Petrek J A
Breast Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
Cancer. 1994 Jul 1;74(1 Suppl):518-27. doi: 10.1002/cncr.2820741341.
Breast cancer during pregnancy involves a host of psychosocial, ethical, religious, and legal considerations, as well as medical multidisciplinary decisions. Treatment modalities. Breast or chest wall radiation therapy should be avoided because the fetal dose, regardless of the trimester, can cause permanent complications. In the second and third trimester, chemotherapy is associated with intrauterine growth retardation and prematurity in approximately half of the infants; the risk of birth defects is a concern during the first several weeks. Typical anesthetic agents readily reach the fetus but are not known to be teratogenic. Modified radical mastectomy without delay is the best option in pregnant patients with Stage I or II and some Stage III cancer. Although abortion allows full treatment to the mother, it is not known whether the procedure is therapeutic. Early in pregnancy abortion deserves strong consideration. Prognosis. The poor prognosis of pregnancy-associated breast cancer in the past probably is attributable to a combination of initial delay and possibly to the unfavorable biologic characteristics of pregnancy. When pregnant patients are matched stage for stage with control subjects, survival seems equivalent, although pregnant patients have more advanced stage disease.
妊娠期乳腺癌涉及一系列社会心理、伦理、宗教和法律方面的考量，以及医学多学科决策。治疗方式。应避免进行乳房或胸壁放射治疗，因为无论处于孕期的哪个阶段，胎儿所受剂量都可能导致永久性并发症。在妊娠中期和晚期，化疗约会导致半数婴儿出现宫内生长迟缓及早产；在孕早期的最初几周，出生缺陷风险是一个令人担忧的问题。典型的麻醉剂很容易到达胎儿体内，但尚无致畸的报道。对于患有Ⅰ期或Ⅱ期以及部分Ⅲ期癌症的妊娠患者，立即进行改良根治性乳房切除术是最佳选择。虽然流产能使母亲得到充分治疗，但该手术是否具有治疗作用尚不清楚。孕早期流产值得认真考虑。预后。过去，妊娠相关乳腺癌预后较差可能是由于起初的延误以及妊娠可能具有的不良生物学特性共同导致的。当妊娠患者与对照对象按分期匹配时，尽管妊娠患者的疾病分期更晚，但生存率似乎相当。
