妊娠期乳腺癌.ppt

,Add Your Company Slogan,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Logo,Breast Cancer Diagnosed During,Pregnancy,天津市肿瘤医院,乳腺一科陈祖锦,11,Epidemiology,The Motherisk guide,to cancer in pregnancy and lactation.2nd ed.Toronto,Canada:Motherisk Program;2005.,Epidemiology,BCP become more frequent,:,delay childbearing,Breast carcinoma,during pregnancy.International recommendations from an,expert meeting.Cancer 2006;106(2):23746.,History：,P,ositive family history,:,48%,BRCA 1 or BRCA 2 mutations,:,9%,Family,history of breast and ovarian cancers and BRCA1 and BRCA2,mutations in a population-based series of early-onset breast,cancer.J Natl Cancer Inst 2001;93(16):121523.,Diagnos,e,Clinical examination,G,landular and,ductal hyperplasias,:,palpation,cannot discriminate malignant from benign lumps of a similar size,diagnosis can be,delayed,Diagnos,e,Diagnostic,R,adiology,E,xceeding,a dose of 0.05 Gy may cause malformations,microcephaly,intrauterine growth retardation,and mental retardation,Diagnostic,C,linical stage II or higher breast cancer：,metastases bone,liver,and lung,C,hest x-ray with abdominal shielding;,U,ltrasound of the liver,noncontrast MRI exclude,:,liver metastases,thoracic and lumbar spine bone,metastases.,CT scans and bone scans are not recommended for routine use,E,chocardiogram,:,anthracycline-based chemotherapy regimen,Diagnostic,Staging evaluation,Treatment,implantation,(0-2 weeks),organogenesis(2-10 weeks),fetal phase(10 weeks),Treatment,:,Locoregional Therapy,Surgery and Anesthesia,Breast surgery can be safely,performed in all trimesters of pregnancy,after the 12th week of gestation when the risk of spontaneous abortion may be lower,Multiple studies,evaluating the risks of anesthesia during pregnancy have not shown an increase in fetal abnormalities,SLNB,Estimated radiation exposure to the fetus is low and calculated to a maximum of 4.3 mGy,Blue dye should not be used：anaphylaxis be,harmful for the foetus,-Sensitivity decreased,The sensitivity and specificity of,SLNP,has not,been well established,not the technical aspects,accuracy,Pregnancy-associated,breast cancer patients can safely undergo lymphatic,mapping.Breast J 2008;14(3):2504.,Treatment,Radiation therapy,duringpregnancy is rarely indicatedinBCP.In general,it is recommended to postpone RT until after delivery,During the first,months of pregnancy,the uterus does not extend outside the true,pelvis,Treatment,:,Radiation therapy,M,ost chemotherapeutic agents are Category D,Treatment,:,Systemic Therapy,T,he first trimester,(,the fetus is especially,vulnerable):increases the,risk of spontaneous abortion,fetal death,and,major malformations,T,he second and third,trimesters,:,increases the risk of,intrauterine growth,restriction(IUGR)and low birthweight,fetal malformations risk,first trimester 14%to 19%,second and third trimester 1.3%,long-term followup have not shown impairments in learning,behaviour or,haematological or immunological abnormalities.,Antineoplastic agents in pregnancy.Semin oncol 1989;16:337346,A,ntifolates：methotrexate,teratogenesis（畸形）,a known abortifactant（坠胎药）,CMF not given,Prognosis,J Clin Oncol 31:2532-2539.,Thank you,