of cancer through clinical examination , blood tests and radiological imaging , but it does not mean that patients are cured of the disease . However , the moment I felt her neck , I knew that there was trouble .
I felt two tiny lymph nodes , each measuring 0.5 cm in size just above her left collar bone . When I broke the bad news that this could be a cancer recurrence , Jane was shocked and devastated .
The diagnosis of cancer recurrence was confirmed on a PET-CT scan , and a fine needle aspiration of the lymph nodes showed cancer cells . Jane is back on treatment again .
Why did this happen ? Wasn ’ t her cancer supposed to be cured after five years ? Did her pregnancy cause her cancer to relapse ? How long does one need to wait before it ’ s safe to conceive ?
First , one must understand that despite the surgery , chemotherapy , radiotherapy , and five years of Tamoxifen , we did not manage to eradicate all the breast cancer cells in Jane ’ s body . If we had eradicated all the cancer cells , Jane would not have relapsed .
Second , her pregnancy did not cause Jane to relapse . However , her pregnancy is likely to have brought forward the time to relapse . Even if Jane had not gotten pregnant , the likelihood is that at some time in the future , she would still have relapsed .
The flush of hormones during her pregnancy may have played a part in driving the growth of the cancer cells which were already present in her body . Breast cancer is one of the malignancies well known to have the ability to relapse five , 10 , or even 15 years after initial diagnosis . And yet there are many breast cancer survivors who have had children after completing their cancer treatment and never relapsed .
Does it mean that breast cancer survivors must never get pregnant ?
No , I don ’ t think so . But it ’ s important for patients to understand the risks associated with pregnancy and choose for themselves what ’ s important to them . For Jane , the focus now is not just on the ‘ why ’ but on the need to get well , not just for herself , but for her two young children .
Dr Ang Peng Tiam is the medical director of the Parkway Cancer Centre in Singapore . He is a council member of the Singapore Cancer Society and the past president of the Singapore Society of Oncology . He held the concurrent post of Director of the Oncology Centre and Clinical Associate Professor at the Faculty of Medicine of the National University of Singapore .
GlobalHealthAsiaPacific . com APRIL 2021
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