Title : Experience in managing a patient with breast cancer during pregnancy
Abstract:
Despite advancements in the diagnosis and treatment of breast cancer, malignant neoplasms are still occasionally found in pregnant women. A patient presented to our clinic at 16 weeks of gestation (second trimester). Ultrasound examination revealed a pathological mass in the left breast, 2 cm from the areola, measuring 3.64 x 2.5 x 1.7 cm, classified as BI-RADS-6. The right breast was classified as BI-RADS-1. A suspicious lymph node measuring 1.54 x 0.54 cm was found in the left axillary region. Histology results indicated infiltrative lobular carcinoma. Immunohistochemistry showed ER(++), PR(++), Her2 (Score3), Ki67 (60-65%). Biochemical blood analysis results were: ALT – 17.9 U/L, AST – 17.7 U/L, Creatinine – 40 mmol/L, Tumor marker CA 15.3 – 24.3 U/mL. Chemotherapy was administered every 21 days from the 16th week of pregnancy, following the regimen of Doxorubicin 90 mg IV and Paklitaksel+trastuzumab. Cyclophosphamide 900 mg up to the 34th week of pregnancy. A triple test was conducted on the patient, revealing no pathology. The pregnancy proceeded without complications. At 37 weeks, a cesarean section was performed. The fetus was in a breech position. Apgar scores were 0.0 at birth and 0.3 at 5 minutes. There was no spontaneous breathing or heartbeat. Following intubation, the heartbeat was restored. After 24 hours, the baby was transitioned to spontaneous breathing. Seizures continued. MRI and EEG showed no pathology. The seizures ceased after 7 days, but signs of necrotizing enterocolitis appeared. Surgical colostomy was performed. The baby was discharged for outpatient treatment. Five months post-cesarean, the patient underwent radical mastectomy with lymph node dissection. Histological analysis confirmed infiltrative lobular carcinoma with ER(++), PR(++), Her2 (Score3), Ki67 (60-65%). MRI was performed one month post-surgery. One year post-surgery, no recurrence was detected. The child is being prepared for reconstructive surgery. Despite thorough examinations and an uncomplicated pregnancy, the fetus exhibited signs of hypoxia, which were not confirmed by instrumental examinations.
Audience Take Away:
- Diagnosis and treatment protocols for breast cancer during pregnancy.
- Challenges and outcomes of chemotherapy during pregnancy.
- Management of neonatal complications following chemotherapy and surgery during pregnancy.
- The audience will be able to apply the discussed protocols and management strategies in similar cases, improving patient care and outcomes in complex scenarios involving cancer and pregnancy.
- This information will assist healthcare professionals in making informed decisions regarding the treatment of pregnant patients with cancer, ensuring both maternal and fetal health are prioritized.
- This case study provides valuable insights that can be used for further research and teaching on the intersection of oncology and obstetrics.
- Not directly applicable to designers, but it does provide practical clinical solutions for healthcare providers.
- It will improve the accuracy of clinical decision-making and provide new information for managing complex pregnancies.
