Management of CA breast in 2nd trimester- all except?

Management of CA breast in 2nd trimester- all except?

a) Chemotherapy Doxorubicin + Cyclophosphamide + 5FU

b) Mastectomy

c) Focal 3D

d) Breast conservative surgery is a valid option

Ans: C Reference: Sabiston 20th ed; pg. 2059-2060 Explanation:
BREAST CANCER AND PREGNANCY

• Radiotherapy definitely avoided • Chemotherapy avoided in first trimester, risk of teratogenicity is 10 to 25% and in second and third trimesters its 1.3% • After first trimester, sentinel node biopsy can be done safely • Breast conserving therapy is becoming option nowadays in late 2nd trimester and 3rd trimester, where neoadjuvant chemotherapy is given to downsize tumor and BCS done in third trimester along with C section followed by RT after delivery

First trimester Mastectomy with axillary dissection Second trimester Mastectomy with axillary dissection or sentinel node axillary staging Neoadjuvant chemotherapy followed by Breast conservation surgery and RT post delivery Third trimester Mastectomy or BCS followed by RT post delivery

• Important considerations: • Trastuzumab avoided in pregnancy • Methotrexate avoided • Chemotherapy drugs should not be given after 35 weeks of gestation – cause myelosuppression in newborn