During the second trimester of her first pregnancy, Michelle Cohen initially mistook the sharp pains she felt as something that occurs naturally when expecting a baby, but medical tests soon would reveal the cause wasn’t good news.
On Wednesday during a news conference, Cohen, of East Norwich, flanked by her husband, baby and doctors, told a bittersweet story of developing ovarian cancer while pregnant. Being diagnosed with a malignancy of any kind during pregnancy is an occurrence so rare that only one in every 1,000 women experience it annually in the United States.
Doctors at Northwell's Monter Cancer Center, where Cohen was treated, said cancer during pregnancy may be rare, but the risk of it happening isn't zero. They announced Northwell's new Center for Cancer, Pregnancy and Reproduction, where a wide range of experts will address the unique needs of pregnant women who are battling malignancies.
Cohen’s medical odyssey involved three surgeries, chemotherapy, the loss of her hair — and the birth of a healthy son. It was a journey that encompassed sadness and joy, she said.
“In late December 2017, in my second trimester, I started having pain in my lower left side and thought it was just part of the pregnancy,” Cohen said. “After a sonogram and a two-day stay at North Shore University Hospital, we learned there was a mass on or near my left ovary.
“At this point, there were many things it could be, like a cyst. The team of doctors said I should take it easy and monitor it. Two weeks later, I began to have more pain in the same area.”
Tests revealed the mass had doubled in size and tripled in volume. Doctors said it had to be removed. Cohen was facing surgery while pregnant, another medical rarity.
“I was extremely nervous and scared of what could happen to the baby and me,” Cohen said. “All of my doctors explained the surgery in detail and gave us great confidence that everything would be fine for both of us.
“Three days later, we got the devastating news that the mass was cancerous. I was in shock. I felt sad and confused. I thought: Why me? Soon after this news, my family and I mobilized again. We needed to focus on our plan to get rid of the cancer. We were thankful that it was caught early."
Her doctors were prepared to pull out all the stops to save both mother and baby.
“After a multidisciplinary discussion, we performed the surgery,” said Dr. Lisa Dos Santos, a surgeon and gynecological oncologist who removed the mass and Cohen’s left ovary. Accessing both were difficult, Dos Santos explained, because they were behind the uterus, which contained a growing fetus.
“Treating cancer during pregnancy is an extremely complex process,” added Dr. Veena John, Cohen’s medical oncologist who noted that two patients are involved in the treatment — one with cancer and another who is cancer-free.
John said physicians and pharmacists worked together to determine the appropriate chemotherapy and number of chemo cycles that would be safe for two patients. Baby Franklin was born healthy by cesarean section April 2 with a full head of hair, Cohen said.
The placenta acts as a barrier, preventing many of chemo's molecules from reaching the developing baby, said Dr. Frederic Amant, a professor of gynecological oncology at the University of Amsterdam in the Netherlands. Amant is collaborating with Dr. Richard Barakat, physician-in-chief of the Northwell Cancer Institute, to develop a U.S. database involving cancer and pregnancy.
No one knows the long-term effects of chemo on babies exposed in the womb, Amant and Barakat said.
And there still isn't enough research on ovarian cancer during pregnancy, according to the American Pregnancy Association, a nonprofit in Irving, Texas.
Cohen's husband, Josh, credits his 7-month-old son with playing a role in helping to signal that something was amiss with his mom.
“He’s a blessing,” Josh Cohen said of Franklin. “He helped save her life. We wouldn’t have known about the cancer if it wasn’t for him.”