Surgery on breast cancer in pregnancy

Liberale, Viola; Tripodi, Elisa; Ottino, Laura; Biglia, Nicoletta

doi:10.21037/tcr.2019.07.16

Cited by 5 publications

(6 citation statements)

References 66 publications

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“…Whenever possible, surgery (either open or endoscopic) should be performed during the second trimester 20 . In the second trimester, the risk of miscarriage is the lowest and the size of the uterus does not radically change the positions and relations of intraabdominal and thoracic organs, thereby allowing different interventions 21,22 . Our study proved that all operable stages of malignancies could be successfully surgically treated during the second pregnancy trimester.…”

Section: Discussionmentioning

confidence: 61%

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

Milosevic,

Likic Ladjevic,

Dotlic

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionCancer complicating pregnancy is a rare but potentially life‐threatening condition for both the mother and her child. The aim of the present study was to assess the outcomes for mothers and children after pregnancy complicated by malignancy and to investigate which parameters are important for their 1‐year survival.Material and methodsThe study included 84 pregnant women diagnosed with malignant tumors during pregnancy from 2001 to 2022. The pregnancy course and outcome, as well as parameters that could influence the survival and condition of the mother and child were evaluated. Mothers and children were followed up for 1 year after delivery to assess their condition/complications and overall survival.ResultsMost malignancies were gynecological (31%) or hematological (23.8%) and were diagnosed and surgically treated in the second trimester. Most children (69%) showed adequate growth and development throughout pregnancy but were delivered before term (53.6%) to allow mothers to receive therapy. Adjuvant therapy during pregnancy mostly caused a transitory deterioration of the child's condition, while surgery did not significantly impact the pregnancy course. Deliveries, on average, occurred during the 33.01 ± 6.16 gestational week (range: 20–40) and mostly by cesarean section (76.2%). For mothers, the pregnancy survival rate was 95.2% and survival after 1 year was 87.5%. However, 37.5% of women were still ill and required additional therapy 1 year postpartum. The pregnancy survival rate for children was 94%, whereas the 1‐year survival rate was 76.2%. Most children had a favorable condition (alive, adequately growing and developing, and without complications) at birth (81%) as well as at the 1‐year follow‐up (63.7%). Regression analysis identified the following predictors of favorable 1‐year maternal condition: applying therapy during pregnancy, no progression of the malignancy during pregnancy, and delivery at a later gestational week. Predictors of favorable 1‐year condition of children were lower histopathological grade of malignancy, surgery as therapy for malignancy, obtaining higher birthweight, and delivery by cesarean section.ConclusionsIf the malignancy is not progressing, pregnancy should be continued as long as possible for the child to obtain adequate birthweight. Both surgery and chemotherapy were safe therapeutic choices, as most pregnancies continued successfully after therapy.

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Section: Discussionmentioning

confidence: 61%

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

Milosevic,

Likic Ladjevic,

Dotlic

et al. 2024

Acta Obstet Gynecol Scand

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“…Modified radical mastectomy is also a standard treatment throughout pregnancy. Palliative care is recommended for younger women, but the side effects of radiotherapy during pregnancy should be considered as well (81,82).…”

Section: Breast Cancer Treatment During Pregnancymentioning

confidence: 99%

Breast Cancer and Ways to Diagnose the Risk Factors and Treat it During Pregnancy: A Narrative Review

Ghamari¹,

Ghaderi²,

Moghaddam³

et al. 2020

International Journal of Women’s Health and Reproduction Scienc

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IntroductionBreast cancer is a type of cancer that starts in the breast tissue and can spread to other nearby tissues in addition to affecting the entire breast tissue (1). It is the most common cancer worldwide, causing extensive mortality and many complications (2-4). The incidence of breast cancer is globally increasing, especially in developing countries. Notably, about 6 million women with breast cancer were globally identified during 2008-2013 (5). More than 255 000 new cases of breast cancer occurred in the United States in 2017. Meanwhile, the annual incidence of breast cancer is 33 cases per 100 000 people in Iran, and the highest rate has occurred in Tehran, Isfahan, Yazd, Markazi, and Fars provinces (6).One of the concerns associated with breast cancer is its experience during pregnancy (7). Pregnancy-associated breast cancer refers to cancer that occurs during pregnancy, breastfeeding, or one year after delivery. It is the second most common cancer in pregnancy, which rarely occurs and does not cause many deaths (8,9). Diagnostic and therapeutic interventions during this period are implemented with special considerations. Women with breast cancer are clearly at a more advanced stage of the disease during pregnancy and usually have a poorer prognosis (10,11). One of the major challenges in diagnosis and treatment during this period is maintaining a balance in the aggressive care of these patients and appropriate treatments to maintain the health of the fetus/ baby. Given that the occurrence of this cancer during pregnancy can have adverse effects on the health of the mother, the baby, and the fetus, the current study aimed to investigate the factors affecting the incidence of this type of cancer during pregnancy. Materials and MethodsThis review study aimed at evaluating the relationship between pregnancy-related variables and the risk of breast cancer. This article review focused on all studies performed in this field until 2019. The related studies were selected from Persian and English databases. Iranian databases included SID, Irandoc, and Magiran, and English databases included PubMed, Scopus, Science Direct, Cochrane, Google Scholar, and Embase. Keywords were based on Mesh, including breast cancer and pregnancy. The inclusion criterion was accessing the full text of the articles, and the exclusion criterion was conference papers and articles, full-text versions of which were unavailable. ResultsIn general, 161 articles were found in the first stage although they were excluded from the review process at different stages and for scientific reasons. Finally, 83

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“…The American College of Obstetricians and Gynecologists (ACOG), in its 2017 guidelines, emphasizes that medically necessary surgery should never be denied or delayed for a pregnant woman, irrespective of the trimester, as it can have detrimental effects on both the pregnant woman and the fetus [2]. However, performing surgery during pregnancy poses risks for the mother and the developing fetus, thereby presenting challenges for anesthesiologists.…”

mentioning

confidence: 99%

“…If unavoidable, the second trimester is considered safe and ideal as fetal organogenesis occurs in first trimester, and the risk of preterm labor is less than in the third trimester [4]. Although neurotoxicity and teratogenic effect do not occur in fetus when in-utero exposure to anesthetic is limited (<3 hours), exposure of > 3 hours was found to be associated with effects on fetal neurodevelopment [2,3]. Concentration of inhalational agent used may also lead to preterm labor [3].…”

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confidence: 99%

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Anesthetic Management of Carcinoma Breast during Third Trimester of Pregnancy: a Case Report

Gautam,

Dhakal,

Khadka

2023

JBPKIHS

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Although malignancy during pregnancy is uncommon, if occurs, it adds challenge to ensure safety of both the mother and fetus. A 36-year lady was diagnosed with carcinoma breast and scheduled for modified radical mastectomy at 29 weeks of gestation. The case was conducted under general anesthesia with intraoperative pectoralis nerve block for postoperative analgesia. Care was taken to avoid hypotension, tachycardia and hypercarbia so that the placental perfusion was not hampered. The trachea was extubated and immediate postoperative obstetrician review revealed no abnormality in the fetal heart rate and activity. Postoperative course was uneventful. Pregnancy was continued till 34 weeks of gestation when elective cesarean section was done under subarachnoid block. A healthy baby was delivered without any adverse consequences. Anesthesia during last trimester of pregnancy can be safely performed, when precautions are taken with involvement of proper teamwork, and the benefit of surgery outweighs the risk of postponing it.

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Surgery on breast cancer in pregnancy

Cited by 5 publications

References 66 publications

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

Cancer during pregnancy: Twenty‐two years of experience from a tertiary referral center

Breast Cancer and Ways to Diagnose the Risk Factors and Treat it During Pregnancy: A Narrative Review

Anesthetic Management of Carcinoma Breast during Third Trimester of Pregnancy: a Case Report

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