Beruflich Dokumente
Kultur Dokumente
During
Pregnancy
Scientific session by Rizqy Tanza
A discussion among the patient, the oncologist, and the obstetrician on the
relative benefits of early delivery followed by treatment
versus commencement of therapy while continuing the
pregnancy is of utmost importance in order to reach a consensual
decision. The best available evidence suggests that pregnancy after breast
cancer increases the risk of recurrence. The birth outcome in women with a
history of breast cancer is no different from that in the normal female
population; however, increased risks of delivery complications have been
reported in the literature.
As concurrent pregnancy and breast cancer are uncommon, there are no
recommendations are
data from large randomized trials; hence,
mainly based on retrospective studies.
P regnancy B C
reast ancer Review
01 Risk of Breast Cancer
Diagnosis and
02 Presentation
03 Principles of Treatment
04 Multidiciplinary Approach
INTRODUCTION AND BACKGROUND
Scientific session : Pregnancy Breast Cancer
Attributed to physiologic
Incidence 1:3.000 change and discounted
Average 3.5 cm not recognized on
2nd most common cancer in pregnancy
pregnancy
Vascular invasion
42% ER negative,
PR negative,
compared with 21%
in the age-matched
controls. Receptor
downregulation by
circulating estrogen
Risk of breast
cancer
Nulliparous
01 Multiparous
Early menarche
Late menopaused 02
Diagnostic and
presentation
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100%
ALL PREGNANT
Undergo breast evaluation +++
PRESENT OF LUMPS
Team of breast specialitis
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Mammography
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ultrasonography
Detecting axillary metastases
Responses to neoadjuvant Chemotheraphy
Chest Radiography
Magnetic Resonance
Imaging
D
Does not use ionizing radiation
EX
treatment versus disease(TNM), hormone
AM
TU
commencement of receptor status, and
EN
IN
trimester of pregnancy
AT
therapy
M
O
IO
M
N
ASCO Guideline: counsel
N
Pregnancy and future Fertility preservation.
IO
FU
AT
fertility Embryo and oocyte
TU
IC
PL
R
cryopreservation are both
E
M
O
standard fertility
C procedures
SURGERY
First trimester
1st
• Mastectomy and axillary staging is
recommended in the 1st trimester
• BCS not preferred because need
Radiotheraphy
• Breast reconstruction not
recommended 2nd and 3rd trimester
• Surgery can be performed safely
without unexpected complications • Underwent mastectomy with
axillary clearance
• BCS with axillary dissection
• Isosulfan blue dye SNB not
2nd-3rd recommended
• In woman with advance
presentation , neoadjuvant
chemotherapy and surgery after
pospartum
Maternal effect
Alteration in hepatic metabolism, renal clearance, protein
binding may effect drug clearance, amniotic fluid may
act as third space , increased toxicity like metotrexate.
Chemo-
Pre-Eclampsia and Myelosupression.
Fetal effect
All drugs have potential to across the
Remain unclear
Paclitacel combination with Taxanes 5FU Bony aplasia and hypoplasia
cisplatin >28 weeks, docitaxel
single or combination with
doxorubricin >14 weeks,
vinorelbine with 5FU at least 2nd
trimester
Anti emetic
Combination of dexamethason and ondansetron safe
01 during 2nd -3rd
Hormonal agent
Tamoxifen potentially teratogenic in animal studies. In
03 patient with metastatic disease with no damage.
Ambigous genitalia and cranifacial defect. Usually delay
until late pregnancy
Biposphonates
The use of pamidronate reported with malignancy
04 associated hypercalsemia
Termination of Pregnancy
Future Pregnancy
It is recommended that pregnancy should be delayed for at least two
years after treatment completion. The recommendation for future
conception may be based on the prognosis of individual women.
Women with Stage IV disease should not consider pregnancy, and
women with Stage III disease should avoid becoming pregnant for at
least five years after treatment. Women with recurrent Stage I or II
tumors should not consider conception because of the intensity of the
required treatment and the poor prognosis.
Thank You
Scientific session : Pregnancy Breast Cancer