'My cancer was so aggressive I had to have chemo while pregnant'

'My cancer was so aggressive I had to have chemo while pregnant' Joanna Walters, 33, originally thought she had an infection A mum who thought she had pregnancy-related symptoms or an infection was diagnosed with one of the deadliest forms of cancer while pregnant with her daughter. Joanna Walters says she was overjoyed when she learned she was expecting her fourth child. The 33-year-old and her husband already had three sons and were thrilled when they later discovered they were finally having a daughter. But as she prepared to welcome her baby girl, Joanna unknowingly began developing inflammatory breast cancer (IBC), a rare and aggressive form of the disease that can often resemble an infection. At first, she chalked it up to pregnancy symptoms – and is speaking out to warn other mums. “I felt a tiny pea-sized nodule in my breast, but a few days later, I found out I was pregnant, so I thought it was just a milk duct change related to pregnancy,” said Joanna, from Florida. “I then began experiencing breast swelling in the cancer-affected breast that was asymmetrical to the other breast, and the typical tenderness that comes with pregnancy turned into sharp pain on that side. Then the pea-sized nodule suddenly grew, and I then had a red rash and developed orange-peel textured skin. “My nipple became inverted on that side, and that's where I became concerned. It resembled mastitis, except for the orange-peel texture that appeared. I thought that all the beginning signs were pregnancy-related. “Even when I developed the rash, I thought it must be mastitis related to the breast changes that pregnancy brings. The symptoms came on so quickly that I didn’t even consider that it could be cancer, because I had never heard of inflammatory breast cancer and didn’t know that breast cancer could mimic an infection.” By the time the education worker mentioned her concerns to her midwife at the 20-week appointment, the disease had already spread outside of her breast. Mum-of-four Joanna said: “I asked if I could get mastitis in pregnancy. As soon as they did a visual exam, they were concerned about inflammatory breast cancer and sent me to a doctor the same day for a mammogram. The mammogram revealed three tumours in Joanna’s left breast and one in her lymph nodes that were positive for cancer and she was diagnosed the next day. Joanna said: “I was in shock because of how quickly everything happened and that I could get a rare aggressive cancer, since I had spent the better part of 10 years before that trying to eat organic and use clean products. “It was overwhelming because when I googled at the time, I found that the overall survival rate for five years was 40%, but if I were stage four, that survival rate dropped to 19%. We didn’t know if I was stage three or stage four because I didn’t get a PET scan, as the radiation could affect the baby, so we moved forward with treatment, not knowing what the future looked like. “I was scared I wouldn’t see my kids grow up.” Joanna says that the emotional burden of facing a potentially life-threatening illness while carrying a baby was “extremely difficult.” She said: “Having life growing in me while simultaneously having a tumor growing, trying to kill me, was a really hard dichotomy to face. “It made treatment a lot more difficult physically and I got to a point where I couldn’t walk more than a few steps without resting. It made it emotionally harder in the sense that I felt like I had one more thing to lose, but her birth also gave me something to look forward to. “I saw each chemo session as one step closer to meeting her. It felt like it was going to be my reward for getting through it.” Treatment began just one week after diagnosis. In June 2022, Joanna had a chemotherapy port implanted before heading directly to a cancer centre for her first treatment. She underwent four rounds of AC chemotherapy followed by four rounds of the cancer drug Taxol. Despite being heavily pregnant, she completed chemotherapy in September 2022 at 35 weeks of gestation. Two weeks after finishing chemotherapy, Joanna was induced. In October 2022, she gave birth to a healthy baby girl, Naomi, now four. Just one week later, Joanna underwent a PET scan for the first time and discovered there was no evidence of measurable tumours elsewhere in her body. But a week later, surgeons performed a modified radical mastectomy and discovered active cancer remained in five of ten lymph nodes removed during surgery. Tests also showed the cancer had already spread beyond the lymph nodes and into surrounding tissue and blood vessels. Following surgery, Joanna underwent intensive radiation treatment twice daily throughout December 2022 before starting endocrine therapy and targeted treatment designed to reduce the risk of recurrence. A blood test in April showed no detectable cancer cells in the body. Joanna said: “I felt so relieved since and had another follow-up test a few months later that was negative again. “All my PET scans since then have been clear. “I've been on a variety of medications to prevent cancer and to manage the symptoms that cancer treatment has caused, but I am doing really well. I’m working full time, taking care of my kids and regularly exercising.” Joanna believes greater awareness could save lives. She added: “When I was going through treatment, I learned that this cancer is so rare that many doctors are not familiar with the protocol put out by the leaders in treating this type of cancer, which is the best way to treat IBC. “In my case, I had to advocate for the correct surgery since there was still cancer in my skin even after chemo. If they had performed the originally planned surgery, I would have still had cancer and might not be here. Patients have to make sure that they are receiving the proper treatment and not be afraid to advocate for themselves or get second opinions.”