What would you do if you were diagnosed with cancer during your pregnancy? One expectant mom had some tough choices to make.
When 35-year-old Gina Zapanta-Murphy called her OB because of unusual discharge at 29 weeks pregnant, she was more worried about leaking amniotic fluid or a ruptured placenta than anything else. But she received the shock of her life when a biopsy revealed she had cervical cancer, and it would have to be dealt with soon. "My immediate response was just trying to process the actual words I had heard followed by disbelief," she tells Fit Pregnancy. "The 'what ifs' were overpowering. I had to counter the fear and worry with positivity as I didn't want uncontrolled emotions to affect the baby."
Cervical cancer during pregnancy is uncommon, thanks in part to reliable screenings like Pap smears, which can detect even pre-cancerous cells. The disease is usually slow-growing, which gave Gina's doctors at PIH Health in Whittier, California, time to let the baby develop before taking action—although not as much time as they'd hoped. "This is the first time in 20 years that I have been involved in a case as rare as Gina's," gynecological oncologist Samuel Im, MD, tells Fit Pregnancy. "I've only seen about three patients with the same condition, but the difference in Gina's case was that she was near full term when we detected the cancer. It was the first time I had seen a diagnosis this far into a pregnancy."
"I had to deliver early"
The initial plan was to allow her to get to 37 weeks. "But after a few more visits the doctors decided the cancer was growing too quickly and bumped the date up to 34 weeks, October 14th," Gina says. "It was a fine balancing of act of protecting both mom and baby."
Although chemotherapy is generally considered safe in the second and third trimesters, Im recommended a radical hysterectomy—removal of the uterus, ovaries, fallopian tubes and cervix—at the same time as a C-section, a surgery he says was extremely complicated. "Performing a radical hysterectomy in general is a very difficult procedure," Im says. "And a patient who is 30-plus weeks pregnant with an enlarged uterus and engorged blood vessels that come with being pregnant made it even more difficult."
For Gina, the surgery meant the end of her fertility, although she had already decided that Valentina, her second child, was to be her last. "The hysterectomy meant I would have to start hormone therapy because I would no longer have ovaries to create my hormones," Gina says. "At the time, the thought of being unable to conceive any more children didn't bother me, but now I do feel a sadness sometimes at the finality of it all."
The morning of the birth, Gina says she felt only "relief and hope. I was totally calm and collected, and knew that the best possible medical decision had been made for the both of us." Her husband, Brian, who she describes as her "rock," was by her side in the OR, in addition to her father, an orthopedic surgeon.
Luckily, Gina was able to be awake for her daughter's birth. "The doctors initially wanted me under general anesthesia for the entire C-section and hysterectomy, but I really wanted to be awake for the birth," Gina says, so her OB/GYNs, Dr. Brent Gray and Dr. Peter Roca, agreed they would put her under after Valentina was born. "I was anxious during the C-section portion, and then heard her beautiful cries," she says. "At that same moment, they began administering the general anesthesia so I remember starting to 'go out' but then heard a loud voice say, 'Gina, kiss the baby, kiss the baby.' I turned to my left and kissed her perfect little warm face. I didn't see her again for 24 hours."
"You just never know"
When she woke up, she didn't feel any more pain than she had with her previous C-section. "If you didn't tell me I had a hysterectomy, I wouldn't have known," she says. "But I found out I had lost a significant amount of blood during surgery and needed a blood transfusion. They had told me it was a high possibility considering surgery on a pregnant woman typically means tremendous blood loss. I was just happy to be done with it."
Gina began pumping breast milk for her daughter in the NICU, who she finally got to see the next day. "She was in an incubator and I was amazed by all the tubes and wires sticking out of her—I felt sorry that she was put in that position but knew she would have no recollection of it," Gina says. "When I held her, she was so light and tiny but perfect. I couldn't believe all we had gone through to get to that moment. We named her Valentina because in Spanish valiente or valiant describes her as a strong successful fighter, and the middle name Angela, because she was my angel—only because of her was I saved."
The surgery was successful in removing Gina's cancer, and she didn't require any other treatment. Her prognosis today looks good. "Standard ongoing observation is an exam with the oncologist every three months for three years and a CT scan every six months," she says. "I will complete year one this October 14th." Im is happy with her progress as well. "I still see her for regular checkups and she brings in her baby—I'm pleased to say she is doing great," he says.
Although Gina's case was rare, it's important to let your doctor know about any unusual symptoms you have during pregnancy—your OB will be able to tell what's "normal weird" and what's truly concerning. And continue your regular Pap tests, even while pregnant. "My advice is to be overly cautious about any symptoms," Gina says. "You just never know."