hodgkin Lymphoma Collide
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Published on July 28, 2020

An NHL Diagnosis in Pregnancy is Challenging But Can be Overcome

Receiving a cancer diagnosis during pregnancy is rare, but it does happen. It can be challenging to diagnose because so many changes are happening in a pregnant person, that some symptoms may be masked by the pregnancy itself.

The most common malignancies associated with pregnancy are melanoma, breast cancer, cervical cancer, lymphomas and leukemias.1

Non-Hodgkin Lymphoma

Non-Hodgkin lymphoma (NHL) is a type of cancer that originates in the lymphatic system, the disease-fighting network spread throughout your body. Approximately 1 in 6,000 pregnant women will face this diagnosis.

This type of lymphoma is often diagnosed at a later stage in pregnant women because an otherwise healthy pregnancy can mask certain symptoms, like increased blood flow. It’s important for women and their medical teams to be aware of the risk factors and early signs of NHL and other blood cancers, because the pregnancy itself may produce symptoms similar to the symptoms of lymphoma. 

In pregnancy-associated NHL, the reproductive organs (breasts and ovaries) are affected.

Are These Symptoms of Pregnancy or Non-Hodgkin Lymphoma?

When Pregnancy and NHL Collide

Below is a list of symptoms. Do you think they are from pregnancy, NHL, or both?

  • Painless, swollen lymph nodes in your neck, armpits or groin
  • Abdominal pain or swelling
  • Chest pain, coughing or trouble breathing
  • Persistent fatigue
  • Fever
  • Night sweats
  • Unexplained weight loss

These are symptoms of NHL, according to the Mayo Clinic, but for a pregnant person, there is a lot of overlap. And if it is your first pregnancy, every unusual ache or pain can be alarming. First-trimester fatigue is unlike other types of tiredness, and if a person is unable to keep their food down during this time, some weight loss is likely.

Treatment Options for Cancer During Pregnancy

A study published in the Journal of Clinical Oncology looked at women who were diagnosed with NHL during pregnancy. Eighty-four women waited to have therapy until after the baby was born. These patients were diagnosed at a median of 30 weeks’ gestation.

This compared with 56 patients who received antenatal therapy (before delivery) with median lymphoma diagnosis at 21 weeks’ gestation. Complications arose for some, the most common of which was preterm labor. A little more than half of the patients delivered their baby at 37 weeks. There were no differences in maternal complications, perinatal events, or median infant birth weight based on deferred versus therapy administered before the delivery.2

Chemotherapy in general is not without its risks, but it depends on the age of the fetus. The risk is highest between the ages of two weeks and 8 weeks. During these early days of pregnancy, the risk of major organ malformation is estimated between 10 percent and 20 percent. After 16 weeks, the risk is lower for organ malformation or brain development. However, getting chemotherapy at any stage in pregnancy is associated with an increased risk of intrauterine death, fetal growth restriction (FGR), preterm delivery, and low birth weight.3

So, it appears that chemotherapy can be considered safer later in the pregnancy, but more data would help us understand NHL in the pregnant patient population on a larger scale.

Breast Isn’t Always Best

Once the baby is born, you have other things to consider, such as using formula instead of breast milk, because of the toxins in the drugs you are being administered. I know that the “breast is best” mantra is the drumbeat of many a lactation consultant, but the health of the baby is the utmost important thing.

As my parents said when I struggled to breastfeed my newborn, “You were a formula baby and you turned out OK!?” It’s true. My five siblings and I all did. You have to pivot when a cancer diagnosis throws your life into a tailspin, but there is hope.

Sign up for Patient Power e-news to have more information about non-Hodgkin lymphoma delivered right to your inbox.

 ~Lauren Evoy Davis


References:

1Hepner A, et al. Cancer During Pregnancy: The Oncologist Overview. World J Oncol. 2019;10(1):28-34.

2Evens AM, et al. Lymphoma occurring during pregnancy: antenatal therapy, complications, and maternal survival in a multicenter analysis. J Clin Oncol. 2013;31(32):4132-4139.

3Hodby K, et al. Management of lymphoma in pregnancy. Obstet Med. 2009 Jun; 2(2): 46–51. Published online 2009 May 22.

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