A Stage IV Diagnosis In The Second Trimester
- Venelina Vateva, 28, was just 27 and 23-weeks pregnant when she learned that she had cancer after experiencing sharp pains when she attempted to breathe that made it difficult to stand up.
- Before being diagnosed, doctors thought it could be allergies or linked to her pregnancy, for which she underwent IUI (intrauterine insemination), which is a fertility procedure. After she learned that she had lung cancer ,doctors found a way to treat her with chemotherapy that would not harm her unborn children. She gave birth to healthy twins in July, one month early.
- For pregnant women requiring immediate treatment for their cancer, the most common and safest option is surgery. Some options, like radiation, are never used during pregnancy because the rays used would harm the unborn child. Treatment is almost never administered in the first trimester and delayed if at all possible until after birth.
Venelina Vateva is fighting for her life as she battles stage IV ALK-positive lung cancer.Read More
The diagnosis is still a shock to Vateva, a 28-year-old never-smoker and wife Lindsay Saunders.
“It will never make sense because she doesn’t have a family history of cancer. She doesn’t have any known risk factors for cancer,” Saunders told WRAL.
Her symptoms began with a dry cough shortly after she and Saunders learned they would be welcoming twins.
That dry cough soon developed into unbearable pain every time Vateva tried to breathe.
“One day, I came to the point where I just could not walk. Couldn’t breathe. It was just like a sharp pain like someone was stabbing me in the back,” said Vateva.
Those symptoms eventually required hospitalization, at which time doctors diagnosed her with pneumonia.
Not convinced, Vateva and Saunders pushed for a lung biopsy, a decision that may have saved Vateva and the twins’ lives.
That biopsy led doctors to diagnose Vateva with stage 4 ALK-positive lung cancer while 23 weeks pregnant.
Vateva started treatment while pregnant after doctors found a chemotherapy option that they believed would benefit the mother and not impact her twins.
Given the advanced state of her pregnancy, Vateva stayed in the hospital for much of her third trimester before delivering two healthy babies in July.
She and Saunders are now juggling raising two children with Vateva’s ongoing treatment.
The treatment is complex due to a mutation that prevents Vateva from responding to treatment.
“It doubled in size in my lungs, and I have a big mass in my liver now as well, which wasn’t there before,” said Vateva.
For now, her cancer is only a secondary focus as she devotes her time and energy to her newborns.
Vateva is also back at work, so that she can afford her treatment and the costs of two new babies.
There has been a groundswell of support in the community. Residents raised over $25,000 after learning of the couple’s plight.
The couple said it “restores their faith in people.”
ALK-Positive Lung Cancer
Only about five percent of patients with lung cancer have ALK-positive lung cancer, but it accounts for over 30 percent of cancer among people under 40.
Vateva was just 27 when she learned she had stage IV ALK-positive lung cancer.
ALK stands for anaplastic lymphoma kinase, a gene in the human body responsible for functions of the gut and nervous system.
The gene gets turned off while in utero but then turns back on at some point for individuals with ALK-positive lung cancer. It does this by fusing with another gene in the human body, which is how the cancer grows.
“Most lung cancers present with symptoms. Most lung cancers present with a cough, shortness of breath. Most of my patients had been treated for pneumonia before it turns out they end up having lung cancer,” explained Dr. Oxnard.
“Sometimes it presents with symptoms from a metastasis. Bone pain from a spot in the bone. A seizure from a spot in the brain. Some patients just are kind of feeling not right, tired, losing weight, evidence that something is brewing until finally they end up with that CAT scan, brain scan, that shows a spot, a tumor, a metastasis suggesting cancer is there.”
Lung tumors in non-smokers are more likely to have mutations in a gene called EGFR or ALK. Doctors have treatments that can stop or slow the growth of cancers with these genetic traits.
People who have EGFR-positive lung cancer often respond to drugs that target that gene, known as “targeted therapy,” such as erlotinib (Tarceva) and gefitnib (Iressa). People who have the less common ALK gene mutation may take a targeted medication that blocks that gene’s activity, such as alectinib (Alecensa), brigatinib (Alunbrig), ceritinib (Zykadia), crizotinib (Xalkori), or lorlatinib (Lorbrena).
ALK-Positive Lung Cancer Screening
Getting A Cancer Diagnosis While Pregnant
It is very rare for individuals to be diagnosed with cancer while pregnant. The good news for those like Vateva is that cancer rarely passes from mother to child.
It is difficult to detect cancer in a pregnant woman since almost all symptoms of the disease mirror symptoms of pregnancy. Once cancer is detected, there are still treatment options.
For pregnant women requiring immediate treatment for their cancer, the most common and safest option is surgery. Some options, like radiation, are never used during pregnancy because the rays used would harm the unborn child.
Doctors may delay treatment depending on when the cancer is diagnosed as there is seldom any treatment of any kind administered in the first trimester. The treatment may also be delayed until after the pregnancy if the cancer is early-stage or if it is discovered close to a woman’s due date.
Have A Family After Cancer