I have ER+ Breast cancer and I am 16 weeks pregnant:Please help

Benny, i am sorry. I do not have a lot of info to pass on to your case because it sounds very complicated due to the pregnancy and I am not a doctor. I would recommend that you try to get a second opinion as soon as possible. Are you in the US? Here in the US, it is recommended to go to an NCI designated cancer center. Here is a list: http://www.cancer.gov/researchandfunding/extramural/cancercenters/find-a-cancer-center.

Also, go to this website: http://www.hopkinsbreastcenter.org/services/ask_expert/. Here you can get advise from an expert on your specific case and what to do.

I think you definitely need a second opinion so that you can ask questions to another doctor to check if you are following an appropriate treatment plan.

Below I pasted some info from cancer.org on treating pregnant women with breast cancer. I am sorry you have to go through this at what is supposed to be the happiest time of your life. Will keep you in my thoughts and wishing that you can find a good treatment plan. Best wishes- CHAR

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Breast cancer treatment during pregnancy

If breast cancer is found during pregnancy, the type and timing of treatment depends on many things, such as:

• The size of the tumor
• Where the tumor is
• Whether and how far the cancer has spread
• How far along the pregnancy is
• What the woman prefers

Treating a pregnant woman with breast cancer has the same goals as treating a non-pregnant woman: control the cancer in the place where it started and keep it from spreading. But the extra concern of protecting a growing baby may make reaching these goals more complex.

If a pregnant woman needs chemotherapy, hormone therapy, or radiation to treat breast cancer in early pregnancy, she may be asked to think about ending the pregnancy. This is because these treatments may harm the fetus. It’s easier to treat a woman who is not pregnant because there is no fear of harming the fetus. But no studies have proven that ending a pregnancy in order to have cancer treatment improves a woman’s prognosis (outlook). Still, this option may be discussed when looking at all the treatment choices available.

Surgery

When possible, surgery is the first treatment for any woman with breast cancer, including those who are pregnant. Removing only the part of the breast with the tumor (breast-conserving surgery) or the entire breast (mastectomy), and/or taking out the lymph nodes under the arm carry little risk to the fetus. But there are certain times in pregnancy when anesthesia (the drugs used to make you sleep for surgery) may be riskier for the fetus.

Many doctors, such as a high-risk obstetrician, a surgeon, and an anesthesiologist will need to work together to decide the best time during pregnancy to do surgery. If the surgery is done later in the pregnancy, the obstetrician may be there just in case there are any problems with the baby during surgery. Together, these doctors will decide which drugs and techniques are the safest for both the mother and the baby.

Mastectomy can often be used as the first treatment for early-stage cancers. Lymph nodes in the armpit may also be taken out if the doctor suspects that the cancer has spread there. Depending on the how far along you are in pregnancy and your cancer stage, your doctor may not be able to do a sentinel lymph node biopsy (SNLB). This procedure uses tracers and dye to pinpoint the nodes most likely to contain cancer cells. SNLB allows the doctor to remove fewer nodes. But there is concern that the radioactive tracer used for SNLB may affect the fetus if used when its organs are growing quickly. More research is needed on this. But for now, it’s standard to take out the lymph nodes to decrease the chance of cancer spread.

Depending on the cancer’s stage, a woman may get more treatment such as chemotherapy, radiation, and/or hormone therapy after surgery to help lower the risk of the cancer coming back. This is called adjuvant treatment. In some cases, this treatment can be put off until after delivery.

Women who have breast-conserving surgery often need radiation therapy afterward. The need for radiation is an important issue for pregnant women when choosing which surgery to have. Radiation could affect the fetus if given during the pregnancy, so it’s not used until after delivery. Doctors don’t know how this delay may affect a woman’s risk of the cancer coming back. Cancer found in the third trimester may involve very little delay in radiation treatments, so there would likely be no effect on outcome. And a woman who will be getting chemotherapy before radiation may have little or no delay in her radiation treatments. But cancers found early in the pregnancy may mean a longer delay in starting radiation. Treatment must always be considered on a case-by-case basis.

Chemotherapy

Chemotherapy, which is also called chemo, may be used along with surgery (as an adjuvant treatment) for some earlier stages of breast cancer. It also may be used by itself for more advanced cancers.

Chemo should not be given during the first 3 months of pregnancy (the first trimester). This is because most of the baby’s internal organs develop during this time. The risk of miscarriage (losing the baby) is also the greatest during the first trimester. The safety of using chemo during this time has not been studied because of concerns about damage to the growing baby.

It was once thought that all chemo drugs would harm an unborn baby. But studies have shown that certain chemo drugs used during the second and third trimesters (months 4 through 9 of pregnancy) do not raise the risk of birth defects, stillbirths, or health problems shortly after birth. But researchers still do not know if these children will have any long-term effects.

When a pregnant woman with early breast cancer needs adjuvant chemo after surgery, it’s usually delayed until at least the second trimester. If a woman is already in her third trimester when the cancer is found, the chemo may be delayed until after birth. The birth may be induced (brought on) a few weeks early in these cases. These same treatment plans may also be used for women with more advanced cancer.

Chemo should not be given after 35 weeks of pregnancy or within 3 weeks of delivery because it can lower the mother’s blood 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 blood counts to return to normal before childbirth.

Radiation therapy

Radiation therapy to the breast is often used after breast-conserving surgeries (lumpectomy or partial mastectomy) to help reduce the risk of the cancer coming back. The high doses of radiation used for this can harm the fetus any time during pregnancy. It may cause miscarriage, birth defects, slow fetal growth, or a higher risk of childhood cancer. Because of this, doctors don’t use radiation treatment during pregnancy.

Pregnant women who choose lumpectomy or partial mastectomy can usually have surgery during pregnancy and then wait until after the baby is born to get radiation therapy. But this treatment approach has not been well-studied in pregnant women. It’s not known if the delay might affect how well the radiation works.

Hormone therapy

Hormone therapy, such as treatment with tamoxifen, may be used as adjuvant treatment after surgery or as treatment for advanced cancer. Its use in pregnant women has not been well-studied, so its full effects are not known. But there have been reports of miscarriage and fetal death, as well as head and face birth defects and genital defects in babies born to women who became pregnant while taking tamoxifen in early pregnancy.

Hormone therapy should not be used during pregnancy, but delayed until after the woman has given birth.

Targeted therapy

Drugs that target HER2, like trastuzumab, pertuzumab, and lapatinib, are an important part of the treatment of HER2-positive breast cancers. Only trastuzumab is used as a part of adjuvant treatment after surgery, but all 3 of these drugs can be useful in treating advanced cancer. Based on animal studies and reports of women who were treated during pregnancy, none of these drugs are safe for the fetus if taken during pregnancy.

Breastfeeding during cancer treatment

Most doctors recommend that women who have just had babies and are about to be treated for breast cancer should stop (or not start) breastfeeding.

If surgery is planned, stopping breastfeeding will help reduce blood flow to the breasts and make them smaller. This can help with the operation. It also helps reduce the risk of infection in the breast and can help avoid having breast milk collect in biopsy or surgery areas.

Many chemo, hormone, and targeted therapy drugs can enter breast milk and be passed on to the baby. So, if the mother is getting chemo, hormone, or targeted therapy, she shouldn’t breastfeed.

If you have questions, such as when it might be safe to start breastfeeding, be sure to talk with your health care team. If you plan to start back after you’ve stopped breastfeeding for a while, you will want to plan ahead. You may need extra help from breastfeeding experts.

Pulling all the treatment plans together

The hardest part of treatment is when there is a conflict between the best known treatment for the mother and the well-being of the fetus. A woman who has breast cancer during her pregnancy may have hard choices to make—she needs to know all her options and she needs expert help. Her obstetrician will need to work with her surgeon, her oncologist, her radiation oncologist, and others involved in her care. Through all this, the woman with breast cancer will need emotional support, so a counselor or psychologist should also be part of her health care team.

If you would like more information on breast cancer and its treatment, please read our document called Breast Cancer.