One Cancer, Two Lives at Stake

Amanda Ruiz was 18 weeks pregnant when she learned she had head and neck cancer. Her medical team successfully treated her cancer and she delivered a healthy baby girl.

Louis de Guzman Portugal, MD, Amanda Ruiz, Jonas de Souza, MD Amanda Ruiz, center, was diagnosed with head and neck cancer while she was pregnant with her third child. Otolaryngologist Louis de Guzman Portugal, MD, left, and medical oncologist Jonas de Souza, MD, worked together with other UChicago Medicine specialists to ensure Ruiz received effective, safe cancer care that also protected the health of her baby.

Amanda Ruiz of Aurora, Ill., wondered why her right earring was knocking against her neck. Reaching up to adjust it, the 26-year-old felt an egg-shaped lump under her ear lobe.

"It felt like a swollen lymph node," she said. But when she sought advice from nurses in her medical terminology class, they urged her to see a doctor.

Amanda, who was just over four months pregnant with her third child at the time, and her husband, Andy, contacted the head and neck care team at the University of Chicago Medicine.

"Another family member was diagnosed with cancer a few years before and I did a lot research then," Andy said. "I knew the medical center had the top program in Chicago for head and neck cancer."

A needle biopsy performed at the hospital raised suspicion for cancer. A second biopsy led to a definitive diagnosis: nasopharyngeal carcinoma -- cancer in the cells that line the upper part of the throat behind the nose.

Designing a Custom Treatment

Cancer in patients who are pregnant is rare, occurring in just one out of every 1,000 pregnancies. Most cancers do not spread to or affect a fetus. But for each of these patients, the challenge is the same -- how to battle the cancer without harming the unborn child.

Daniel Haraf, MD Daniel Haraf, MD

A multidisciplinary group of specialists was assembled to design a care plan for Amanda’s unique situation. Her team included otolaryngologist Louis de Guzman Portugal, MD, medical oncologist Jonas de Souza, MD, radiation oncologist Daniel Haraf, MD, and maternal-fetal medicine specialist Laura DiGiovanni, MD.

The four physicians agreed on a split approach to treatment. Carefully selected chemotherapy drugs, which do not cross the placenta, would be given until a few weeks before the baby’s due date. Radiation, which is known to increase the risk of birth defects, would be delayed until after the birth.

"We were very confident we could treat her safely and effectively," said de Souza, whose team had a similar experience with another young patient a few years ago.

Laura DiGiovanni, MD Laura DiGiovanni, MD

The Ruiz couple was comfortable with the care plan from the start. "There was no hearing ‘if we cure you’ from the oncologists," Andy recalled. "It was ‘when we cure you.’"

DiGiovanni, an expert in high-risk pregnancy care, assessed the baby’s well being with regular fetal ultrasounds and non-stress tests during the course of Amanda’s chemotherapy treatment. "We could see that the baby was growing well," DiGiovanni said, adding, "Amanda had an incredibly positive attitude and always approached this necessary surveillance with grace and a smile."

Delivering a Healthy Baby

Ruiz family The Ruiz family

Amanda and Andy welcomed Isabela Ruiz through induced labor and vaginal delivery on March 18, 2013, four weeks before her due date. "Isabela was 6 lbs., 6 oz., 20 inches long and perfectly healthy," Amanda said. The newborn was cared for in the hospital’s regular nursery before going home with her mother.

A few weeks later, Haraf initiated Amanda’s radiation therapy and de Souza reactivated the remaining course of chemotherapy. The combination treatment has an 80 percent cure rate for patients with nasopharyngeal cancer.

When the young mother was hospitalized for several days at a time to undergo treatment, family and friends stepped in to care for Isabela and her two other young children. Amanda faced challenges related to the therapy and its side effects, but today, she says, "No one believes I had cancer because I look so good."

De Souza reports that Amanda has totally recovered and is free of disease. Still, as part of her comprehensive care, the medical team monitors her regularly for any signs of the cancer recurring.

Now, when Amanda comes to the medical center for her appointments, she brings the latest photos of Isabela and her siblings. During a recent visit, she also shared some exciting news: she is pregnant again.

Amanda Ruiz and Jonas de Souza, MD Amanda Ruiz and medical oncologist Jonas de Souza, MD, share baby photos during a recent appointment.  DeSouza says that because his wife was pregnant at the same time as Amanda, treating her was a "very personal experience" for him.

July 2014