Valentine’s Day 2016 was joyful for Shantill Zeznanski. The 35-year-old West Bend resident made the exciting discovery that she was pregnant with her third child. She and her fiancé, Mark, were thrilled.
But their joy was tempered during Shantill’s first prenatal visit 10 days later when she mentioned to her nurse midwife that she had felt a lump in her right breast. Jess Tischler , certified nurse midwife, quickly arranged an ultrasound and biopsy of the lump. Shantill was 10 weeks pregnant when she was diagnosed with an aggressive form of breast cancer.
Shantill was afraid, but believes it helped to focus on the health of her baby rather than the cancer diagnosis. “I put all of my energy into making sure my pregnancy was as easy and relaxed as possible to increase the chances that the baby would be okay,” she said.
Given the complexity of Shantill’s diagnosis, her midwife transferred her care to Ashley Wanless, MD, obstetrician/gynecologist. Dr. Wanless co-managed her care with maternal fetal medicine specialists, who handle high-risk pregnancies, as well as medical oncologist John Burfeind, MD.
This multidisciplinary approach is key to cancer treatment throughout our Cancer Network. For example, Shantill’s care team discussed her case at the hospital’s breast cancer conference, which meets weekly to consider all new breast cancer patients and develop a personalized treatment plan for each patient. The conference includes medical oncologists, radiation oncologists, a breast surgical oncologist, a plastic and reconstructive surgeon, radiologists and others who weigh in on the best treatment options.
“In that one meeting we draw on expertise from a variety of disciplines to help direct treatment,” Dr. Burfeind said.
The biopsy revealed that Shantill had invasive ductal carcinoma, a common form of breast cancer, but the tumor carried the HER2/neu gene mutation, which indicates an aggressive type of cancer.
Surgery and Chemotherapy
Breast cancer treatment is a combination of surgery, radiation therapy and systemic therapy, which includes chemotherapy, hormone therapy, targeted drugs and immunotherapy. “It’s a different plan for each patient,” Dr. Shah-Khan said. For Shantill, the cancer care team began with surgery to remove the cancer but waited until she had reached her second trimester of pregnancy, which is safer for the baby.
A mammogram performed before surgery showed that, in addition to the malignant tumor, Shantill had calcifications in her right breast, likely an early sign of cancer growth. Dr. Shah-Khan performed a modified radical skin-sparing mastectomy and sentinel lymph node biopsy, removing the entire breast and some lymph nodes to check for cancer cells. The lymph nodes, fortunately, were clear. The surgical team worked swiftly to minimize the time that Shantill and her baby were under anesthesia and monitored the baby’s heartbeat closely. Both baby and mom came through the surgery well.
Shantill recovered from surgery and began chemotherapy. “It definitely surprises people that patients can receive chemotherapy when they’re pregnant,” Dr. Burfeind said. “But there are dozens of different medications used to treat cancer, and some have a good track record of being safe during pregnancy.”
Chemotherapy can be challenging for anyone, but Shantill was especially worried about the health of her baby and periodically called Dr. Burfeind for advice and reassurance. “He always called me back immediately, even on weekends,” Shantill said. “He was very caring and empathetic about everything that I was thinking and feeling.”
A Joy-Filled Arrival
Shantill visited Dr. Wanless’ office every two weeks for ultrasounds to monitor her baby’s growth and was encouraged to see the baby progressing well. As she approached the end of her pregnancy, Shantill’s team prepared to induce her early. Their goal was to schedule the birth as far as possible from a chemotherapy treatment. “We wanted to expose the baby to the least amount of chemotherapy we could,” Dr. Wanless said. “We avoid inducing birth in patients who have just had chemotherapy because it can affect their blood counts.”
“We worked closely with Dr. Wanless to time Shantill’s delivery,” Dr. Burfeind said. “It was important that her white blood cell count and platelets were within normal range to reduce the risks of infection or bleeding.” The early birth also allowed Shantill to start stronger cancer treatment drugs, which may not be safe during pregnancy.
In a room filled with loved ones, Mark Anthony III, named for his father and late grandfather, was born in late August. Shantill was ecstatic to hold her baby, whom they nicknamed Marky. “It was the best day of my life,” she said.
Home Away From Home
After Marky’s birth, Shantill resumed her cancer treatment. In February, Dr. Shah-Khan completed a preventive mastectomy of Shantill’s left breast, while Mark Bosbous, MD, plastic and reconstructive surgeon, performed a delayed reconstruction on her right breast and an immediate reconstruction on her left breast. Chemotherapy will continue through the fall, but Dr. Burfeind said she is unlikely to need radiation therapy.
Shantill is grateful for her family, including Mark, her daughters Autumn and Trinity, and her sister Jessica, who have provided continuous support and encouragement.
She is also thankful for the hospital, which she says is her “home away from home,” with a staff that’s like family. The doctors, nurses and staff greet her with hugs and argue over who gets to hold Marky, she said, laughing. “He belongs to everyone there.”
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