Breast Cancer Treatment and Pregnancy (PDQ�)
General Information about Breast Cancer and Pregnancy
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
Each breast also contains
Breast cancer is sometimes detected (found) in women who are pregnant or have just given birth.
In women who are pregnant or who have just given birth,
Possible signs of breast cancer include a lump or change in the breast.
Breast cancer may cause any of the following signs and
A lump or thickening in or near the breast or in the underarm area.
A change in the size or shape of the breast.
A dimple or puckering in the skin of the breast.
A nipple turned inward into the breast.
Fluid, other than breast milk, from the nipple, especially if it's bloody.
Scaly, red, or swollen skin on the breast, nipple, or
areola(the dark area of skin that is around the nipple).
Dimples in the breast that look like the skin of an orange, called
It may be difficult to detect (find) breast cancer early in pregnant or nursing women, whose breasts are often tender and swollen.
Women who are pregnant, nursing, or have just given birth usually have tender, swollen breasts. This can make small lumps difficult to detect and may lead to delays in
Breast examination should be part of prenatal and postnatal care.
To detect breast cancer, pregnant and nursing women should examine their breasts themselves. Women should also receive
Tests that examine the breasts are used to detect (find) and diagnose breast cancer.
Ultrasoundexam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissuesor organs and make echoes. The echoes form a picture of body tissues called a sonogram. Mammogram: An x-rayof the breast. A mammogram can be performed with little risk to the fetus. Mammograms in pregnant women may appear negativeeven though cancer is present. Biopsy: The removal of cellsor tissues by a pathologistso they can be viewed under a microscope to check for signs of cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The stage of the cancer (whether it is in the breast only or has spread to other places in the body).
The size of the
The type of breast cancer.
The age of the fetus.
Whether there are
The patient?s general health.
Stages of Breast Cancer
After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.
The process used to find out if the
Methods used to stage breast cancer can be changed to make them safer for the fetus.
Standard methods for giving
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
tissue. Cancer invadesthe surrounding normal tissue.
lymph system. Cancer invades the lymph system and travels through the lymph vesselsto other places in the body.
blood. Cancer invades the veinsand capillariesand travels through the blood to other places in the body.
The following stages are used for breast cancer:
Stage 0 (carcinoma in situ)
There are 2 types of
Ductal carcinoma in situ(DCIS) is a noninvasive conditionin which abnormal cellsare found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissuesin the breast. In some cases, DCIS may become invasive cancerand spread to other tissues, although it is not known at this time how to predict which lesionswill become invasive. Lobular carcinoma in situ(LCIS) is a conditionin which abnormal cellsare found in the lobulesof the breast. This condition seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancerin either breast.
stage IA, the tumoris 2 centimetersor smaller and has not spread outside the breast.
stage IB, either:
tumoris found in the breast, but small clusters of cancer cells(larger than 0.2 millimeterbut not larger than 2 millimeters) are found in the lymph nodes; or
the tumor is 2
centimetersor smaller and small clusters of cancer cells (larger than 0.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes.
tumoris found in the breast, but canceris found in the axillary lymph nodes( lymph nodesunder the arm); or
the tumor is 2
centimetersor smaller and has spread to the axillary lymph nodes; or
the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.
stage IIB, the tumor is either:
larger than 2
centimetersbut not larger than 5 centimeters and has spread to the axillary lymph nodes; or
larger than 5 centimeters but has not spread to the axillary lymph nodes.
tumoris found in the breast. Canceris found in axillary lymph nodesthat are attached to each other or to other structures, or cancer may be found in lymph nodesnear the breastbone; or
the tumor is 2
centimetersor smaller. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
the tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
the tumor is larger than 5 centimeters. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.
has spread to the
chest walland/or the skin of the breast; and
may have spread to
axillary lymph nodesthat may be attached to each other or to other structures, or cancer may have spread to lymph nodesnear the breastbone.
Cancer that has spread to the skin of the breast is
has spread to
lymph nodesabove or below the collarbone; and
may have spread to
axillary lymph nodesor to lymph nodes near the breastbone.
Cancer that has spread to the skin of the breast is
In operable stage IIIC, the cancer:
is found in ten or more axillary lymph nodes; or
is found in lymph nodes below the collarbone; or
is found in axillary lymph nodes and in lymph nodes near the breastbone.
In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone.
Inflammatory Breast Cancer
Recurrent Breast Cancer
Treatment Option Overview
There are different types of treatment for patients with breast cancer.
Different types of treatment are available for patients with
For some patients, taking part in a clinical trial may be the best treatment choice. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from
Clinical trials are taking place in many parts of the country. Information about clinical trials is available from the NCI Web site.
Treatment options for pregnant women depend on the stage of the disease and the age of the fetus.
Three types of standard treatment are used:
Most pregnant women with breast cancer have
Types of surgery to remove the breast include:
Simple mastectomy: A surgical procedure to remove the whole breast that contains cancer. Some of the lymph nodes under the arm may also be removed for biopsy. This procedure is also called a total mastectomy. Modified radical mastectomy: A surgical procedure to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wallmuscles. Lumpectomy: A surgical procedure to remove a tumor(lump) and a small amount of normal tissuearound it. Most doctors also take out some of the lymph nodes under the arm. Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. Some of the lymph nodes under the arm may also be removed for biopsy. This procedure is also called a segmental mastectomy.
Even if the doctor removes all of the cancer that can be seen at the time of surgery, the patient may be given
Radiation therapy is a cancer treatment that uses high-energy
Radiation therapy should not be given to pregnant women with early stage (
Chemotherapy is a cancer treatment that uses
Chemotherapy should not be given during the first 3 months of pregnancy. Chemotherapy given after this time does not usually harm the fetus but may cause early labor and low birth weight.
See Drugs Approved for Breast Cancer for more information.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Hormone therapy is a cancer treatment that removes
The effectiveness of hormone therapy, alone or combined with chemotherapy, in treating breast cancer in pregnant women is not yet known.
Ending the pregnancy does not seem to improve the mother?s chance of survival.
Because ending the pregnancy is not likely to improve the mother?s chance of survival, it is not usually a treatment option.
Treatment Options by Stage
Early Stage Breast Cancer (Stage I and Stage II)
Treatment of early
Modified radical mastectomy. Breast-conserving surgery: Lumpectomy, partial mastectomyor segmental mastectomy.
Breast-conserving surgery during pregnancy followed by
radiation therapyafter the baby is born.
Surgery during pregnancy followed by
chemotherapyafter the first 3 months of pregnancy. Clinical trialsof surgery followed by hormone therapywith or without chemotherapy.
Late Stage Breast Cancer (Stage III and Stage IV)
Treatment of late
Radiation therapy. Chemotherapy.
Radiation therapy and chemotherapy should not be given during the first 3 months of pregnancy.
Other Considerations for Pregnancy and Breast Cancer
Lactation (breast milk production) and breast-feeding should be stopped if surgery or chemotherapy is planned.
Breast cancer does not appear to harm the fetus.
Pregnancy does not seem to affect the survival of women who have had breast cancer in the past.
Some doctors recommend that a woman wait 2 years after treatment for breast cancer before trying to have a baby, so that any early return of the
Effects of certain cancer treatments on later pregnancies are not known.
The effects of treatment with
To Learn More About Breast Cancer and Pregnancy
For more information from the
Breast Cancer Home Page
What You Need to Know About? Breast Cancer
Breast Cancer Prevention
Breast Cancer Screening
Drugs Approved for Breast Cancer
Reproductive History and Breast Cancer Risk
What You Need to Know About? Cancer
Understanding Cancer Series: Cancer
Chemotherapy and You: Support for People With Cancer
Radiation Therapy and You: Support for People With Cancer
Coping with Cancer: Supportive and Palliative Care
Information For Survivors/Caregivers/Advocates
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Changes to This Summary (07/20/2011)
Editorial changes were made to this summary.
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
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