A CT of the chest, abdomen and pelvis was performed and revealed no evidence of disease. BRCA testing is pending. The care of a pregnant patient with breast cancer involves the utilization of a multidisciplinary team, including a geneticist, obstetrician, maternal–fetal medicine

specialist, medical oncologist, surgical oncologist and neonatologist. Early ultrasound dating should be obtained in order to provide adequate counseling regarding pregnancy management. In addition, a detailed fetal anatomic evaluation during the mid second trimester is recommended to exclude Selleckchem TSA HDAC pre-existing fetal anomalies [4]. The safest interval for most cancer therapies in pregnancy is between the second and third trimesters, avoiding induction of teratogenic risks or miscarriages [4]. If growth restriction or non-reassuring fetal status is discovered, these conditions should be managed selleck according to standard obstetrical guidelines. The timing of delivery should take into account maternal and fetal status as well as need for further chemotherapy and expected perinatal outcome, while the mode of delivery should be determined by standard obstetrical indications [5]. Chemotherapy during pregnancy should not be given within 3 weeks of planned delivery in order to avoid problems associated with maternal and fetal

myelosuppression [12], [13] and [14]. Chemotherapy and radiation may be started immediately following a vaginal delivery and one week after cesarean section [7]. Breastfeeding is contraindicated during treatment with chemotherapy or radiation therapy [7]. If breast cancer is discovered during pregnancy, diagnostic and staging evaluations can be modified to limit fetal exposure [8]. The search for distant metastases may be performed using ultrasonography and MRI [8]. Mastectomy may be performed without fetal injury or spontaneous abortion [8]. Generally breast surgeons prefer to wait until after the first trimester due to the increased risk of spontaneous abortion associated with first trimester surgical intervention, although women who undergo surgery for breast cancer in the first trimester do not seem to have a higher rate of spontaneous loss compared with the

Carnitine dehydrogenase general population [9]. Both mastectomy and breast-conserving surgery with axillary lymph node dissection are surgical options for pregnancy-associated breast cancer [8]. Mastectomy is sometimes preferred for breast cancer in pregnancy since follow-up radiation therapy is typically not required post-operatively. Isosulfan blue or methylene blue dye lymph node mapping is not recommended in pregnant women because anaphylaxis has been observed [8]. Technetium-based sentinel node identification, however, has been performed safely in pregnancy [8]. Doxorubicin and cyclophosphamide (AC regiment) as well as 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC regimen) may be administered during the second and third trimesters for pregnancy-associated breast cancer; Hahn et al.