#HEALTH: Pregnant and battling cancer

PREGNANCY is a time of joy, hope and anticipation for an expectant mother.She can't wait to feel her baby's first kick, to see the first scan and watch her child grow and develop in every trimester.

For Tan Chiew Mei, it was a different experience altogether. She had to face a cancer diagnosis during what should have been a happy phase of life.

Tan was carrying her second child in 2021 when she was diagnosed with breast cancer and treatment was only part of what she had to navigate.

The diagnosis was devastating. Tan recalls crying through the night, her thoughts filled with anxiety for her unborn child and the young daughter she already had.

Like every mother, she was deeply worried about who would care for her children if she didn't survive.

"I wanted to get the cancer treated and I wanted to keep my baby too," says Tan, recalling those difficult days.

Tan's cancer journey began at 37 when she found a hard lump in her breast. An initial ultrasound left her reassured that it was nothing serious, but another assessment two weeks later showed that the lump had grown, leading to a biopsy.

The diagnosis was shocking - triple-negative breast cancer, the type Tan had feared.

ROCKY ROAD

Within days, she had to start chemotherapy and her days became filled with hospital appointments and medical decisions. Tan tried her best to concentrate on getting through the treatments but understanding what to ask her doctors proved challenging.

"Often, I could not think of a question to ask during the consultation. I would go blank. I just didn't know what to ask," she recalls.

She trusted her doctors with the major treatment decisions. However, trusting the plan did not mean she understood every change she experienced along the way.

There was also the constant worry of how cancer treatment would affect her unborn child.

Some aspects of treatment were easier than she had feared: she could eat and did not vomit. However, this did not mean she felt well in every other way, and other symptoms were difficult to cope with.

She lost her hair and experienced leg pain and tingling that made it hard to walk, as well as sore gums and itchy skin.

But one of her hardest moments came after childbirth. She had an induced delivery and the very next morning had to have surgery to remove the breast tumour. Weak and in pain, it was the lowest point of her journey.

" I felt very emotional. It had been so difficult for me to get to that stage and yet, the journey was not over."

There was now a newborn to care for, alongside her older daughter, and more chemotherapy ahead, which left her unable to breastfeed her newborn son.

Thankfully, her family stepped in to provide support during this daunting period. Her husband accompanied her to doctor's appointments, her mother cooked for her and her siblings helped care for the children.

Tan's boss was equally supportive and her company's prolonged-illness leave policy allowed her to take time away from work.

"Whenever there was a doctor's appointment, the whole village would come to my house," she recalls.

It's an experience that Tan looks back on with both gratitude and warmth. Her son is now 5 years old and she went on to have a third child too.

The lesson she learnt is that during life's most difficult journey, the people we love help to cushion the blows and get us back on our feet.

Looking back, she encourages cancer patients to prepare for appointments and ask questions about everything, even the things that seem small, rather than dismissing them.

More importantly, gather your "village" because love and support is crucial in rising above cancer.

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Difficult But Necessary Conversations

For a woman diagnosed with breast cancer during pregnancy, decisions about treatment can feel especially difficult as she worries about both her own health and her baby's well-being, says OncoCare Malaysia consultant clinical oncologist Dr John Low Seng Hooi.

Navigating these concerns requires a treatment plan that considers both mother and baby, he explains.

The choice of medicines, their timing and monitoring require close coordination between the oncology team, obstetrician and surgeon. As not all cancer medicines are suitable during pregnancy, the plan must also take into account each woman's circumstances.

Dr Low encourages patients to understand what their treatment aims to achieve, why it is recommended, how long it may take, possible side effects and what they should watch for at home.

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A patient can also ask what the cancer's type and stage mean for her own treatment, rather than trying to interpret a report alone.

These conversations need not be confined to the first appointment as different concerns may arise along the way.

Support beyond medication matters as well. Dr Low encourages patients to ask about counselling, psychological support and patient groups that may help them navigate the experience.

"There are no questions that you cannot ask your treatment team," he says.

Oncology nurse educator Norhaniza Mohd Rashid adds that questions often surface only after a consultation, when someone begins thinking about what treatment will mean.

Before the first chemotherapy cycle, it helps to bring a caregiver along, she explains. This is because patients receive a great deal of information and they may not remember everything themselves.

For someone with a poor appetite, she suggests smaller, more frequent meals rather than large portions. For someone trying to keep working, she encourages them to recognise their energy limits rather than push themselves too much.

"We encourage patients to do something manageable that they enjoy, whether it's gardening or catching up with friends."

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For doctors and healthcare personnel, it's important to ask about patients' concerns and listen.

Understanding what worries each patient is an important part of the conversation, alongside explaining how the medical team can help with treatment, symptom management and emotional support.