4. The case may be inoperable and the child viable.
In the first case the supposition is that the case is operable but the child inviable. To save the woman the uterus, with its adnexa, must be removed, and this, of course, kills the fetus. The case differs from the enucleation of a gangrenous myoma which involves the death of an inviable fetus. In the myoma case the woman has practically every chance for her life through operation; in this cancer case the woman has only one chance in four, as 75 per cent. of such operations fail through recurrence of the cancer.
The child has about one chance in two of going on to viability, owing to the tendency to abortion, if no operation is done; but the mother loses her chance for life if the operation is not done at once, as the cancer will spread beyond cure. Zweifel has seen such a growth extend a finger's breadth in one week. The one chance in four in immediate operation gives the mother a solid ground for hope, and the probability is sufficient, in my opinion, to permit the operation with a permissive loss of the fetus.
In the second case the cancer is operable and the child is viable. The child should at once be delivered by cesarean section, and the uterus with its adnexa removed.
The third case is that of an inoperable cancer and an inviable child. There the operation should be deferred, if possible, until the child becomes viable.
The fourth case supposes the cancer is inoperable but the child viable. In the interest of the child, immediate cesarean section is the best thing to do; it is much better than waiting until term. At term this operation will have to be done anyhow, and the earlier it is done, the better the woman can stand the strain. There is a risk that she will die from the first operation done to deliver the viable child, but she may licitly take this risk, as she might licitly run into a burning house to save a child, even if not her own. She may also licitly refuse the first operation.