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妊娠期乳腺癌的治疗

Authors
Jennifer K Litton, MD
Richard Theriault, DO, MBA
Section Editors
Daniel F Hayes, MD
Charles J Lockwood, MD, MHCM
Deputy Editor
Sadhna R Vora, MD
Translators
赵新汉, 主任医师，教授

引言

妊娠期乳腺癌(或妊娠相关乳腺癌)的定义是在妊娠期间、产后第1年，或哺乳期的任何时间被诊断的乳腺癌。由于必须考虑母亲和胎儿的健康，妊娠期乳腺癌在临床上具有挑战性。目前有关妊娠期乳腺癌的诊断、治疗和结局的前瞻性研究资料十分有限，许多临床证据局限于回顾性病例系列研究和病例报告。

妊娠期乳腺癌的治疗和预后将总结在此。妊娠期乳腺癌的流行病学和诊断将单独讨论。 (参见“妊娠期乳腺癌的流行病学与诊断”)

治疗

总的来讲，妊娠期乳腺癌患者的治疗应遵循非妊娠期乳腺癌患者的治疗指南，同时进行某些调整以保护胎儿。然而，治疗应以根治为目的。因此，妊娠期乳腺癌的治疗不应因为妊娠而被不必要地延迟。知情同意对于选择合适的治疗方案至关重要。虽然在制定治疗计划时可能考虑终止妊娠，但目前尚无证据表明终止妊娠可改善妊娠期乳腺癌的结局。 (参见下文‘选择性终止妊娠’)

重要的是，所有妊娠期乳腺癌患者均应根据非妊娠期乳腺癌患者的指南，对疾病的远处转移进行评估。为保护胎儿，可减少一些检查，应进行的检查包括：屏蔽胎儿的胸片检查、肝脏超声，以及为评估骨转移而进行的不使用造影剂的脊柱磁共振成像(magnetic resonance imaging, MRI)检查[1,2]。 (参见“妊娠期乳腺癌的流行病学与诊断”，关于‘诊断和分期’一节和“新近诊断乳腺癌的临床特征、诊断和分期”，关于‘诊断后的评估’一节)

局部区域性治疗 — 除放射治疗(radiation therapy, RT)外，对妊娠期乳腺癌患者应考虑使用与非妊娠期患者相同的局部治疗方法。与非妊娠女性一样，手术治疗是妊娠期乳腺癌患者的根治性局部治疗方法。在妊娠的任何阶段进行乳房和腋窝淋巴结手术，对胎儿来说风险似乎均极小[3-8]。 (参见“Management of the pregnant patient undergoing nonobstetric surgery”)

                           

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Literature review current through: 2017-06 . | This topic last updated: 2015-11-20.
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