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radiation, Chemo ports, and breastfeeding after pumping and dumping during chemo

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  • radiation, Chemo ports, and breastfeeding after pumping and dumping during chemo

    I have a 7 month old who I am breastfeeding. We both really love it and I nursed my older daughter until she was almost 3. However, I was recently diagnosed with colorectal cancer for which I will need chemo, radiation, and surgery. I have a few questions.

    First, my radiation is to the pelvis and my doctor said it will put me in menopause but that I should still be able to breastfeed and that it would be safe since the radiation will be to my pelvis. Do you agree with that?

    Second, for chemo I will need a port. I will still be lactating when that is put in as I want to keep breastfeeding as long as I can. Would placement of the chemo port impact the milk or breastfeeding at all?

    Third, Once chemo starts I need to stop breastfeeding. I am trying to decide if I should pump or dump for the entire duration or just stop all together. I would like to pump and dump and then restart, but am wondering how successful and safe that is likely to be. I am expecting about 12 weeks of chemo, which I think would be doable to pump and dump during. The tricky bit is the wash out period before the milk is safe again. I looked up the drugs and most are cleared within a few days, but one, oxaliplatin stays for a very long time - 3 months according to lact med and the infant risk app says to discontinue breastfeeding unless you can test the milk for platinum. I did find a lab who will test milk for platinum (they said they: "test for the parent compound platin at one part per trillion detection limit" and to wait at least 3 weeks before even trying to test.) i am wondering if you think returning to breastfeeding would be safe/feasible after say, 2 consecutive tests where platinum is not detected? Or should I just quit all together?

    Thank you!

  • #2
    Nickis:

    First, radiation to pelvis will pass on out and not harm the milk. I'm assuming its X-Ray irradiation. It might suppress milk production if your hormones (particularly estrogen) are suppressed. Some estrogen is required for milk synthesis.

    Two: they may use a bit of lidocaine to place the port. If so, wait until pain returns, and then you can breastfeed. Pump and discard milk exposed during procedure.

    Three: Yes, you'll need to stop breastfeeding during chemotherapy. Yes, pump and discard all during this process and for weeks after the last platinum. If you do test for platinum, would you be so kind as to send me the lab results and exact timing and dose of cisplatinum. I might use it to help some other mom.

    I'd suggest, if you want 3 weeks to test platinum, and it is low, then it should be ok to return to breastfeeding if you have milk.

    But let me be honest with you, I'll be surprised if you have much milk left after all this. Sorry.

    I'm hoping you do well and recover. Good Luck.

    Tom Hale Ph.D.
    Infantrisk Center

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    • #3
      Thanks. I hadn't realized breastfeeding required estrogen once established. I can imagine that might complicate things. I will be sure to send you the testing info if I end up having milk to test.

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      • #4
        Wanted to follow up on this as you requested. I did breastfeed through radiation which went fine - no noticeable changes in supply. I had to start chemo when my baby was 8.5 months. I stopped breastfeeding which was very hard. I pumped and dumped during my 12 weeks of chemo and after. My supply did fall a lot during chemo, but I still had some milk left and wanted to go back to breastfeeding. About 4 weeks after finishing chemo I got my milk tested. The drug of concern was oxaliplatin and I had 4 infusions of it. Each dose was 200 mg (or 130 mg per meters squared). My last dose was 11/23 and I expressed milk for testing on 12/26 and 12/27. (Was told to sample over several sessions). The platinum level was 0.0078 ppm. This was still a bit too high. Unfortunately getting the results back took almost a month during which time I was still pumping and dumping and had surgery. The surgery was successful, but the doctors decided I should do a bit more chemo afterwards (which was not unexpected, and my prognosis is still good, I was just hopeful I might be able to get away with less). Given that I have to go back on chemo, my supply fell so much, and my baby is now over 1 and doesn't seem very interested in nursing anymore, I decided I should stop pumping and dumping. It is very disappointing, but I am glad I tried. Anyway, hope the info on the drugs and platinum levels are helpful to others!

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        • #5
          Hello,

          Thank you for following up with us! Dr. Hale and I would like to explore your experience and format it in a way that is accessible to other healthcare professionals. If you'd like to help, please send me an email at [email]contact@infantrisk.com[/email] with your contact info.

          All the best,
          Dr. Krutsch, PharmD
          InfantRisk Center

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