Over the course of the arduous 6- to 12-hour operation, a surgeon then reconstructs the digestive system to permit pancreatic juices, bile, and food to pass through the body. It’s a daunting prospect for anyone with cancer. For a pregnant woman, it’s almost unthinkable. But for Karalayne Maglinte, who was pregnant with her third child when she was diagnosed with pancreatic cancer in 2013, the Whipple was a lifeline. As Maglinte prepares to celebrate her daughter Emlee’s fourth birthday, she describes this extraordinary surgery — one of only three published cases of a successful Whipple performed on a pregnant woman — and everything leading up to it. “People always ask me how I got through it,” she says. “I had no other options. I just know that I fought for my baby girl.” She adds, “I also had two boys at home I had to fight for. I had to fight for the family.”
An Itch That Sounded the Alarm
Maglinte’s symptoms began when she was 15 weeks pregnant. “I wasn’t feeling well,” she recalls. “There was just something off.” Her feet and hands became intensely itchy. “I remember taking a loofah and scrubbing, but that made it worse.” The itchiness got so bad that it began waking her up at night. “And my stool turned white, and my urine turned dark. It was just so weird,” she says. So Maglinte did what many people do: “I went to Dr. Google,” she says. “I just put in ‘itching hands and feet while pregnant’ and what popped up was ICP, intrahepatic cholestasis of pregnancy. It has something to do with your liver and is really bad for the baby. So I said, ‘OK, I’m calling my doctor.’” When blood tests revealed that her liver enzyme and bile acid levels were high, her doctor referred her to a gastroenterologist. An ultrasound showed that her gallbladder was slightly enlarged but no gallstones. The gastrointestinal (GI) specialist told her to come back in two weeks for monitoring. When she made her return visit, she recalls, “I’m itching and burning, and now my eyes are yellow.” The doctor took one look at her and admitted her to the hospital. “So I ended up sitting in a local hospital for five days. Nobody told my OB that I was there. Nobody cared about the baby. I had my own Doppler, and I said to my husband, ‘Bring it. I’m going to check the baby’s heart rate myself.’” The hospital finally had Maglinte transferred to UC Irvine Health in Orange, California, by ambulance: “I’m like, where? I don’t even care. As long as they’ll take me as both an OB and a GI [patient], get me there,” she says. Maglinte underwent an endoscopic ultrasound, which required going under anesthesia. When she woke up, her husband and her GI doctor, John Lee, MD, were there. Dr. Lee told her that she had pancreatic cancer. “The tumor was blocking the bile duct and causing the backup that led to all my symptoms,” she explains.
One Shot at Treating the Cancer
Maglinte’s tumor was small but waiting to begin treatment until after the baby was born might have given it time to spread. And because of the pregnancy, chemotherapy was not an option. When Maglinte’s medical team at UC Irvine Health recommended the Whipple, she did not hesitate. Maglinte would not hear of delivering early. She says, “I pretty much told them, ‘I am fighting for my baby.’” Her doctors told her that the procedure could be done no later than the 22nd week of pregnancy, when the size of the uterus would block access to the pancreas and the risk of premature labor was too great. Since Maglinte was 20-weeks pregnant at the time of her diagnosis, the timing was extremely fortuitous. Maglinte is one of only three pregnant women who have had a Whipple procedure. The operating room was packed. The surgeons did the procedure in seven-and-a-half hours, and they were able to do it without moving the baby out of the way. The one thing Maglinte remembers her surgeon, Aram Demirjian, MD, saying after the surgery was: “I didn’t have to touch her.” Because of the placement of the placenta, Maglinte hadn’t yet felt the baby kick. “But I will tell you, the day they removed my epidural, I swear she turned, and she kicked me, as hard as she could, and it was like, Oh, my gosh, that hurts, but oh, my gosh, you’re okay,” she says. Maglinte’s pregnancy motivated her to go to superhuman lengths to recover post-op. “It’s really hard after the Whipple to eat,” she says. “In fact, I was rehospitalized for a week because I was not able to keep anything down. But once I got back to eating, it was like, I’m going to make myself eat because of the baby. I’m probably the only Whipple patient who ever gained weight.” Thanks to her efforts and the skill of her medical team, Maglinte gave birth to a healthy baby girl at full term, 39 weeks. The experience was not without its complications: Maglinte tore her abdominal wall during delivery and developed a hernia, requiring surgery, plus she had bouts of pancreatitis that landed her back in the hospital twice. Yet she currently has no evidence of disease. “With pancreatic cancer, the survival rate is only 9 percent within five years, and I’m almost there,” she says. “I am one of the rare ones."
Thriving and Hoping to Inspire
Maglinte is unusual because of both her pregnancy and her age, 36, when she was diagnosed. “The average age of pancreatic cancer diagnosis is probably 70 or 71,” says Victoria Manax Rutson, MD, chief medical officer of the Pancreatic Cancer Action Network (PanCAN). “I have heard of other individuals being diagnosed in their thirties and forties, but it’s not common.” Though her pregnancy made her tricky to treat, Maglinte believes that Emlee saved her life: Only 20 percent of pancreatic cancers are diagnosed early, says Dr. Manax Rutson, mainly because symptoms can overlap with those of other conditions: abdominal or mid-back pain, jaundice, pale stool, weight loss, indigestion. “Without Emlee, I probably wouldn’t have reacted to my symptoms the way I did,” says Maglinte. While Maglinte’s case is exceptional, she hopes that talking about her experience will open up a broader conversation about pancreatic cancer, a disease that is rising in incidence, driven, in part, by the increasing rate of obesity and type 2 diabetes, both of which are risk factors for the disease. PanCAN estimates that by 2020, pancreatic cancer will surpass colorectal cancer to become the second leading cause of cancer-related deaths in the United States. To help the cause, Maglinte now takes part in events like PurpleStride Orange County, PanCAN’s fund-raising walk. “My husband and I try to go with the kids,” Maglinte says, “so everyone’s watching them grow up.”
