Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, the Netherlands.
Best Pract Res Clin Obstet Gynaecol. 2022 Jun;82:46-59. doi: 10.1016/j.bpobgyn.2022.05.001. Epub 2022 May 9.
Although it is uncommon in general, breast cancer is the most commonly diagnosed cancer during pregnancy. While treatment for pregnant patients should adhere to treatment guidelines for non-pregnant patients, there exist specific considerations concerning diagnosis, staging, oncological treatment, and obstetrical care. Imaging and staging are preferably performed using breast ultrasound and mammography. Other ionizing radiation imaging modalities, including computed tomography (CT) and Positron Emission Tomography/ Computed Tomography (PET/CT), can be selectively performed when the estimated benefit for the mother outweighs the risks to the foetus, e.g., when the results will change clinical management. MRI is appropriate to stage for distant disease on the indication. Breast cancer during pregnancy is less often hormone receptor-positive and more frequently triple-negative breast cancer compared to age-matched controls. The basic principle is that women should receive state-of-the-art oncological treatment without delay if possible and that the pregnancy should be maintained as long as possible. Treatment strategy should be multidisciplinary defined, carefully weighing the selection, sequence, and timing of treatment modalities depending on patient-, tumour-, and pregnancy-related characteristics, as well as patient preferences. Initiating cancer treatment during pregnancy often decreases the risks of early delivery and prematurity. Breast cancer surgery is possible during all trimesters. Radiotherapy is possible during pregnancy in the first half of pregnancy. Chemotherapy can be safely administered starting from 12 weeks of gestational age, but endocrine and HER2 targeted therapy are contraindicated throughout the whole pregnancy. Importantly, foetal growth should be monitored and long-term follow-up of the children is encouraged in dedicated centres.
虽然在一般情况下较为少见，但乳腺癌是妊娠期最常见的癌症。虽然妊娠患者的治疗应遵循非妊娠患者的治疗指南，但在诊断、分期、肿瘤治疗和产科护理方面存在特定的考虑因素。影像学和分期最好使用乳腺超声和乳房 X 线摄影进行。当对母亲的估计益处超过对胎儿的风险时，可以选择性地使用其他电离辐射成像方式，包括计算机断层扫描（CT）和正电子发射断层扫描/计算机断层扫描（PET/CT），例如，当结果将改变临床管理时。在指示的情况下，MRI 适合进行远处疾病分期。与年龄匹配的对照组相比，妊娠期乳腺癌的激素受体阳性率较低，三阴性乳腺癌的发生率较高。基本原则是，如果可能的话，妇女应尽快接受最先进的肿瘤治疗，并且应尽可能长时间维持妊娠。治疗策略应由多学科定义，根据患者、肿瘤和妊娠相关特征以及患者偏好，仔细权衡治疗方式的选择、顺序和时机。在妊娠期间开始癌症治疗通常会降低早产和早产的风险。在整个妊娠期间都可以进行乳腺癌手术。在妊娠的前半段可以进行放疗。从妊娠 12 周开始可以安全地给予化疗，但整个妊娠期间均禁忌内分泌和 HER2 靶向治疗。重要的是，应监测胎儿生长情况，并鼓励在专门中心对儿童进行长期随访。
