Coping With Pregnancy and Cancer
- MaKenna Lauterbach, of Washburn, Illinois, was 26 years old and 36-weeks pregnant when doctors found a grapefruit-sized tumor in her “middle chest cavity and right lung, completely blocking the artery to the right lung.” She was ultimately diagnosed with stage three melanoma.
- Now, more than a year after she first experienced symptoms of a dry cough, which led her to the hospital this past March, she no longer has any evidence of the disease and is ready to celebrate Christmas with her healthy nine-month-old son Colter.
- Melanoma starts in the same cells that give your skin, hair, and eyes their color. Only, in melanoma, the cells change in a way that makes them able to spread to other organs. You’re most likely to find melanoma on sun-exposed areas of skin, like your face, neck, arms, and legs.
- Here at SurvivorNet, we say that no one knows your body better than you, so if you feel like something is wrong, keep pushing.
It wasn’t until after Lauterbach had imaging done that doctors found a grapefruit-sized tumor in her “middle chest cavity and right lung, completely blocking the artery to the right lung,” which she later learned was stage three melanoma, according to Northwestern Medicine.
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Fast-forward to Lauterbach being taking to the hospital months later, and learning she had large tumor during her pregnancy, she was determined to be in critical condition as she, including her baby, was in “respiratory distress.”
She was then airlifted to Northwestern Memorial Hospital in Chicago, where doctors performed an emergency cesarean section on March 31, 2024, and Lauterbach and her husband Parker welcomed a healthy baby boy named Colter.
Dr. Lynn Yee, MD, the maternal-fetal medicine specialist who performed the C-section, told Northwestern Medicine, “MaKenna was in real trouble, and we had to act quickly – this wasn’t something that could wait for Monday morning.
“When you’re pregnant with a baby that’s nearly full-term, your lungs already aren’t functioning at full capacity, and when you add a huge tumor on top of it, you run the risk of having respiratory collapse and cardiac arrest.”
It wasn’t until after Colter was delivered that doctors discovered what type of cancer the new mom had, by taking a “sample of the tumor with advanced bronchoscopy.”
One of her doctors, Dr. Kalvin Lung, MD, a thoracic surgeon with the Northwestern Medicine Canning Thoracic Institute told Northwestern Medicine, “The tumor was sitting on top of MaKenna’s heart and extended into the right lung, impacting all three lobes and the entire main trunk of the pulmonary artery, which is why we had to remove the right lung.”
She ended up having her entire right lung, parts of the main pulmonary artery and lymph nodes removed.
Another doctor, Dr. Sunandana Chandra, MD, medical oncologist with the Robert H. Lurie Comprehensive Cancer Center, noted, “We think at some point, MaKenna had a melanoma on her skin and her own immune system took care of it, but not before a cell or two may have escaped and eventually started growing inside her body.
“After three doses of immunotherapy, once she was taken to surgery, the surgical specimen showed no melanoma cells that were viable.”
Her most recent scans “currently show no evidence of metastatic melanoma” and she will continue being checked to see if the cancer returns.
Lauterbach, who will continue with immunotherapy treatments, turned 27 this past October and says her son Colter is “the best baby” and she’s looking forward to spending Christmas with him and her loved ones.
Lauterbach will continue immunotherapy treatments for one year. Her cancer is currently a stable disease, meaning no new tumors have appeared. She celebrated her 27th birthday in October and is looking forward to her son’s first Christmas on the farm.
Learning More About Melanoma
Melanoma is the most dangerous form of skin cancer. It starts in the same cells that give your skin, hair, and eyes their color. In melanoma, the cells change in a way that allows them to spread to other organs.
Changes to a mole you’ve had for a while or a new growth on your skin could be signs of melanoma, according to SurvivorNet’s experts. You’ll want to watch them and tell your doctor about any changes you notice.
WATCH: How do you perform a skin check using the ABCDEs?
You’re most likely to find melanoma on sun-exposed skin areas like your face, neck, arms, and legs. Surprisingly, you might also find them in other places as well, like:
- The palms of your hands or soles of your feet
- On your eyes or mouth
- Under your nails
SurvivorNet experts recommend avoiding unprotected sun exposure because ultraviolet (UV) radiation can lead to melanoma. Tanning beds pose ultraviolet radiation risks for skin cancer and should be avoided. Many dermatologists recommend using spray tans to reduce the risk of melanoma skin cancer.
Expert Melanoma Resources
- Blood Test Could Predict the Best Type of Treatment for Metastatic Melanoma
- Dramatic Improvement in Melanoma Survival Rates– The Treatment Revolution is Working
- How is Melanoma Treated After Surgery? The Landscape of Therapies Explained
- Melanoma Relapse Treatment: Advances on the Horizon
- Melanoma in Situ is Highly Treatable
- The Future of Biomarkers in Melanoma Treatment
What Are the Symptoms of Melanoma?
The most important thing to look out for when it comes to finding melanoma is a new spot on your skin or a spot that is changing in size, shape, or color, SurvivorNet’s medical experts say.
When you check your skin, use the acronym ABCDE as your guide:
- Asymmetrical moles: If you drew a line straight down the center of the mole, would the sides match?
- Borders: Is the mole irregular or jagged?
- Colors: Are there multiple distinct colors in the mole?
- Diameter: Is the mole larger than 6 millimeters (mm), about the size of a pencil head eraser?
- Evolution: Has the mole’s color, shape, or size changed over time?
RELATED: The Genetic Mutation That Drives Many Metastatic Melanomas
If you answered “yes” to any of these questions, our experts say it’s time to see your dermatologist for a skin check.
Melanoma Treatment Options
Melanoma treatment has come a long way. Survival rates have risen dramatically, thanks to a “treatment revolution,” say SurvivorNet’s experts. With breakthrough treatments like targeted therapy and immunotherapy now available, people who are diagnosed today have a much better chance of living a long and healthy life than ever before.
If you’re diagnosed with melanoma, there’s a good chance surgery is going to be the treatment your doctor recommends. In the early stages of the disease, removing the cancer should lead to a cure. The question is typically not whether you’ll get surgery, but which kind you’ll have.
WATCH: Dermatologic Surgeon Dr. Nima Gharavi, On The “Gold Standard Treatment” For Melanoma
For an early-stage melanoma that is close to the skin surface, Mohs surgery might be an option. This technique removes skin cancer, layer by layer, until all the cancer is gone.
In general, stage I melanoma surgery consists of the simple, in-office removal of the cancerous cells by a dermatologist. If the cancer is thicker, your surgeon will remove it through a technique called wide excision surgery.
The removal of stage II and III melanomas are performed by surgeons or surgical oncologists, not dermatologists. You may also have a sentinel lymph node biopsy to see if the melanoma has spread to the first lymph node where it’s most likely to travel. If your cancer has reached this first lymph node, it may have spread to other neighboring lymph nodes, and possibly to other organs. Where the cancer is will dictate your treatment.
After surgery, the removed tissue and lymph nodes will go to a specialist called a pathologist, who will measure the melanoma and find out if it has clear margins. Having clear margins means the cells around the area of tissue that was removed don’t contain any melanoma. When there aren’t any cancer cells left around the removed area, your cancer is less likely to come back.
Once your cancer spreads, treatment gets a little more complicated, but there are still ways to stop it. New treatments have vastly improved the outlook for people with metastatic, or stage IV, melanoma.
Targeted drugs and immunotherapy have been shown to be more effective than chemotherapy. So, with many more choices, there is no standard treatment. Treatment will vary based on your condition and whether there is recurrent disease.
Research has found that immunotherapy drugs such as Keytruda (pembrolizumab) and Opdivo (nivolumab) helped some people live longer. Combining immunotherapy drugs Yervoy (ipilimumab) and Opdivo (nivolumab) has also extended survival. Opdivo (nivolumab) + relatlimab is a new therapy option added to the National Comprehensive Cancer Network guidelines in 2022. The combination of two immunotherapies is called Opdualag.
For those with the BRAF mutation, targeted drugs which shrink or slow the tumor can be a good option. This could include a combination of drugs, such as:
- Zelboraf (vemurafenib) and Cotellic (cobimetinib)
- Braftovi (encorafenib) and Mektovi (binimetinib)
- Tafinlar (dabrafenib) and Mekinist (trametinib)
- Zelboraf (vemurafenib) and Cotellic (cobimetinib) can also be combined with atezolizumab.
“Every patient is different and every situation is different,” says Dr. Anna Pavlick, medical oncologist at Weill Cornell Medicine. She emphasized that “there is no cookie-cutter recipe,” for treating stage IV melanoma.
There Is No “Cookie Cutter Recipe” for Treating Stage Four Melanoma
Dr. Pavlick also notes the importance of personalized care and treatment. “It really is a matter of looking at the tools we have so that we can pick the right tools to give the patient the best outcome.”
So, while there is no one-size-fits-all approach to treating metastatic melanoma, your doctor will work with you to develop a treatment plan that is tailored to your individual situation. Advances in research and technology are making the fight against metastatic melanoma more hopeful than ever.
How Cancer Treatments Impact Fertility
According to the American Cancer Society, in addition to breast cancer, the types of cancer pregnant women may experience include:
- Melanoma
- Leukemia
- Cervical cancer
- Thyroid cancer
- Ovarian cancer
- Colon cancer
- Lymphoma
Remember, during pregnancy, the body undergoes several changes making cancer-related changes harder to detect. Still, some things to be watchful for include:
- Hormone levels change during pregnancy, which causes breasts to become larger, lumpy, and/or tender.
- Rectal bleeding could possibly be due to benign hemorrhoids, a common occurrence during pregnancy, or from colon or rectal cancer.
- Feeling tired could be from pregnancy weight gain or from low red blood cell counts (anemia), which can be seen in leukemias and lymphomas or during pregnancy.
- As the fetus and uterus grow throughout pregnancy, ovarian tumors get more difficult to detect.
Staying current on all of your health and cancer-related screenings will help you manage your cancer risk.
Meanwhile, it’s important to understand that chemotherapy can destroy eggs in your ovaries. This can make it impossible or difficult to get pregnant later. Whether or not chemotherapy makes you infertile depends on the drug type and age since your egg supply decreases with age.
“The risk is greater the older you are,” reproductive endocrinologist Dr. Jaime Knopman told SurvivorNet.
“If you’re 39 and you get chemo that’s toxic to the ovaries, it’s most likely to make you menopausal. But, if you’re 29, your ovaries may recover because they have a higher baseline supply,” Dr. Knopman continued.
Radiation to the pelvis can also destroy eggs. It can damage the uterus, too. Surgery to your ovaries or uterus can hurt fertility as well.
Meanwhile, endocrine or hormone therapy may block or suppress essential fertility hormones and may prevent a woman from getting pregnant. This infertility may be temporary or permanent, depending on the type and length of treatment.
If you have a treatment that includes infertility as a possible side effect, your doctor won’t be able to tell you whether you will have this side effect. That’s why you should discuss your options for fertility preservation before starting treatment.
WATCH: How chemotherapy affects fertility.
Research shows that women who have fertility preserved before breast cancer treatment are more than twice as likely to give birth after treatment than those who don’t take fertility-preserving measures.
Most women preserve their fertility before cancer treatment by freezing their eggs or embryos.
After you finish your cancer treatment, a doctor specializing in reproductive medicine can implant one or more embryos in your uterus or the uterus of a surrogate with the hope that it will result in pregnancy.
If you freeze eggs only before treatment, a fertility specialist can use sperm and eggs to create embryos in vitro and transfer them to your uterus.
When freezing eggs or embryos is not an option, doctors may try these approaches:
- Ovarian tissue freezing is an experimental approach for girls who haven’t yet reached puberty and don’t have mature eggs or for women who must begin treatment immediately and don’t have time to harvest eggs.
- Ovarian suppression prevents the eggs from maturing so they cannot be damaged during treatment.
- For women getting radiation to the pelvis, Ovarian transposition moves the ovaries out of the line of treatment.
In addition to preserving eggs or embryos, positive research has shown that women with early-stage hormone-receptor (HR) positive breast cancer were able to safely pause endocrine therapy (ET) to try to get pregnant, and they did not have worse short-term recurrence rates than people who did not stop endocrine therapy.
Contributing: SurvivorNet Staff
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