'Twin' turns out to be tumour

'Twin' turns out to be tumour

She thought she was having twins. Instead, the 38-year-old marketing executive had a rare form of cancer.

We meet Priscilla, as she prefers to be called, at a coffee shop outside her home near Toh Yi in Bukit Timah.

She appears vibrant and healthy, but as she talks about her experience, her tone becomes clipped.

Priscilla was then 33 and unmarried.

When morning sickness landed her in hospital, she was given a surprise diagnosis: One of the twins she thought she was carrying was, in fact, a cancerous mass, called a gestational trophoblastic tumour.

Dr Quek Swee Chong, clinical director of Parkway Gynaecology Screening & Treatment Centre, who is not Priscilla's doctor, explains that this is a rare cancer where instead of a baby, the egg does not fertilise properly and develops into a mass of cells which can be cancerous.

Some forms of these tumours are less sensitive to chemotherapy and tend to spread rapidly to other organs.

Priscilla was advised to abort the pregnancy immediately to start treatment.

"I had to make a choice - me or the baby?" she says.

"Someone asked if I were to give birth to the baby and died later, leaving the kid alone, would that not be cruel?"

Still, she chose to keep the baby.

"After all, the unborn child is still a life. I felt him move. I felt him kick," she says.

There is a hint of emotion now to her matter-of-fact narrative as she stirs her cup of tea.

In her seventh month of pregnancy, Priscilla flew to Chicago for treatment. She claims that when she touched down, her water bag broke.

According to her account, she gave birth prematurely to her son just 24 hours later.

"He was tiny and he was wheeled away quite soon after.

"I made sure I visited him in the NICU (neonatal intensive care unit) every day."

Three days after his birth, Priscilla underwent chemotherapy.

But tragically, her baby deteriorated in the NICU and after 2½ weeks, he died.

Priscilla said she was told he had an infection and because he was premature, his immune system was not strong enough to fight it.

"I was undergoing chemo and was very weak. My baby had died. I was alone and had to handle the cremation and administrative details.

Priscilla remembers calling home to break the news of her baby's death to her parents.

"In my mind, I was telling them rationally that their grandson had died but my parents told me much later that I was a blubbering mess.

"They couldn't understand a word I was saying.

" I was sobbing, sniffing, crying. They couldn't get a word in either.

"It was the loneliest time of my life. I had to undergo treatment that was making me sick and at the same time I was grieving."

Religion gave her strength when she needed it most.

Priscilla returned to Singapore about three months later, after she had three cycles of chemotherapy, with her son's ashes.

"I told myself life goes on. I have to fight the cancer and not let it overwhelm me," she recalls.

She held a small memorial service in church for her baby.

That helped her start to rebuild her life. She is in remission today.

"All I can say is I am thankful I got to know and love my son, even for that short 2½ weeks," she says.

Facts about cancer and pregnancy

1. When making treatment decisions, factors to consider include the stage of pregnancy, the type, location and size of the cancer, and the wishes of the patient and her family.

2. Pregnancy can mask some of the symptoms. Breast cancer, for instance, occurs once in every 3,000 pregnancies, but the enlarging breast can hide the telltale lumps, says Dr Ong Kong Wee, who heads the SingHealth Duke-NUS Breast Surgery Centre. Sufferers are also likely to be diagnosed later.

3. Some treatments can harm the foetus, especially during the first three months when the baby's vital organs are forming. Dr Christopher Chong of Chris Chong Women and Urogynae Centre explains: "Chemotherapy (at that point) can damage the organs and cause abnormality, damage the cells or genes and increase the risk of organ failure or cancer in the unborn child."

4. Doctors are more likely to begin chemotherapy after the first trimester, as the placenta begins to protect the developing foetus, preventing most of the drugs from crossing over to the baby.

5. A known complication of administering chemotherapy in the late stage of pregnancy is that it can cause premature labour and babies that are of low birth weight, says Dr Quek Swee Chong, clinical director of Parkway Gynaecology Screening and Treatment Centre.

6. Radiotherapy is usually not administered as the high doses of radiation can harm the foetus. Dr Quek says that most times, doctors will prefer to deliver the baby as soon as possible.

This article was first published on Nov 16, 2014.
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