Monday, January 29, 2018

Facing realities:When cancer of cervix strikes during pregnancy

Dr. Christopher Peterson

Dr. Christopher Peterson 

By Dr Chris Peterson

        Agnes* tried for more than five years to conceive but in vain. It’s until she turned 30 that her dream came true, however, she had to surmount more barriers.

For Agnes and her husband, Moses*, discovering that conception had taken place, was a surprise of their life. The family was now in excitement as the two got ready for a new born.

But it was not going to be a bed of roses. Agnes found out that her cervix was developing cancer. That was shocking.

It was a difficult situation to deal with. This was akin to jumping out of the frying pan into the fire.

How it started…

She began experiencing some light vaginal bleeding at the beginning of her second trimester.

That was exactly the time when she was referred to me for further checkups.

Then, a tissue was chopped off her cervix (biopsy) for analysis and it turned out that Agnes had stage 1b cervical cancer.

I can remember so vividly, that day when I invited Agnes and her husband in my office for the cancer news. They couldn’t hold the tears.

They had sort of lost hope, given the dream they had waited for so long.

In the middle of all this, Moses aggressively asked me, “So what next doctor? Is my wife going to be okay?

“After all the expectations we had, does this mean it won’t happen anymore?” he asked me, looking straight into my eyes.

At that moment, it wasn’t easy to give the way forward immediately. I allowed the couple to go and come back to me right after two days.

This allowed me time to discuss the situation with the gynecologist who attended to Agnes at the beginning, and the medical team.

Terminate pregnancy or not?

Actually, the couple thought the next option was to terminate the pregnancy. I also realized that the doctor who initially attended to them had the same idea.

But, at the back of my mind, I understood how hard it would be for them to accept pregnancy termination.

Like any gynecological cancer, cervical cancer and its treatment options tend to cause a number of complications especially during pregnancy. In most cases, women opt to terminate their pregnancies to avoid such complications, Agnes’ case being the latest testimony.

My colleague, Dr. Heri Tungaraza, who is senior oncologist based at Muhimbili National Hospital (MNH) says abortion may not be an option.

Based on his experience, Dr Tungaraza suggests that Agnes has a chance to bear a child even after going through several rounds of therapy.

But to avoid further complications on her pregnancy and life, she should continuously attend to both gynecology and oncology clinics for routine assessment.

“It is now a journey for her and her husband, that they should now visit both the two clinics more often for a comprehensive approach in order to monitor the development of pregnancy and cancer management throughout the time of pregnancy” says Dr Tungaraza.

When the couple returned to my office, I delivered this good news to them that they still had a chance to become parents.

I checked the size and location of the tumor and offered her three rounds of chemotherapy, a type of cancer treatment that is safe during pregnancy.

After this treatment, I expected the tumor would regress and Agnes would be able to deliver her new born.

The couple is now happily waiting to meet their child while they are often visiting both the gynecology and oncology clinic for routine assessment.

Always make an informed decision before taking action.

(*not their real names)