<ul><li>Cancer complicate 1 / 1,000 pregnancies </li></ul><ul><li>1/3 maternal death during pregnancy </li></ul><ul><li>Co...
<ul><li>Diagnostic delay is not rare </li></ul><ul><li>The management of pregnant mother is difficult </li></ul><ul><li>Co...
4/46
<ul><li>Tumours diagnosed during pregnancy or within one year post partum </li></ul>5/46
6/46
<ul><li>Diagnosed 1 / 3000 pregnancies </li></ul><ul><li>Incidence 0.76 – 3.8 % </li></ul><ul><li>Median age 33  ( 23 - 47...
8/46
<ul><li>Similar to non pregnant lady </li></ul>- Painless mass - Nipple discharge - Inflammatory breast  9/46
10/46
Histopathology LN Status Receptor  status 11/46
Histopathology Invasive ductal ca Invasive lobular ca Inflammatory breast ca Middleton LP , et al. Breast carcinoma in pre...
<ul><li>Similar to non pregnant women in : </li></ul><ul><ul><ul><li>Histological frequencie </li></ul></ul></ul><ul><ul><...
<ul><li>+ve ER , PR  < 30 %  </li></ul><ul><li>Her-2 / neu over expression 28-58% </li></ul><ul><li>p53 50 %  </li></ul>Re...
<ul><li>Involved in 60 - 90 %  </li></ul><ul><li>Similar to general population  </li></ul>LN status Isaac J . Cancer of th...
 
<ul><li>Diagnostic delay </li></ul><ul><li>Average delay 8.2 months ‘ 2-15 months ‘ </li></ul><ul><li>Advanced breast canc...
<ul><li>FNA </li></ul><ul><li>Core biopsy – Cost effective </li></ul><ul><li>Early stage breast ca accounts 60% </li></ul>...
 
Radiation effect  Dose dependant Gestational age 20/46
< 0.1 Gy > 3 Gy Dose No effect Fetal malformation 21/46
Teratogenic Gestational age 16 w 2 w Abortion 25 w Sterility  malignancy Mole RH.childhood cancer after prenatal exposure ...
<ul><li>Ultrasound  sensitivity 93 % </li></ul><ul><li>Diagnostic Mammogram: </li></ul><ul><li>-  0.004 Gy </li></ul><ul><...
<ul><li>Staging – CXR , Ultrasound </li></ul><ul><li>Avoid CT  </li></ul><ul><li>Pvlidis NA.  The oncologist 2002;7:279-87...
 
Surgery Chemotherapy Radiotherapy 26/46
<ul><li>Gold standard </li></ul><ul><li>BCS </li></ul><ul><li>2 nd -  3 rd  trimester </li></ul><ul><li>Axillary LN dissec...
<ul><li>Chemotherapy </li></ul>Chemotherapy 28/46 teratogenic <ul><li>2  -  3 trimester </li></ul><ul><li>CAF , CMF </li><...
<ul><li>Epirubicin  not recommended   </li></ul><ul><li>Peccatori F. chemotherapy during pregnancy : what is really safe? ...
<ul><li>Not offered during pregnancy </li></ul><ul><li>Threshold fetal dose for complication </li></ul><ul><ul><ul><ul><li...
 
<ul><li>Inadequate information  </li></ul><ul><li>Delivery 2-3 wk after Rx </li></ul><ul><li>Similar survival rate among p...
<ul><li>Rate of malformation 2-3% </li></ul><ul><li>Stillbirth 5-15% </li></ul><ul><li>Breast feeding – not recommended  <...
<ul><li>G-CSF: </li></ul><ul><li>-  Reduce duration of neutopenia </li></ul><ul><li>-  Improve overall survival </li></ul>...
<ul><li>Erythropoietin  </li></ul><ul><li>Scott LL et al.Erythropoietin use I pregnancy: two cases & review </li></ul><ul>...
 
<ul><li>Recommended 1950-1960s </li></ul><ul><li>Abortion doesn’t prolong survival </li></ul><ul><li>Currently indicated i...
Petrek JA et al. Prognosis of pregnancy associated breast cancer. Cancer 1991;67:869-72
<ul><li>Chemotherapy may cause premature ovarian failure </li></ul><ul><li>Depending upon the woman’s age & the Rx regimen...
<ul><li>‘ </li></ul><ul><li>CMF </li></ul><ul><li>> 40 y  96% developed amenorrhoea  </li></ul><ul><li>< 40 y  54% </li></...
<ul><li>Resumption of menstruation doesn’t confirm restoration of fertility </li></ul><ul><li>It seems that pregnancy afte...
<ul><li>Long-term survival after breast cancer  not affected by pregnancy </li></ul><ul><li>five-year survival rate of 80%...
<ul><li>No difference between those who had subsequent pregnancies & who did not  </li></ul>43/46
<ul><li>Delay pregnancy < 33 years </li></ul><ul><li>Decisions about future conception based on prognosis : </li></ul><ul>...
<ul><li>It is recommended that pregnancy  should be deferred for at least  2 years after treatment </li></ul>Berry  et al ...
<ul><li>Women planning a pregnancy after  Rx for breast cancer should consult their obstetrician, breast surgeon and  clin...
 
Upcoming SlideShare
Loading in...5
×

Breast Cancer during pregnancy

2,936

Published on

Published in: Health & Medicine
0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,936
On Slideshare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
165
Comments
0
Likes
4
Embeds 0
No embeds

No notes for slide

Breast Cancer during pregnancy

  1. 3. <ul><li>Cancer complicate 1 / 1,000 pregnancies </li></ul><ul><li>1/3 maternal death during pregnancy </li></ul><ul><li>Commonly diagnosed cancer during pregnancy: </li></ul><ul><ul><ul><ul><li>Breast cancer </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cervical ca </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Melanoma </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Thyroid ca </li></ul></ul></ul></ul>2/46
  2. 4. <ul><li>Diagnostic delay is not rare </li></ul><ul><li>The management of pregnant mother is difficult </li></ul><ul><li>Concern : </li></ul><ul><ul><ul><ul><li>Save mother’s life </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Protect fetus </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Intact reproductive system </li></ul></ul></ul></ul>3/46
  3. 5. 4/46
  4. 6. <ul><li>Tumours diagnosed during pregnancy or within one year post partum </li></ul>5/46
  5. 7. 6/46
  6. 8. <ul><li>Diagnosed 1 / 3000 pregnancies </li></ul><ul><li>Incidence 0.76 – 3.8 % </li></ul><ul><li>Median age 33 ( 23 - 47 y) </li></ul>Saunders CM,Baum M Breast cancer and pregnancy review .J R Soc Med 1993;86:162-5 7/46
  7. 9. 8/46
  8. 10. <ul><li>Similar to non pregnant lady </li></ul>- Painless mass - Nipple discharge - Inflammatory breast 9/46
  9. 11. 10/46
  10. 12. Histopathology LN Status Receptor status 11/46
  11. 13. Histopathology Invasive ductal ca Invasive lobular ca Inflammatory breast ca Middleton LP , et al. Breast carcinoma in pregnant women.Assissment of clinicopathologic & immunohistochemical features. Cancer 2003;98:1055-60 12/46
  12. 14. <ul><li>Similar to non pregnant women in : </li></ul><ul><ul><ul><li>Histological frequencie </li></ul></ul></ul><ul><ul><ul><li>Grade </li></ul></ul></ul>Histopathology Middleton LP , et al. Cancer 2003;98:1055-60 13/46
  13. 15. <ul><li>+ve ER , PR < 30 % </li></ul><ul><li>Her-2 / neu over expression 28-58% </li></ul><ul><li>p53 50 % </li></ul>Receptor status Elledge RM ,et al ER , PR and Her-2/neu protien in breast cancer from pregnant patients. Cancer 1993;71:2499-506 14/46
  14. 16. <ul><li>Involved in 60 - 90 % </li></ul><ul><li>Similar to general population </li></ul>LN status Isaac J . Cancer of the breast in pregnancy. Surg clin North Am 1995;75:47-51 15/46
  15. 18. <ul><li>Diagnostic delay </li></ul><ul><li>Average delay 8.2 months ‘ 2-15 months ‘ </li></ul><ul><li>Advanced breast cancer ‘ 2.5 fold ‘ </li></ul>Moore HCF, Foster Jr Rs. Breast cancer and pregnancy Semin oncol.2000;27:646-53 17/46
  16. 19. <ul><li>FNA </li></ul><ul><li>Core biopsy – Cost effective </li></ul><ul><li>Early stage breast ca accounts 60% </li></ul>Sorosky JI ,Scott-conner. Breast cancer complicating pregnancy.Obst Gynecol clin North Amer 1998;25(2):353-63 18/46
  17. 21. Radiation effect Dose dependant Gestational age 20/46
  18. 22. < 0.1 Gy > 3 Gy Dose No effect Fetal malformation 21/46
  19. 23. Teratogenic Gestational age 16 w 2 w Abortion 25 w Sterility malignancy Mole RH.childhood cancer after prenatal exposure to diagnostic x-ray examinations in Britain. Br J Cancer 1990;62:152-68 22/46
  20. 24. <ul><li>Ultrasound sensitivity 93 % </li></ul><ul><li>Diagnostic Mammogram: </li></ul><ul><li>- 0.004 Gy </li></ul><ul><li>- sensitivity 70% </li></ul>Nicklas A, Baker M. Imaging strategies in pregnant caner patients. Semin oncol 2000;27:623-32 23/46
  21. 25. <ul><li>Staging – CXR , Ultrasound </li></ul><ul><li>Avoid CT </li></ul><ul><li>Pvlidis NA. The oncologist 2002;7:279-87’ </li></ul><ul><li>MRI </li></ul><ul><li>- No proof of safety </li></ul><ul><ul><ul><li>Aloraini et al Ann.Saud.Med. July-Aug. 2006 </li></ul></ul></ul>24/46
  22. 27. Surgery Chemotherapy Radiotherapy 26/46
  23. 28. <ul><li>Gold standard </li></ul><ul><li>BCS </li></ul><ul><li>2 nd - 3 rd trimester </li></ul><ul><li>Axillary LN dissection </li></ul><ul><li>SLNB not recommended </li></ul>Surgical Rx 27/46
  24. 29. <ul><li>Chemotherapy </li></ul>Chemotherapy 28/46 teratogenic <ul><li>2 - 3 trimester </li></ul><ul><li>CAF , CMF </li></ul><ul><li>Giacalone PL.et al chmotherapy for breast carcinomaduring </li></ul><ul><li>pregnancy . Cancer 1999;86:2266-72 </li></ul>
  25. 30. <ul><li>Epirubicin not recommended </li></ul><ul><li>Peccatori F. chemotherapy during pregnancy : what is really safe? </li></ul><ul><li>Lancet oncol 2004;5:398 </li></ul><ul><li>Taxol </li></ul><ul><li>Eur J Cancer care 2000;9:235-7 </li></ul>Chemotherapy 29/46
  26. 31. <ul><li>Not offered during pregnancy </li></ul><ul><li>Threshold fetal dose for complication </li></ul><ul><ul><ul><ul><li>10-15 rad 20 wks gestation </li></ul></ul></ul></ul><ul><ul><ul><ul><li>25-50 rad after </li></ul></ul></ul></ul>Radiotherapy Woo JC et al Breast cancer in pregnancy: a literature review. Arch Surg 2003;138:91-8 30/46
  27. 33. <ul><li>Inadequate information </li></ul><ul><li>Delivery 2-3 wk after Rx </li></ul><ul><li>Similar survival rate among pregnant & non pregnant lady </li></ul>Mother and fetal outcome Petrek JA et al. Prognosis of pregnancy associated breast cancer. Cancer 1991;67:869-72 32/46
  28. 34. <ul><li>Rate of malformation 2-3% </li></ul><ul><li>Stillbirth 5-15% </li></ul><ul><li>Breast feeding – not recommended </li></ul><ul><li>Suppression of lactation does not improve prognosis </li></ul>Mother and fetal outcome 33/46
  29. 35. <ul><li>G-CSF: </li></ul><ul><li>- Reduce duration of neutopenia </li></ul><ul><li>- Improve overall survival </li></ul><ul><li>- safe ? </li></ul>Supportive drug 34/46
  30. 36. <ul><li>Erythropoietin </li></ul><ul><li>Scott LL et al.Erythropoietin use I pregnancy: two cases & review </li></ul><ul><li>Am JP parinatol 1995;12:22-4 </li></ul><ul><li>Ondansteron , metochlopramide </li></ul>Supportive drug 35/46
  31. 38. <ul><li>Recommended 1950-1960s </li></ul><ul><li>Abortion doesn’t prolong survival </li></ul><ul><li>Currently indicated in : </li></ul><ul><li>- Very aggressive tumor </li></ul><ul><li>- Advanced disease with dismal </li></ul><ul><li>prognosis </li></ul>Petrek JA et al. Prognosis of pregnancy associated breast cancer. Cancer 1991;67:869-72 37/46
  32. 39. Petrek JA et al. Prognosis of pregnancy associated breast cancer. Cancer 1991;67:869-72
  33. 40. <ul><li>Chemotherapy may cause premature ovarian failure </li></ul><ul><li>Depending upon the woman’s age & the Rx regimen Bonadonna and Valgussa ‘ </li></ul>39/46
  34. 41. <ul><li>‘ </li></ul><ul><li>CMF </li></ul><ul><li>> 40 y 96% developed amenorrhoea </li></ul><ul><li>< 40 y 54% </li></ul><ul><li>Doxorubicin </li></ul><ul><li>< 35 y 9% permanent amenorrhea </li></ul><ul><li>Taxol ??? </li></ul>40/46
  35. 42. <ul><li>Resumption of menstruation doesn’t confirm restoration of fertility </li></ul><ul><li>It seems that pregnancy after Rx for breast cancer has an increased chance of spontaneous pregnancy loss </li></ul>Bonadonna G, Valgussa P. Adjuvant systemic therapy for resectable breast cancer . J Clin Oncol 1985:3:259–75. 41/46
  36. 43. <ul><li>Long-term survival after breast cancer not affected by pregnancy </li></ul><ul><li>five-year survival rate of 80% </li></ul><ul><li>The survival of women who were node-negative was 90% at ten years </li></ul>42/46
  37. 44. <ul><li>No difference between those who had subsequent pregnancies & who did not </li></ul>43/46
  38. 45. <ul><li>Delay pregnancy < 33 years </li></ul><ul><li>Decisions about future conception based on prognosis : </li></ul><ul><li>- Stage IV deferring pregnancy for 5 y </li></ul><ul><li>- Recurrent stage-I or -II should not </li></ul><ul><li>contemplate conception </li></ul>44/46
  39. 46. <ul><li>It is recommended that pregnancy should be deferred for at least 2 years after treatment </li></ul>Berry et al . Management of breast cancer during pregnancy using a standardized protocol J Clin Oncol 1999 45/46
  40. 47. <ul><li>Women planning a pregnancy after Rx for breast cancer should consult their obstetrician, breast surgeon and clinical oncologist </li></ul>46/46
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×