Рак молочной железы, ассоциированный с беременностью: клинический случай

Доброхотова Ю.Э., Аракелов С.Э., Данелян С.Ж. и др. Рак молочной железы, ассоциированный с беременностью: клинический случай. Гинекология. 2018; 20 (1): 102–108. DOI: 10.26442/2079-5696_20.1.102-108

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Dobrokhotova Yu.E., Arakelov S.E., Danelyan S.Zh. et al. Breast cancer associated with pregnancy: a clinical case. Gynecology. 2018; 20 (1): 102–108. DOI: 10.26442/2079-5696_20.1.102-108

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Аннотация

Ассоциированным с беременностью является рак молочной железы, который впервые выявлен во время беременности, в течение первого года после родов или в любое время на фоне лактации. Диагностика заболевания в I триместре является показанием для прерывания беременности. Выявление болезни после 20 нед и желание женщины сохранить беременность являются основанием для проведения тотальной мастэктомии с последующей полихимиотерапией доксорубицином с циклофосфамидом или фторурацилом. Лучевая терапия во время беременности не применяется. Сроки и метод родоразрешения определяются индивидуально и зависят от стадии процесса и срока беременности, когда он был выявлен. Представлен клинический случай ведения пациентки с отечно-инфильтративной формой рака молочной железы IV стадии, впервые диагностированной в 22 нед беременности.

Ключевые слова: рак молочной железы, беременность, химиотерапия, метастаз, рак яичника.

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Associated with pregnancy is breast cancer, which was first detected during pregnancy, during the first year after childbirth or at any time against lactation. Diagnosis of the disease in the first trimester is an indication for abortion. The detection of the disease after 20 weeks and the desire of the woman to maintain pregnancy is the basis for conducting a total mastectomy followed by polychemotherapy with doxorubicin with cyclophosphamide or with fluorouracil. Radiation therapy during pregnancy is not applied. The timing and method of delivery are determined individually and depend on the stage of the process and the period of pregnancy, when it was identified. A clinical case of a patient with edematous-infiltrative form of breast cancer of the IV stage, diagnosed for the first time in 22 weeks of pregnancy, is presented.

Key words: breast cancer, pregnancy, chemotherapy, metastasis, ovarian cancer.

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Список литературы

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________________________________________________

1. Parokonnaia A.A. Rak molochnoi zhelezy i beremennost'. Sovremennoe sostoianie problemy. Prakticheskaia onkologiia. 2009; 10 (4): 179–83. [in Russian]
2. Andersson TM, Johansson AL, Hsieh CC et al. Increasing incidence of pregnancy-associated breast cancer in Sweden. Obstet Gynecol 2009; 114: 568.
3. Smith LH, Danielsen B, Allen ME, Cress R. Cancer associated with obstetric delivery: results of linkage with the California cancer registry. Am J Obstet Gynecol 2003; 189: 1128.
4. Stensheim H, Moller B, van Dijk T, Fossa SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol 2009; 27: 45.
5. Woo JC, Yu T, Hurd TC. Breast cancer in pregnancy: a literature review. Arch Surg 2003; 138: 91.
6. Cullinane CA, Lubinski J, Neuhausen SL et al. Effect of pregnancy as a risk factor for breast cancer in BRCA1/BRCA2 mutation carriers. Int J Cancer 2005; 117: 988.
7. Collins JC, Liao S, Wile AG. Surgical management of breast masses in pregnant women. J Reprod Med 1995; 40: 785.
8. De Bree E, Makrigiannakis A, Askoxylakis J et al. Pregnancy after breast cancer. A comprehensive review. J Surg Oncol 2010; 101: 534.
9. Dominici L, Kuerer H, Babiera G et al. Wound complications from surgery in pregnancy-associated breast cancer. American Society of Breast Surgeons Annual Meeting 2009.
10. Elledge RM, Ciocca DR, Langone G, McGuire WL. Estrogen receptor, progesterone receptor, and HER-2/neu protein in breast cancers from pregnant patients. Cancer 1993; 71: 2499.
11. Middleton LP, Amin M, Gwyn K et al. Breast carcinoma in pregnant women: assessment of clinicopathologic and immunohistochemical features. Cancer 2003; 98: 1055.
12. Reed W, Hannisdal E, Skovlund E et al. Pregnancy and breast cancer: a population-based study. Virchows Arch 2003; 443: 44.
13. Wohlfahrt J, Andersen PK, Mouridsen HT, Melbye M. Risk of late-stage breast cancer after a childbirth. Am J Epidemiol 2001; 153: 1079.
14. Azim HA Jr, Santoro L, Pavlidis N. Safety of pregnancy following breast cancer diagnosis: a meta-analysis of 14 studies. Eur J Cancer 2011; 47: 74.
15. Ahn BY, Kim HH, Moon WK et al. Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings. J Ultrasound Med 2003; 22: 491.
16. Yang WT, Dryden MJ, Gwyn K et al. Imaging of breast cancer diagnosed and treated with chemotherapy during pregnancy. Radiology 2006; 239: 52.
17. Behrman RH, Homer MJ, Yang WT, Whitman GJ. Mammography and fetal dose. Radiology 2007; 243: 605.
18. Shellock FG, Crues JV. MR procedures: biologic effects, safety, and patient care. Radiology 2004; 232: 635.
19. Azim HA Jr, Santoro L, Russell-Edu W et al. Prognosis of pregnancy-associated breast cancer: a meta-analysis of 30 studies. Cancer Treat Rev 2012; 38: 834.
20. Nicklas AH, Baker ME. Imaging strategies in the pregnant cancer patient. Semin Oncol 2000; 27: 623.
21. Gemignani ML, Petrek JA, Borgen PI. Breast cancer and pregnancy. Surg Clin North Am 1999; 79: 1157.
22. Kal HB, Struikmans H. Radiotherapy during pregnancy: fact and fiction. Lancet Oncol 2005; 6: 328.
23. www.bt.cdc.gov/radiation/prenatalphysician.asp
24. Annane K, Bellocq JP, Brettes JP, Mathelin C. Infiltrative breast cancer during pregnancy and conservative surgery. Fetal Diagn Ther 2005; 20: 442.
25. Azim HA, Bellettini G, Liptrott SJ. Breastfeeding in breast cancer survivors: pattern, behavior and effect on breast cancer outcome. Ann Oncol 2010; 21 (suppl 8): viii89 (251P).
26. Amant F, Deckers S, Van Calsteren K et al. Breast cancer in pregnancy: recommendations of an international consensus meeting. Eur J Cancer 2010; 46: 3158.
27. Cardonick E, Gilmandyar D, Somer RA. Maternal and neonatal outcomes of dose-dense chemotherapy for breast cancer in pregnancy. Obstet Gynecol 2012; 120: 1267.
28. Ring AE, Smith IE, Jones A et al. Chemotherapy for breast cancer during pregnancy: an 18-year experience from five London teaching hospitals. J Clin Oncol 2005; 23: 4192.
29. Cardonick E, Iacobucci A. Use of chemotherapy during human pregnancy. Lancet Oncol 2004; 5: 283.
30. Germann N, Goffinet F, Goldwasser F. Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients. Ann Oncol 2004; 15: 146.
31. Largillier R, Savignoni A, Gligorov J et al. Prognostic role of pregnancy occurring before or after treatment of early breast cancer patients aged <35 years: a GET(N)A Working Group analysis. Cancer 2009; 115: 5155.
32. Hahn KM, Johnson PH, Gordon N et al. Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer 2006; 107: 1219.
33. Turchi JJ, Villasis C. Anthracyclines in the treatment of malignancy in pregnancy. Cancer 1988; 61: 435.
34. Mir O, Berveiller P, Goffinet F et al. Taxanes for breast cancer during pregnancy: a systematic review. Ann Oncol 2010; 21: 425.
35. Zagouri F, Sergentanis TN, Chrysikos D et al. Trastuzumab administration during pregnancy: a systematic review and meta-analysis. Breast Cancer Res Treat 2013; 137: 349.
36. Kelly H, Graham M, Humes E et al. Delivery of a healthy baby after first-trimester maternal exposure to lapatinib. Clin Breast Cancer 2006; 7: 339.
37. Isaacs RJ, Hunter W, Clark K. Tamoxifen as systemic treatment of advanced breast cancer during pregnancy – case report and literature review. Gynecol Oncol 2001; 80: 405.
38. Amant F, von Minckwitz G, Han SN et al. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol 2013; 31: 2532.
39. Litton JK, Warneke CL, Hahn KM et al. Case control study of women treated with chemotherapy for breast cancer during pregnancy as compared with nonpregnant patients with breast cancer. Oncologist 2013; 18: 369.
40. Moran MS, Colasanto JM, Haffty BG et al. Effects of breast-conserving therapy on lactation after pregnancy. Cancer J 2005; 11: 399.
41. National Library of Medicine drug and lactation database, LactMed. http: //toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
42. Talele AC, Slanetz PJ, Edmister WB et al. The lactating breast: MRI findings and literature review. Breast J 2003; 9: 237.
43. Helewa M, Lévesque P, Provencher D et al. Breast cancer, pregnancy, and breastfeeding. J Obstet Gynaecol Can 2002; 24: 164.

Авторы

Ю.Э.Доброхотова1, С.Э.Аракелов2, С.Ж.Данелян2, Е.И.Боровкова*1, А.Е.Зыков2, С.А.Залесская1, Е.А.Нагайцева2

1. ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1;
2. ГБУЗ «Городская клиническая больница №40» Департамента здравоохранения г. Москвы. 129301, Россия, Москва, ул. Касаткина, д. 7
*katyanikitina@mail.ru

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Yu.E.Dobrokhotova1, S.E.Arakelov2, S.Zh.Danelyan2, E.I.Borovkova*1, A.E.Zykov2, S.A.Zalesskaya1, E.A.Nagaytseva2

1. N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1;
2. City Clinical Hospital №40 of the Department of Health of Moscow. 129301, Russian Federation, Moscow, ul. Kasatkina, d. 7
*katyanikitina@mail.ru

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