New Beginnings: A Career After Cancer E38

Aged only 29, she wanted to wear something that allowed her to feel like herself. There wasn’t anything available for patients going through this debilitating experience.

Porto & Bello was inspired by one of Alexia’s most challenging obstacles in her life. Throughout her treatment, she couldn’t help but think about everyone else going through cancer alone. She created a business to help make patients’ journeys easier in a small way, just as her portobello did. Her new brand is port-friendly accessible clothing for patients undergoing treatment. Their hoodie and crew sweaters have discrete 2-way zips along the chest and arms, making it easy to access a port, PICC line, or veins during treatment.

What is An Implantable Port Used For?

A port can be used to give you:

• Chemotherapy
• Blood transfusions
• Antibiotics and other drugs
• Intravenous (IV) fluids

This means you will not need to have needles put into your arms every time you have treatment. Ports can also be used when you need to have blood tests. You can go home with the port in. It can be left in for weeks or months. Some people have a port for years.

A port may be helpful if doctors or nurses find it difficult to get needles into your veins. It is also beneficial if you do not like needles.

Although the method is only suitable for some, Alexia was a great candidate and said she would try it. She didn’t lose her hair completely; however, she did experience hair thinning.

For scalp cooling to work, your scalp temperature needs to be kept low while the chemotherapy drugs are in your blood.

Alexia explained that this process means your chemotherapy appointment is extended for up to three hours during each treatment. 

Scalp cooling is unsuitable if you have blood cancer, such as myeloma, leukaemia or lymphoma. This is because there is a risk of cancer cells surviving in the scalp’s blood vessels. Therefore, patients are at risk of cancer returning. 

Further reasons for unsuitability: 

• You have already had your first course of chemotherapy without scalp cooling.
• You need very high doses of chemotherapy. Scalp cooling is less likely to work with high-dose chemotherapy.
• You are having continuous chemotherapy through a pump for several days.
• Your liver is not working as well as it should be. The chemotherapy drugs may stay in the body for longer than usual. It may not be possible to keep the scalp cold for long enough.
• You have severe migraines.

Breast Cancer During Pregnancy

Many Women of a certain age are encouraged to look out for the signs and symptoms of breast cancer, but what if you’re younger or happen to be pregnant? Cancer doesn’t discriminate. 

The disease didn’t run in Alexia’s family; she was only 29 and aware that breast tissue changes during pregnancy. But she did notice something different and decided to get it checked out.

Alexia explained that the surface of her breast felt hard and made an appointment with her GP. Initially, her doctor gave her antibiotics to treat a possible infection. Still, she took an extra precaution and booked an appointment for an ultrasound.

Unfortunately, Alexia was diagnosed with breast cancer and had to wait a few weeks to induce and start her treatment.

Treatment During Pregnancy and After the Birth 

Effective breast cancer treatment can be given during pregnancy, and your team will discuss your options. Generally, the treatment you’re offered will depend on the type and extent of your breast cancer, your situation, and how far you are into your pregnancy.

The aim will be to give you the most effective treatment for your breast cancer while keeping your baby safe. If you’re near the end of your pregnancy, your treatment team may delay treatment until after the birth.

Surgery

Surgery can safely be done during all trimesters of pregnancy. You may be offered a choice between:

• A mastectomy: removal of all the breast tissue, including the nipple area
• Breast-conserving surgery: removal of cancer with a margin (border) of normal breast tissue around it, also known as wide local excision or lumpectomy

During the first trimester (first 12 weeks)

You’re more likely to be offered a mastectomy in the first trimester of pregnancy.

Not all women with a mastectomy need radiotherapy, whereas radiotherapy is usually needed after breast-conserving surgery. Radiotherapy is generally not recommended during pregnancy because of the small risk of radiation to the baby.

During the second trimester (13–27 weeks)

Suppose you’re diagnosed in your second trimester and will be having chemotherapy after your surgery. In that case, breast-conserving surgery may be an option.

Radiotherapy will be given after your chemotherapy and your baby’s birth.

During the third trimester (28 weeks to delivery)

Breast-conserving surgery may be an option if you’re in your third trimester, as radiotherapy can be given after the baby is born.

Having a general anaesthetic

Whichever type of surgery you have will involve a general anaesthetic. This is generally considered safe while pregnant, although there’s a very slight risk of miscarriage in early pregnancy.

Breast Reconstruction

Breast reconstruction at the time of surgery (immediate reconstruction) is not usually offered during pregnancy.

Reasons include a higher risk of bleeding during pregnancy and minimising the time under general anaesthetic.

Breast reconstruction will generally be offered later (delayed reconstruction).

Surgery to the lymph nodes

Your treatment team will usually want to check if any cancer cells have spread to the lymph nodes under the arm. You may have one or a few lymph nodes removed for testing.

This sentinel lymph node biopsy is usually done at the same time as your cancer surgery. A sentinel lymph node biopsy involves injecting a small amount of radioactive material (radioisotope) into the area around cancer. This will not affect the baby.

A blue dye is usually injected with the radioisotope but is not recommended during pregnancy. Your surgeon will discuss whether a sentinel node biopsy is suitable for you. Some people will have all the lymph nodes removed, known as lymph node clearance.

Chemotherapy

Certain combinations of chemotherapy drugs can be given during pregnancy. Anti-sickness and steroid treatments, used to control the side effects of chemotherapy, are also considered safe for pregnant women.

Chemotherapy should not be given during the first trimester as it may affect the development of an unborn baby or cause miscarriage.

Generally, chemotherapy during the second and third trimesters is safe. Most women treated during this time go on to have healthy babies. However, some evidence suggests they may be born early and have a slightly lower birth weight. The growth and well-being of your baby will be monitored by ultrasound.

You’ll be advised to stop having chemotherapy three to four weeks before your due date to avoid complications like infection during or after the birth.

Chemotherapy can continue after your baby is born.

Radiotherapy

Radiotherapy is not usually recommended at any stage of pregnancy, as even a very low dose may carry a risk to the baby.

Your treatment plan during pregnancy will try to avoid radiotherapy or delay it until after the birth. Suppose there’s no other option than to have radiotherapy during pregnancy. In that case, some changes can be made to protect the baby.

Hormone (endocrine) therapy

Hormone therapies are not given during pregnancy. Hormone therapy treats breast cancers that are oestrogen receptor positive (ER+). Breast cancers diagnosed during pregnancy are less likely to be ER+. If your breast cancer is ER+, you’ll begin hormone therapy after your baby is born.

Targeted (biological) therapy

Targeted therapies are not usually given during pregnancy. If targeted therapy is suitable for you, you will start it after your baby is born. The most widely used targeted therapies are for HER2 positive breast cancer.

Giving Birth

Many women diagnosed during pregnancy complete the full term of their pregnancy and do not have any problems during childbirth because of their breast cancer treatment.

When you have your baby will depend on the treatment you need and your expected due date. If your baby is likely to be born early, you’ll be offered a course of steroid injections. This is to help your baby’s lung development and reduce the chance of the baby developing breathing problems.

Where possible, your treatment team will avoid a caesarean section as there can be complications. For example, you can be more likely to develop an infection if your immune system has been affected by chemotherapy.

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