Gebelik ve Meme Kanseri
Özet
Gebelikle ilişkili meme kanseri (GİMK), gebelik esnasında veya doğum sonrası ilk yılda teşhis edilen ve kadınlarda hamilelik döneminde en sık rastlanan malignitelerden biridir. Son yıllarda sosyolojik faktörlere bağlı olarak gebelik yaşının ilerlemesi, bu hastalığın görülme sıklığını artırmıştır. Gebelik esnasında memede meydana gelen fizyolojik ve hormonal değişiklikler, tümör bulgularını maskeleyerek tanıda ortalama altı ayı bulan gecikmelere yol açabilmekte; bu durum da hastalığın daha ileri evrelerde ve lenf nodu tutulumu ile tespit edilmesine neden olmaktadır. Histopatolojik açıdan çoğunlukla invaziv duktal karsinom tipinde görülen bu kanserler, agresif seyirli, yüksek gradlı ve genellikle hormon reseptör negatif özellikler taşımaktadır. Tanı aşamasında fetüsün radyasyon güvenliği gözetilerek meme ultrasonu ve abdominial korumalı mamografi tercih edilirken, MRG kontrast maddesiz uygulanmalı, BT ve PET gibi yüksek radyasyonlu yöntemlerden kaçınılmalıdır. Tedavi yaklaşımı ise multi-disipliner bir konsey tarafından gebelik haftası, tümör evresi ve biyolojisine göre bireyselleştirilmelidir. Cerrahi müdahale her trimesterde güvenle uygulanabilirken, sistemik kemoterapi teratojenik etkiler nedeniyle ilk trimesterden sonra (FAC veya AC rejimleri) tercih edilmelidir. Radyoterapi, anti-Her2 tedaviler ve endokrin ajanlar ise fetal toksisite ve anomali riskleri sebebiyle gebelik sürecinde kontrendike olup doğum sonrasına ertelenmektedir.
Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy or within the first postpartum year, representing one of the most common malignancies during gestation. Delayed childbearing due to socioeconomic factors in recent years has significantly increased the incidence of this disease. Physiological and hormonal alterations in the breast tissue during pregnancy often mask tumor symptoms, leading to diagnostic delays averaging over six months, which subsequently results in advanced-stage presentation and a higher rate of lymph node metastasis. Histopathologically, the majority of cases are invasive ductal carcinomas characterized by aggressive behavior, high histological grade, and hormone receptor negativity. For diagnostic staging, breast ultrasound and mammography with proper abdominal shielding are prioritized to ensure fetal radiation safety, whereas contrast-free MRI is reserved for selected cases, and high-radiation modalities like CT and PET are strictly avoided. Management requires an individualized, multidisciplinary team approach tailored to gestational age, tumor stage, and molecular subtypes. While surgical intervention can be safely performed during any trimester, systemic chemotherapy is contraindicated in the first trimester due to teratogenic risks and is restricted to the second and third trimesters. Conversely, radiotherapy, anti-Her2 targeted therapies, and endocrine treatments are contraindicated throughout pregnancy due to severe fetal toxicity risks and must be postponed postpartum.
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