BREAST CANCER

DURING PREGNANCY
 PATIENT’S PROFILE

• JS
• 34 year old
• Female
• PU G1P0 22 weeks AOG by LMP
CHIEF COMPLAINT
BREAST MASS, RIGHT
HISTORY OF PRESENT ILLNESS
 HISTORY OF PRESENT ILLNESS

2 months
PTC
 HISTORY OF PRESENT ILLNESS

2 months
PTC
 HISTORY OF PRESENT ILLNESS

2 months
PTC
 HISTORY OF PRESENT ILLNESS

2 months
PTC
 HISTORY OF PRESENT ILLNESS

2 months
PTC
 HISTORY OF PRESENT ILLNESS

2 mos • Progressive enlargement of

PTC palpable breast mass, right
• Consult
• Ultrasound
• (+) 9.4 x 4.2 cm well defined mass with
solid and cystic foci on the right breast
• Core Needle biopsy
• Invasive Ductal Carcinoma

Consult
 PAST MEDICAL HISTORY

• No Hypertension
• No Diabetes Mellitus
• No Asthma
• No Allergies

PAST SURGICAL HISTORY

• No previous surgery
• No history of trauma or accident
 REVIEW OF SYSTEMS

General Survey: (-) loss of appetite, (-) fever, (-)

weight loss
Skin: (-) pruritus, (-) rashes
HEENT: (-) headache, (-) dizziness, (-) eye redness/
discharge, (-) lacrimation, (-) rashes on ears, (-) aural
discharge, (-) nasal discharge, (-) epistaxis, (-) sore
throat
Respiratory: (-) cough, (-) colds, (-) difficulty of
breathing
Cardiovascular: (-) chest pain, (-) orthopnea, (-)
cyanosis, (-) syncope, (-) easy fatigability
 REVIEW OF SYSTEMS

Gastrointestinal: (-) nausea, (-) vomiting, (-)

diarrhea, (-) constipation
Genitourinary: (-) flank pain, (-) dysuria, (-)
frequency, (-) nocturia
Endocrine: (-) heat/ cold intolerance (-) polyphagia,
(-) polydipsia, (-) polyuria
Nervous: (-) tremors, (-) mood changes, (-) sleeping/
eating problems
Hematologic: (-) gum bleeding, (-) easy bruisability
Special senses: (-) blurring of vision, (-) hearing
difficulty
 PHYSICAL EXAMINATION

(+) 10 x 6 cm nontender,
retroareolar mass almost
occupying the entire breast with
purple discoloration of the
overlying skin.
No Axillary Lymph Nodes
 PHYSICAL EXAMINATION

(+) 10 x 6 cm nontender,
retroareolar mass almost
occupying the entire breast with
purple discoloration of the
overlying skin.
No Axillary Lymph Nodes
 SALIENT FEATURES

• J. S.
• 34 year old
• Female
• First Pregnancy
• 22 weeks AOG by LMP
• 2 month history of
rapidly enlarging breast (+) 10 x 6cm nontender,
mass retroareolar mass almost
occupying the entire breast
with purple discoloration of
the overlying skin.
No Axillary Lymph Nodes
 IMPRESSION

Malignant neoplasm of the

breast, right
Stage IIIB (T4N0MX)
 DISCUSSION
BREAST CANCER DURING PREGNANCY
 BREAST CANCER IN PREGNANCY

• It has been estimated that up to 3.8% of breast

cancers may be diagnosed in women who are
pregnant
• Axillary lymph node metastases are present in up to
75% of these women
• Breast cancer occurs in 1 of every 3000 pregnant
women
• Average age of the pregnant woman with breast
cancer is 34 years.
 BREAST CANCER IN PREGNANCY

• Pregnant women with breast cancer often present

at a later stage of disease because breast tissue
changes that occur in the hormone-rich
environment of pregnancy obscure early cancers.
• However, pregnant women with breast cancer
have a prognosis, stage by stage, that is similar to
that of non-pregnant women with breast cancer.
 BREAST CANCER IN PREGNANCY

• ALN –positive and with larger primary tumor size

• Histologically
• Poorly differentiated
• ER/PR negative
• 30% HER2-positive
• The median gestational age at diagnosis is 17–25 weeks
• Approximately 60–80% of breast cancers diagnosed in
pregnant women may be oestrogen receptor (ER)
negative
• between 28% and 58% have been reported to be
human epidermal growth factor receptor (EGFR) 2
(HER2) positive
 LABORATORY TESTS

• Liver function test

• Renal function test
• Complete blood count with differential
 IMAGING

• Mammogram
• Ultrasound
• MRI of the thoracic and lumbar spine
 HISTOPATHOLOGY

• Fine needle aspiration biopsy

• Core needle biopsy
MANAGEMENT
MANAGEMENT
 CHEMOTHERAPY

• Maternal Physiology
• Blood volume
• Hepatic metabolism
• Renal plasma flow
• Plasma Albumin
• Amniotic fluid
• Fetal Development
• Implantation
• Organogenesis
 CHEMOTHERAPY: 1ST TRIMESTER

• Antimetabolites and alkylating agents

• Miscarriage
• Malformations

• Anthracyclines and cyclophosphamides

• Not associated with birth defects
 CHEMOTHERAPY:
2ND AND 3RD TRIMESTER
• Anthracycline-based regimens
• Absence of any congenital anomalies
 RADIATION THERAPY

• Not favored during pregnancy

• Adjuvant radiotherapy
• Patients with Brain metastasis
 HORMONAL TREATMENT

• Tamoxifen
• associated with birth defects in up to 20% of exposures
• interact with rapidly growing and developing embryonic or
fetal tissues
• postpone tamoxifen up until after delivery
• Trastuzumab
• contraindicated during pregnancy
• pregnancy category B drug
 FETAL AND PREGNANCY
MONITORING
• Multidisciplinary approach
• Timing of delivery
• Administration of chemotherapeutic agents
• Mode of delivery
• Breastfeeding
JOURNALS
 TREATMENT OF PREGNANT BREAST CANCER
PATIENTS AND OUTCOMES OF CHILDREN
EXPOSED TO CHEMOTHERAPY IN UTERO

• https://www.ncbi.nlm.nih.gov/pubmed/16894524/
 MULTIDISCIPLINARY MANAGEMENT OF
BREAST CANCER DURING PREGNANCY

• http://theoncologist.alphamedpress.org/content/2
2/3/324.full
INCREASED MORTALITY IN WOMEN WITH BREAST
CANCER DETECTED DURING PREGNANCY AND
DIFFERENT PERIODS POSTPARTUM.

• https://www.ncbi.nlm.nih.gov/pubmed/21750168