Is there a cure for cancer during pregnancy? How can pregnant women be treated?
Although the occurrence of breast cancer during pregnancy is extremely rare, more and more women are delaying maternal age for personal and professional reasons, increasing the likelihood of breast cancer and pregnancy coexisting. In fact, it is predicted that such cases will become much more common in the coming years. Because in recent years, the age of having a child is delayed until the age of 30-40. Gynecology Obstetrics and IVF Specialist Op. Dr. Betül Görgen gave important information about the diagnosis and treatment methods of breast cancer, which is the most common type of cancer during pregnancy, which occurs in one in 3,000 pregnancies.
How is breast cancer detected during pregnancy?
When breast cancer is detected during pregnancy, we often think that it is a cancer that was diagnosed late and started when there was no pregnancy. Therefore, it may be more likely to spread to lymph nodes. This may be partly the result of hormonal changes during pregnancy. During pregnancy, the routine menstrual cycle ends and estrogen and progesterone levels increase. At the same time, the hormone prolactin increases in preparation for the breastfeeding process. With the effect of this hormone, the breasts enlarge, become sensitive and irregular.
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This delays the detection of a mass until it grows in size for both the doctor and the patient. Another reason for not being able to diagnose breast cancer in early pregnancy is that screening methods are usually postponed until after pregnancy. Pregnancy and breastfeeding cause the breast tissue to become more dense. Thus, mammographic findings of breast cancer in the early stages and normal findings can easily be confused with each other. Delayed diagnosis is an important problem for breast cancer in pregnancy.
How to diagnose breast cancer during pregnancy?
If you notice a mass or any change in your breast, you should pay attention to this and consult your doctor. Your doctor probably won’t recommend mammography during pregnancy. In this case, imaging tests such as US and MRI are appropriate. A suspicious change should be taken into account and a biopsy should be performed if necessary before deciding that it is a pregnancy-related change.
Mammography can detect most breast cancers that start during pregnancy and is considered quite safe even during pregnancy. The amount of radiation created by the mammogram is also very low. Since the radiation is focused on the breasts, the amount that can reach other parts of the body is very low. A protective cover can be placed on the lower waist area for extra protection. However, some scientists still do not agree on the effect of radiation on the unborn baby. However, early diagnosis is very important even during pregnancy and it should not be forgotten.
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Does a breast biopsy affect the baby?
If a breast mass is palpable or a suspicious lesion is detected, biopsy should be considered. Breast biopsies are usually done with a needle and do not require hospitalization even if there is pregnancy. Anesthetizing the area to be biopsied does not pose a risk to the fetus.
Surgical biopsy is the next step in cases where there is no response from needle biopsy. Here, a small incision is made from the suspicious area and a tissue sample is taken. This procedure is performed under general anesthesia and does not carry any risk for pregnancy.
Does breast cancer pass from mother to baby?
If breast cancer is detected, it is necessary to check whether the cancer cells have spread inside the breast and to other parts of the body. This process is called staging. This process is much more important during pregnancy because breast cancer may be at a more advanced stage during pregnancy. It should be kept in mind that the fetus is not exposed to radiation in MRI and US examination. But sometimes the “dye” used during MRI should never be used. Because it can cross the placenta and cause anomalies.
Since the CT X-ray contains a very small dose of radiation, it can be taken easily while protecting the abdomen. PET scan, bone scan and CT are not preferred because of radiation. In very rare cases, the cancer may have reached the placenta, which may affect the nutrition of the fetus. However, the transmission of breast cancer from mother to fetus has not been found.
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How is breast cancer treated during pregnancy?
It varies according to the size of the tumor, the location of the tumor, its spread, how long it is until the termination of pregnancy, and the preference of the mother-to-be. In fact, our aim is to “control the cancer and prevent its spread”, as in non-pregnant breast cancer cases. However, the concern of preserving the fetus complicates the situation.
Surgery is usually a safe treatment. Chemotherapy, radiotherapy or hormonal therapy is not applied as they may harm the fetus. However, chemotherapy may be considered in the later stages of pregnancy. However, in cases where delay in treatment is important for the patient, such as inflammatory cancer, the pregnancy may be terminated, since chemotherapy is mandatory.
Should pregnancy be terminated for treatment?
Some studies conducted in the past show that termination of pregnancy for cancer treatment is not very effective in the course of the disease. However, if it is necessary to start treatment immediately, the risks and benefits of termination of pregnancy should be clearly explained to the family and then the decision should be clarified.
Surgical: Removal of cancerous breast and lymph nodes is a surgery that can be safely performed during pregnancy. Breast conserving surgery is not preferred because it requires radiotherapy afterwards. Because radiation can affect the fetus in the womb.
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Anesthesia: General anesthesia can be applied without fear during breast surgery. However, the obstetrician, surgeon and anesthesiologist should decide together on the application time of the surgery.
Post-surgical treatment: Depending on the stage of the cancer, chemotherapy, radiotherapy and hormonal therapy may be required to prevent recurrence. In some cases, these treatments may be delayed until after delivery.
Chemotherapy: Chemotherapy can be used together with surgery, as well as alone in early-stage cancers and advanced-stage cancers.
It is not used in the first 3 months of pregnancy. If it is used, the probability of pregnancy loss is very high. Studies have been done in pregnancy 4-9. He argues that some drugs can be used for months without putting the fetus at risk, only increasing the risk of preterm birth. However, the long-term effects of these drugs are unknown.
Chemotherapy is not applied after 35 weeks, as it decreases the mother’s blood values and increases the tendency to infection and bleeding.
It is necessary to wait for the postpartum period in order to apply hormone therapy and the preferred target therapy for advanced cancers.
Should the baby be breastfed during the treatment?
Many doctors do not want to breastfeed during treatment. If surgery is planned, discontinuation of breastfeeding is a facilitator for the operation as it will reduce the blood flow of the breast and make the breast smaller. It also reduces the risk of infection. In addition, chemotherapy drugs pass into breast milk and therefore to the baby.
What is life expectancy?
Pregnancy is a process that complicates both the recognition and diagnosis of breast cancer and its treatment. On the other hand, breast cancer outcomes in pregnant and non-pregnant women at the same stages were found to be similar in studies.
They examined more than 300 cases of breast cancer diagnosed during pregnancy in 2013 and reached results comparable to those diagnosed with breast cancer other than pregnancy at the same stage during 5-year follow-up. Only the disease-free period is shorter in cases diagnosed during pregnancy.