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It is not common to be diagnosed with cancer during pregnancy. But it can happen. Thousands of cancers occur during pregnancies each year in the United States.

The most common types of cancer found during pregnancy include breast, cervical, thyroid, colon, and ovarian cancers, as well as melanoma of the skin, lymphoma, and leukemia.  

Although it’s less common, someone might become pregnant while getting treatment for cancer. If this happens, the approach to treatment is the same as if the cancer were diagnosed during pregnancy.

Finding cancer during pregnancy

Cancer during pregnancy is usually found because a person notices a new lump, area of pain, or other body change and then sees a doctor. In some cases, a routine exam or lab test during a person’s pregnancy might show something abnormal that turns out to be cancer.

Cancers can be harder to find when you’re pregnant

During pregnancy, it can sometimes be hard to know if changes in your body are from the pregnancy, cancer, or another health problem. For example:

• The breasts can become larger, lumpy, and tender due to changes in hormone levels during pregnancy. These changes can make it harder for you or your doctor to notice a new lump until it gets quite large.
• Bleeding from the rectum could be from harmless hemorrhoids, which are common during pregnancy. But they can also be a sign of colon or rectal cancer.
• Fatigue, or feeling very tired, is very common during pregnancy. It could be from the effects of hormones, being less active, or weight gain. Another cause of fatigue is a low red blood cell (RBC) count, also known as anemia. Anemia can happen during a normal pregnancy. But it might also be a sign of a blood cancer such as a leukemia or lymphoma.
• The growth of the fetus and the uterus during pregnancy can make it hard to detect ovarian tumors.

Because of these challenges, when cancer develops during a pregnancy, it’s sometimes diagnosed at a more advanced stage than it would be otherwise.

If you find a lump, have a new pain, or notice any other concerning changes in your body, don’t ignore them. Tell your doctor or nurse right away. Any suspicious changes should be checked out as soon as possible.

Are imaging tests safe during pregnancy?

If there is a concern someone might have cancer during their pregnancy, or if cancer is found during pregnancy, imaging tests might be needed.

The main concern with any imaging test during pregnancy is whether it might be harmful to the fetus. This may be an issue if:

• The test exposes the developing fetus to radiation, especially during the first trimester.
• A chemical, known as contrast material, needs to be injected into the body before the test.

Below are some common imaging tests that might be done to diagnose or to stage cancer, along with the possible effects of each on the fetus.

Mammograms (x-rays of the breast) can find most breast cancers that start during a pregnancy. They’re generally thought to be safe during pregnancy. The small dose of radiation is focused on the breasts, so most of it doesn’t reach other parts of the body. Still, the lower part of the belly might be shielded to limit the amount of radiation reaching the fetus even further. For more, see Finding Breast Cancer During Pregnancy.

Ultrasound exams of the body do not use radiation and are thought to be safe during pregnancy. This is typically an easy test to have, so it can be used to evaluate a change (such as a lump or mass) in organs such as the liver, kidneys, ovaries, or breasts during pregnancy.

Chest x-rays use a small amount of radiation. They’re generally thought to be safe when you’re pregnant, especially when your belly is shielded.

Computed tomography (CT) scans use x-rays to make detailed images of the body. They’re often done to look for cancer or for signs of spread to other parts of the body. But because they’re likely to expose the fetus to some level of radiation, they are usually not used during pregnancy if other tests such as ultrasound or an MRI (see below) can be done instead. If a CT scan is needed because it could change a person’s treatment plan, it must be planned carefully, using a low dose of radiation and shielding the belly to limit the radiation exposure for the fetus.

Magnetic resonance imaging (MRI) uses strong magnets instead of x-rays to make detailed pictures of the body. It does not use radiation and is thought to be safe during pregnancy. MRIs can be done with or without contrast material (a chemical injected into the blood to help get better pictures). The contrast material used most often during an MRI is called gadolinium. Sometimes using contrast with the MRI scan might change the treatment plan (for example, if it shows a tumor not seen on images without contrast). But gadolinium can cross the placenta (the organ that connects the mother to the fetus). It has been linked with fetal abnormalities in lab animals. Although gadolinium's effects on humans aren’t clear, its possible risks for the fetus need to be weighed against the benefit of using it.

A bone scan is a type of nuclear medicine scan used to look for signs of cancer spread to the bone. The amount of radiation from a bone scan is small, and it is generally considered safe during pregnancy. But because it uses radiation, it is typically done only if absolutely needed.

A thyroid scan is a different type of nuclear medicine scan that might be done to test for thyroid cancer. This test is usually not advised during the first 12 weeks of pregnancy because of the radioactive iodine that is used.

Positron emission tomography (PET) scans are another type of nuclear medicine scan. They’re often done to look for cancer or for signs of spread to other parts of the body, sometimes combined with a CT scan (PET/CT) or MRI (PET/MRI). PET scans could expose the fetus to radiation, so they’re usually not done during pregnancy unless absolutely necessary. In these cases, scans that use very low doses of radiation might be an option to limit the amount of radiation exposure to the fetus.

Biopsy during pregnancy

If a new lump or mass, skin lesion, or abnormal imaging test result raises concerns about a change in the body possibly being cancer, a biopsy is typically done to help find out for sure. During a biopsy, small pieces of tissue are taken from the area of concern, which are then tested in the lab for cancer.

Needle biopsies are the most common type of biopsy. If the area to be biopsied isn’t near the surface of the body, an ultrasound or CT scan might be used to help guide a thin, hollow needle into the right place for the biopsy. Even if you are pregnant, a needle biopsy is usually done as an outpatient procedure, meaning you will go home the same day. If only local anesthesia is needed to numb the abnormal area or skin where the biopsy will be done, this causes little risk to the fetus.

If a needle biopsy doesn’t give a clear answer or if a needle cannot reach the area of concern, a surgical biopsy is typically needed. For this type of biopsy, a larger piece of tissue or the entire area is removed through a cut (incision). Surgical biopsies are often done while you are under general anesthesia (in a deep sleep), which carries a small risk to the fetus. If a surgical biopsy is needed, it might be delayed until the second or third trimester if possible, when it is believed to be safest for the fetus.

Does pregnancy affect survival rates for cancer?

What the research shows:

• Pregnancy can make it harder to find, diagnose, and treat cancer.
• Most studies comparing cancers found at the same stage have shown the outcomes among pregnant and non-pregnant women with cancer are about the same.
• Studies have not shown that short treatment delays, sometimes needed during pregnancy, affect cancer outcomes. But this has been a difficult area to study.

Each situation can be different. When considering treatment options, both the timing of the cancer diagnosis during the pregnancy and the nature of the cancer itself can be important. For example, for cancers that are growing quickly or are advanced, it might be important to start treatment as soon as possible. But for other cancers, delayed treatment might not be as much of an issue.

Depending on the situation, some people and their doctors might choose to wait until later in the pregnancy before starting treatment. Others might prefer to treat the cancer right away or might even consider ending the pregnancy. This can be influenced by personal preferences and beliefs. For more on this, see “Termination of pregnancy” below. 

When considering options, it’s important to understand the possible benefits and risks of each one before making such an important decision. Talking with your health care team, as well as other health professionals such as a counselor or psychologist, can often be helpful.

Is it safe to get cancer treatment during pregnancy?

Cancer can usually be treated safely during pregnancy, although the types of treatment and the timing of treatment might be affected by the pregnancy. If you are pregnant and have cancer, you might have hard choices to make. It’s important to get expert help and be sure you know all your options.

The main types of cancer treatment are discussed in more detail below, but here are some general principles about the safety of treatment during pregnancy:

• It is generally safe to have surgery for cancer during certain times of a pregnancy.
• Chemotherapy seems to have limited side effects for the fetus if given in the second or third trimester of pregnancy. However, it isn’t safe in the first trimester.
• Radiation therapy to the abdominal or pelvic area near the fetus is not safe during pregnancy. But radiation to an area farther away in the body (for example, the neck) might be an option in special circumstances when shielding is used to protect the fetus.
• Other cancer treatments, such as hormone therapy and targeted drug therapy, are more likely to harm the fetus and are not usually given during pregnancy.
• It’s not clear how much of a risk immunotherapy might pose to the fetus at this time. More research in this area is needed.

Termination of pregnancy

Most often, cancer can be treated during pregnancy. Ending the pregnancy isn’t routinely recommended, but each situation is unique. Ending a pregnancy is called having an induced abortion. For many types of cancer, studies generally haven’t found that outcomes are improved by ending a pregnancy in order to get treatment.  However, treatment choices can become complicated if there is a conflict between the best-known treatment for the cancer and the well-being of the baby.

For example, for some advanced or aggressive cancers that occur early in pregnancy, treating the cancer right away might offer the best chance of saving the mother’s (and possibly the fetus’s) life. If this is the case, the health care team might advise considering ending the pregnancy. This can be a very hard and unsettling decision to face. It can be helpful to speak with and get emotional support from a counselor, psychologist, or other trusted member of your health care team.

Laws regarding terminating a pregnancy are different in each state and should be part of the conversation with your health care team as it relates to your cancer care.

Treating cancer during pregnancy

If you are diagnosed with cancer while pregnant, the treatment goals are the same as they would be if you were not pregnant. The overall goals for cancer treatment are to cure the cancer if possible, or to control it and keep it from spreading. But treatment options will likely be more complicated during pregnancy. Your treatment team will need to balance giving you the best treatment for your cancer while also considering the fetus. Your treatment options will depend on:

• The type of cancer
• The size and location of the tumor
• If the cancer has spread and if so, how far
• How far along you are in your pregnancy
• Your overall health
• Your personal preferences

The type and timing of cancer treatment will need to be planned ?carefully. It’s important that care is coordinated between your cancer care team and your obstetrician (OB) and/or high-risk pregnancy doctor (called a maternal-fetal medicine (MFM) specialist).

Cancer surgery during pregnancy

Surgery is often part of the treatment for cancer. It is generally safe during pregnancy. Surgery may be considered depending on where the cancer is in the body. It is typically believed to be safest if done in the second or early third trimester, but it can be done any time during the pregnancy, depending on the situation.

The type of surgery depends on the extent of the cancer and at what point during the pregnancy the cancer is diagnosed. Sometimes, surgery might be done laparoscopically, which uses a few small incisions instead of one longer one. Laparoscopic surgery usually results in less blood loss, less pain, a shorter recovery time, and fewer preterm contractions compared to traditional open surgery.

Checking lymph nodes for cancer spread

For some types of cancer, along with removing the cancer, a surgeon might need to remove one or more nearby lymph nodes to check if the cancer has spread to them.

One way to do this is with a lymph node dissection (LND). With LND, many of the lymph nodes near the cancer are removed. This is often the preferred procedure during pregnancy.

A sentinel lymph node biopsy (SLNB) might be an option, depending on the type and stage of your cancer. This procedure allows the doctor to remove fewer nodes. However, it requires radioactive tracers (chemicals) to be injected into the body to help identify the lymph nodes closest to the cancer. Most experts recommend that only certain tracer agents, like technetium or indocyanine green, be used for an SLNB during pregnancy. These tracers give off very low doses of radiation. Experts also recommend avoiding use of the blue dye that is often used for a SLNB, as there is a small risk of a life-threatening allergic reaction to it.

Is anesthesia safe during pregnancy?

Surgery for cancer in areas other than the abdomen and pelvis generally carries little risk to the fetus. But there are certain times during pregnancy when anesthesia may be risky for the fetus. There are different kinds of anesthesia, but not all of them may be an option.

Your surgeon, anesthesiologist, and your OB and/or MFM specialist will work together to decide the best time during pregnancy to operate, as well as which anesthesia drugs and techniques are the safest for both you and the fetus. If the surgery is done later in your pregnancy, your OB may be there just in case there are any problems with the fetus during surgery.

Chemotherapy during pregnancy

Chemotherapy (chemo) might be used before or after surgery for some types and stages of cancer. It also can be used for more advanced cancers.

Chemo is generally not given during the first trimester of pregnancy. Because a lot of fetal development happens during this time, the safety of some chemo drugs hasn’t been studied in the first trimester. The risk of miscarriage (losing the baby) is also greatest during this time.

Studies have shown that it is generally safe to give certain chemo drugs during the second and third trimesters. This doesn’t seem to raise the risk of birth defects, stillbirths, or health problems shortly after birth. It might, however, increase the risk of early delivery. And it’s not clear if these children might have any long-term effects.

Chemo is generally not recommended after 35 weeks of pregnancy or within 3 weeks of delivery because it can lower the mother’s and baby’s blood cell counts. This could cause bleeding and increase the chances of infection during birth. Holding off on chemo for the last few weeks before delivery allows the mother’s and baby’s blood counts to return to normal before childbirth.

Radiation therapy during pregnancy

Radiation therapy can be used to treat some types of cancer. It can be given to the area where a cancer was surgically removed to lower the risk of the cancer coming back.

The high doses of radiation typically used for cancer treatment, especially in the area of the abdomen (belly) and pelvis, can harm the fetus at any time during pregnancy. This could lead to miscarriage, birth defects, slow fetal growth, or a higher risk of childhood cancer.

Because of this, doctors usually don’t use radiation treatment during pregnancy, but it can be considered for cancers that occur in parts of the body away from the fetus.

When given during pregnancy, the dose of the radiation, including any scattered radiation that might reach the fetus, needs to be kept as low as possible. For cancers such as breast cancer or lymphoma, the abdomen and pelvis are generally shielded from the radiation with an apron made with lead. If possible, treatment is also limited to early in the pregnancy, when the uterus is smaller and remains far from the radiation field.

It’s important to discuss the risks and benefits of using radiation versus other treatments with your cancer doctors, OB, and MFM specialist.

Hormone therapy during pregnancy

Hormone therapy is often used after surgery or as treatment for advanced cancer for certain types of cancer, such as some breast or endometrial cancers.

Hormone therapy is not usually given during pregnancy because it can affect the fetus. Most often, it is delayed until after delivery.

Targeted therapy drugs during pregnancy

Targeted drugs work differently from standard chemo drugs, but they can still have serious side effects. In general, most targeted therapy drugs aren’t used until after delivery. Most of these medicines have not been studied or used much during pregnancy, so they aren’t considered safe if taken during pregnancy. However, there can be some exceptions.

Immunotherapy during pregnancy

Most immunotherapy treatments have not been studied in pregnancy, so they aren't considered safe. Some may be safe to use at certain times during pregnancy, but there are many things to consider before deciding to use an immunotherapy treatment. In general, the use of immunotherapy drugs is usually delayed until after birth.

Can cancer spread to the baby?

In very rare cases, cancers have reached the placenta (the organ that connects the mother to the fetus) and then spread to the fetus. While extremely uncommon, this is most often seen with melanoma of the skin.

Can I breastfeed during cancer treatment?

Most doctors recommend you stop (or don’t start) breastfeeding if you’ve just had a baby and are about to be treated for cancer. Many chemo, hormone therapy, and targeted therapy drugs can enter breast milk and could be passed on to your baby. Breastfeeding isn't recommended if you are being treated with these types of drugs. Sometimes, it might not be safe to restart breastfeeding until months after treatment has ended.

If you have questions, such as when it might be safe to start breastfeeding, talk with your health care team. If you plan to start breastfeeding after you’ve stopped for a while, plan ahead. Breastfeeding or lactation experts can give you extra help if you need it.

Fertility and cancer

Cancer and its treatment can sometimes affect a person's ability to have children. See How Cancer and Cancer Treatment Can Affect Fertility in Women to learn more, including ways to help preserve fertility and possible fertility options available after treatment.