《妊娠期乳腺癌ppt课件.ppt》由会员分享，可在线阅读，更多相关《妊娠期乳腺癌ppt课件.ppt（22页珍藏版）》请在三一办公上搜索。
1、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 recommendation
2、s from anexpert meeting. Cancer 2006;106(2):23746.,History：Positive family history:48%BRCA 1 or BRCA 2 mutations:9%,Family history of breast and ovarian cancers and BRCA1 and BRCA2mutations in a population-based series of early-onset breastcancer. J Natl Cancer Inst 2001;93(16):121523.,Diagnose,Clin
3、ical examinationGlandular and ductal hyperplasias:palpation cannot discriminate malignant from benign lumps of a similar size diagnosis can be delayed,Diagnose,Diagnostic,Radiology,Exceeding a dose of 0.05 Gy may cause malformations, microcephaly,intrauterine growth retardation, and mental retardati
4、on,Diagnostic,Clinical stage II or higher breast cancer：metastases bone, liver, and lungChest x-ray with abdominal shielding; Ultrasound of the livernoncontrast MRI exclude : liver metastases thoracic and lumbar spine bone metastases.CT scans and bone scans are not recommended for routine useEchocar
5、diogram: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 AnesthesiaBreast surgery can be safely performed in all trimesters of pregnancyafter the 12th
6、 week of gestation when the risk of spontaneous abortion may be lowerMultiple studies evaluating the risks of anesthesia during pregnancy have not shown an increase in fetal abnormalities,SLNBEstimated radiation exposure to the fetus is low and calculated to a maximum of 4.3 mGy Blue dye should not
7、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 lymphaticmapping. Breast J 2008;14(3):2504.,Treatment,Radiation
8、 therapy duringpregnancy is rarely indicatedinBCP. In general, it is recommended to postpone RT until after deliveryDuring the first months of pregnancy, the uterus does not extend outside the true pelvis,Treatment:Radiation therapy,Most chemotherapeutic agents are Category D,Treatment:Systemic Ther
9、apy,The first trimester(the fetus is especially vulnerable):increases the risk of spontaneous abortion, fetal death, and major malformationsThe second and third trimesters :increases the risk of intrauterine growth restriction (IUGR) and low birthweight fetal malformations risk first trimester 14% t
10、o 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,Antifolates ：methotrexate teratogenesis（畸形）a known abortifactant （坠胎药） CMF not given,Prognosis,J Clin Oncol 31:2532-2539.,Thank you,
