Gebelikte Meme Kanseri
Özet
Gebelikle ilişkili meme kanseri (GİMK), gebelik sırasında veya doğum sonrası ilk yılda teşhis edilen ve üreme çağındaki kadınlarda sık görülen malignitelerdendir. Yaşın ilerlemesiyle gebeliklerin ertelenmesi, bu vakaların gelecekte artacağını göstermektedir. Gebelikte memedeki yoğunluk artışı nedeniyle tanı genellikle ileri evrelerde konulur; tanı sürecinde ultrason ve karın koruyuculu mamografi güvenle kullanılırken, kontrastlı MRG ve BT gibi iyonize radyasyon içeren yöntemlerden fetal riskler nedeniyle kaçınılmalıdır. Kesin tanı için altın standart kor biyopsisidir. Tedavi yaklaşımı multidisipliner bir ekip tarafından yönetilmeli; gebeliğin ilk trimesterinde kemoterapi kontrendikeyken, ikinci ve üçüncü trimesterde adriamisin, siklofosfamid gibi ajanlar güvenle uygulanabilir. Ancak kemoterapi, intrauterin büyüme geriliği ve erken doğum gibi riskleri beraberinde getirebileceğinden, yenidoğanda miyelosupresyonu önlemek adına doğumdan en az 3 hafta önce sonlandırılmalıdır. Anti-HER2 tedaviler (trastuzumab) oligohidramniyozis riski nedeniyle gebelikte önerilmez ve doğum sonrasına ertelenir; hormonal tedavi ajanı tamoksifen ise teratojenik etkilerinden dolayı yine doğum sonrasında başlatılmalıdır. Cerrahi olarak genellikle mastektomi tercih edilir, sentinel lenf nodu biyopsisi teknesyum-99 ile güvenle yapılabilirken mavi boya kullanımı anafilaksi riski nedeniyle kontrendikedir. Radyoterapi ise fetusa yönelik zararlarından dolayı gebelikte büyük ölçüde kontrendikedir. GİMK olgularında genel sağkalım gebe olmayan hastalarla benzerlik gösterirken, doğum sonrası teşhis edilenlerin prognozu daha kötüdür.
Pregnancy-associated breast cancer (PABC) refers to malignancies diagnosed during pregnancy or within the first postpartum year, representing a significant condition in women of reproductive age that is expected to rise as childbearing is increasingly delayed. Diagnosis is frequently delayed and occurs at advanced stages due to increased breast density during pregnancy; while ultrasound and mammography with abdominal shielding are safe diagnostic modalities, contrast-enhanced MRI, CT scans, and bone scans should be avoided to prevent potential fetal anomalies. Core needle biopsy remains the gold standard for histopathological diagnosis, and management necessitates a highly specialized multidisciplinary team. Surgical intervention typically involves mastectomy, and sentinel lymph node biopsy using technetium-99 is safe, whereas blue dye and radiotherapy are strictly contraindicated due to anaphylactic and fetal radiation risks. Systemic chemotherapy is contraindicated in the first trimester but can be administered during the second and third trimesters using regimens like adriamycin and cyclophosphamide, though it must be discontinued at least three weeks prior to delivery to allow bone marrow recovery and avoid hematological toxicity. Conversely, anti-HER2 therapies such as trastuzumab and hormonal treatments like tamoxifen are postponed until the postpartum period due to severe risks of oligohydramnios and teratogenic complications, respectively. Although PABC exhibits aggressive features, overall survival rates remain comparable to non-pregnant cohorts when properly adjusted for stage and treatment.
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