She peed in a cup at the health centre, praying that the chemotherapy was not bringing up other health problems. She had walked into the facility after feeling worse than usual. Chemotherapy effects were bad, but this morning she felt worse. She just wanted to be fine, then she would finally start enjoying her new marriage.
A few moments later, the young medical officer walked up to her with a smile. “You have nothing to worry about. You are pregnant,” he said calmly. Jackline Kanyua was not sure how to feel about the news. On one hand she was happy, motherhood did not seem like a far-fetched dream anymore.
But again, her doctor had told her that avoiding pregnancy as she went through her cancer treatment was the best thing for her health. Heck, her monthly period had even disappeared. But the doctor had assured her that the chemotherapy and the drugs she took were enough to cause that.
Yet here she was, in 2017, in her mid-20s, newly married, pregnant but with cancer; Stage 3 breast cancer that needed aggressive treatment. The journey had all began a few months earlier when she felt a tight hard lump in her breast while singing in the shower. She had been planning her wedding then. What luck? she mused.
World over, according to the World Health Organisation, one in 1,000 mothers find themselves in the very same quagmire as Jackline. And just like Jackline’s doctor, other medics warn that pregnancy could complicate cancer treatment, just as much as cancer treatment interferes with pregnancy.
Andrew Odhiambo, a Nairobi-based consultant oncologist, advises that once a woman is diagnosed with breast cancer, the safest option is to avoid pregnancy.
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“Getting pregnant presents serious challenges, but even the treatment itself can cause a stoppage in menstrual flow,” says Dr Odhiambo.
The biggest dilemma presented, he explains, is whether to stop treatment and carry the pregnancy to term or to terminate the pregnancy and continue with medication. If chemotherapy has to start immediately, especially in advanced cancer stages, then termination has to be done. In fact, doctors recommend that women on treatment for cancer should be on contraception until some period after the end of treatment.
“Carrying the pregnancy means stopping treatment, especially radiation or chemotherapy. Surgery can only be done after the second trimester. We always advise women to consider freezing their eggs and probably using them later once treatment is done,” Odhiambo says.
A 2019 study published in PubMed Central (PMC) affirms that radiation can be dangerous and that only non-ionising imaging methods are preferred to reduce exposure to the foetus.
“Unfortunately, not many medications can be safely used during pregnancy and mother should be exhaustive in thought about potential risks and complications of those systemic treatments,” the study states.
At the time when Jackie found out she was pregnant, she had had 10 chemotherapy sessions and a lumpectomy.
To navigate this new development, the couple made an appointment with their doctor at Kenyatta National Hospital (KNH), where tough decisions had to be made. The doctor gave her two options; to keep the baby and forget about the treatment or terminate the pregnancy and continue with her treatment. And being at cancer stage 3 at the time of diagnosis, this was a decision she had to make fully aware of the risks.
Abort or not?
“Keeping the baby was a huge risk but I decided to go for it. I told them that I did not require any time to think about anything because this was the best gift I could have. Or I could even give to my new husband. So I quickly signed the consent forms to stop treatment,” she recalls.
With pregnancy, several changes occur in a woman’s body. They include a drop in the number of lymphocytes that act as defence against foreign objects, including disease-causing pathogens.
“A pregnant woman naturally has increasing levels of oestrogen hormone. But these increasing levels, in the case of a pregnant woman with cancer, have a potential of accelerating breast cancer. Now add to the fact that you have stopped treatment, this can get too bad too fast,” says Dr John Ongech, a consultant gynaecologist.
Jackline’s first trimester was, however, uneventful despite treatment having stopped. The fifth month of pregnancy, however, turned into a nightmare, as her right breast, which had undergone surgery, burst, becoming a raw open wound. She could not, however, be put on medication because of the growing foetus.
“The wound festered and smelled so horrible. The only way to care for the wound was using water and no drugs. My husband, Jude, had to stay home to take care of me. One of the women from church came visiting and found me in such a deplorable condition that she decided to take us into her home to provide care,” says jackline.
When Jackline was six months pregnant she had had enough and told her husband that they had to terminate the pregnancy.
“The pain was unbearable, and the wound didn’t seem to be healing. The cancer seemed to be growing and I wanted to resume treatment.”
And so they booked and paid Sh15,000 for the procedure.
“When we got to the KNH procedure room and I saw the devices that were to be used, I literally ran and called my husband once I was ‘safely’ seated inside a bus headed to the CBD,” she says.
A week later, facing unbearable pain, Jackline and Jude went back to have the pregnancy terminated, the second time. This was never to be, since when they got to hospital she changed her mind, again.
“I remember asking the attendants what they thought was the worst thing that could happen to me now that I had cancer, and their answer was “death”. I also asked them what was the worst that could happen if I carried the pregnancy to term. Their answer was still “death”. I was then ready to give up my life for my baby.”
On noting her dogged determination and the excruciating pain she was in, the medics suggested that she carries the pregnancy to seven months and then she could deliver preterm and have the baby put in incubation.
Pain notwithstanding that seemed like the best choice she had. And so, it would be. At seven months, labour was induced and baby Zawadi made her entrance into the world. The distressed baby would be whisked off to the ICU immediately to begin her recovery. As for her mother, aggressive treatment would resume. Luckily, Zawadi made a good recovery and was moved to the nursery and later to the paediatric ward.
Two months later, mother and baby were back home, where new challenges awaited.
“Due to my medication, I could not breastfeed Zawadi and she had to depend on formula milk,” says Jackline.
All was going on well, until April this year when a cycle of chemotherapy and trouble struck again.
“Because I was lactating, yet the milk was not being consumed, the infected breast started having complications and I had to begin treatment once more.”
Doctors also discovered that the previous surgery had not completely removed the cancerous cells and they had to go in again. Her latest session of chemotherapy ended in October, after which Jackline was taken in for a mastectomy. She is recovering.
“This will be followed by another round of radiation to kill any remaining cancerous cells. I need close to ShI million for that. I have Sh450,000 already, thanks to support from well-wishers after I was featured on comedian MC Jessy’s show. I am hopeful that it will work out, and I will be here for my baby and husband,” she says.
This may have worked out for Jackie, but doctors caution that hers was a big risk they would not encourage because of the potential for fast spread of cancer cells, a complication that would mean she would be on lifelong treatment, or just die.
“Also, pregnancy while with cancer has been linked with a likelihood of recurrence of the cancer,” says Dr Ongech.
As Jackline cradles her baby, with a smile, as the interview comes to a close, it is clear that it was worth the risk.
“My baby was the best choice I made. It will be fine.”