A twenty six-year-old patient underwent multidisciplinary treatment which also included chemotherapy at the Jupiter Hospital in Pune after she was diagnosed with Pregnancy Associated Breast Cancer (PABC), which is a special variant of cancer that can complicate 1 in 3000 pregnancies. Doctors said treating breast cancer during pregnancy requires balancing ontologically which is the effective treatment for the mother, with the safe delivery of a healthy baby.
The diagnosis came as a big surprise to Deepika and her husband Sugat who were expecting their first child. When Deepika first noted a lump in her breast, it did not immediately raise alarms. She had no family history of cancer and knew she had a benign (non-cancerous lump) fibro adenoma in the same area of the breast diagnosed several years ago. The initial assumption was that it was this fibro adenoma that was growing as expected during pregnancy. However, the lump grew from 1 cm to over 5 cm over a few weeks.
When Dr Pranjali Gadgil, Breast Surgeon at Jupiter hospital evaluated Deepika, the lump was almost 5.5 cm. She noted that the fibro adenoma she had before, was nearby but not related to the new growth. Deepika underwent a core needle biopsy; it revealed she is suffering from “Pregnancy associated Breast Cancer”
Dr Gadgil said that the PABC is a rare disease that occurs in 1 in 3000 pregnancies and often tends to be an aggressive type of breast cancer. It can grow rapidly under influence of hormones and growth factors that abound in pregnancy. Average age of women who have PABC is 32-38 years of age. “Deepika’s tumor was large and high grade, prompt initiation of treatment was necessary. We discussed her case on our tumor board and counseled the young couple about the options,” she added.
Jupiter Hospital’s Medical Oncologist Dr Tushar Patil and Breast Cancer Surgeon Dr Pranjali Gadgil planned to administer Deepika chemotherapy during pregnancy and before surgery- an approach called “Neoadjuvant Chemotherapy.”
“Although Deepika was in her 2nd trimester and surgery could have been performed first, a 5.5 cm tumor would have necessitated complete removal of the breast called ‘mastectomy’. We usually perform reconstructive surgery to replace the removed breast in the same setting. However, when we operate on pregnant women, we want to minimize the exposure of the fetus to anesthesia and hence would have deferred reconstruction to a later time,” explained Dr Gadgil.
“Two weeks after completing her 12th cycle of chemo, Deepika completed her last trimester and delivered a healthy baby boy at 39 weeks of gestation. Although Deepika had prolonged labour and more than usual blood loss, Dr Aggrawal was able to conduct a vaginal delivery,” added Dr Gadgil.
Deepika was able to re-start her remaining 4 cycles of chemotherapy three weeks after her delivery. After completion of the chemotherapy, she was evaluated for surgical planning by Breast Surgeon, Dr Pranjali Gadgil. As the tumor had reduced in size with the chemotherapy effect, a mastectomy was no longer necessary and a smaller operation was now feasible. Deepika underwent an oncoplastic breast conservation surgery with a local rotational flap along with removal of lymph nodes in the armpit. Describing the surgery Dr Gadgil elaborated “This oncoplastic technique of surgery enables us to remove adequate extent of the tumor-bearing area, yet preserves the aesthetic appearance of the remaining breast without any deformity”
Paediatrician Dr Shrinivas Tambe attended to the baby at delivery. “The baby's normal birth weight was 3.3 kg and we checked to ensure there were no developmental anomalies. The baby was discharged without additional intensive care or medical treatments.” Dr Tambe said.
Dr. Vikas Kothavade, Radiation Oncology department at Jupiter Hospital said patients had left sided breast cancer, subsequently where heart lies in close proximity of the target area of radiation, she is receiving treatment with a special technique called as breath hold technique (gating), due to which they are able to reduce the radiation dose to the heart significantly and consequently minimize radiation induced heart related side effects in future.
