New Treatment Protocol for Rectal Cancer Saves Pregnant Woman and Her Baby

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Just a few weeks after Michelle Jahnke learned she was pregnant with her first child, the 30-year-old was diagnosed with stage 3 rectal cancer.

The standard treatment recommendation, in the absence of a clinical trial, is combined-modality, neoadjuvant chemoradiation followed by curative-intent surgical resection.

Elana Marie was born to Michelle and Mark Jahnke on November 30, 2012, weighing 6 pounds. “Elana continues to thrive and is reaching all of her milestones,” Jahnke said.

Five physicians told Jahnke she needed to terminate the pregnancy; her unborn child would not survive radiation or surgery.

She quoted one oncologist as saying, “There is nothing I can do to help your baby.’’

But University of Chicago Medicine oncologist Blase Polite, MD, told Jahnke and her husband, Mark, that a novel approach to therapy was possible — one that could treat the cancer and save their baby.

To achieve that goal, Polite assembled a care team that incorporated six more specialists. The physicians and surgeons collaborated closely to plan and implement each step of Jahnke’s treatment and the delivery of her child.

Today, Jahnke has a healthy baby girl and shows no signs of cancer.

THE MEDICAL TEAM

Gastrointestinal oncologist  Polite knew that a new treatment protocol — chemotherapy alone before surgery — would soon be examined in a clinical trial for rectal cancer. Based on previous studies of babies born to mothers who had chemotherapy for breast cancer while pregnant; a careful review of the pharmacology with specially trained oncology pharmacists; and discussions with colleagues around the country, Polite believed giving chemotherapy at full doses to Jahnke during her pregnancy would be safe for her baby.

High-risk obstetrician Mahmoud Ismail, MD, used frequent ultrasounds to regularly observe the growth of the Jahnke’s fetus throughout the pregnancy. He collaborated with Polite and other members of her medical team to monitor Jahnke’s overall health. Ismail delivered Jahnke’s healthy baby girl by cesarean section at 35 weeks gestation.

 Radiation oncologist Stanley Liauw, MD, determined that while the chemotherapy had successfully kept the cancer in check, radiation still was necessary. Jahnke elected to have proton therapy at a suburban location. Liauw consulted with the proton center, reviewing and fine-tuning Jahnke’s treatment plan.

Reproductive endocrinologist David P. Cohen, MD, joined Jahnke’s team early on to determine if anything could be done to save the function of Jahnke’s ovaries. After discussing every alternative with Cohen, the couple decided it was best not to pursue any treatment to preserve her fertility.

Gastroenterologist Sonia Kupfer, MD, specializes in hereditary gastrointestinal cancer syndromes. In Jahnke’s case, genetic sequencing revealed a variant of a gene potentially linked to Lynch syndrome, which is associated with an increased risk of colorectal, ovarian and endometrial cancer. “If upcoming advances in genetic testing give us more information,” Kupfer said, “we may be able to tell her more and help future generations of her family.”

Colorectal surgeon Mukta Krane, MD, performed Jahnke’s colorectal surgery six weeks after Jahnke finished radiation treatment and a second round of chemotherapy. Krane removed the sigmoid colon as well as the majority of the rectum that contained the tumor. The pathology report after surgery showed no remaining tumor cells. “Michelle’s prognosis is good,” said Krane, who, with Polite, will follow Jahnke for years to come.

Gynecologic oncologist Meaghan Tenney, MD, performed a hysterectomy and an oophorectomy as proactive measures to reduce the likelihood of Jahnke later developing ovarian or endometrial cancer. Working in collaboration with Krane, Tenney completed the gynecologic surgery at the same time as the colorectal procedure.

A randomized phase II/III NCCTG/NCI clinical trial is now studying how well chemotherapy alone, compared to chemotherapy plus radiation therapy, works in treating patients with rectal cancer undergoing surgery. Call 1-855-702-8222 for more information.

This story originally appeared in the Winter 2014 edition of Inspired magazine.


Top photo caption: Michelle Jahnke, holding baby Elana, thanks her medical team. From left: Meaghan Tenney, MD,  David P. Cohen, MD, Mahmoud Ismail, MD, Mukta Krane, MD, Michelle, and Blase Polite, MD. Not pictured: Stanley Liauw, MD, and Sonia Kupfer, MD.