Case study from the University of Kiel: breast feeding following breast cancer therapy
H. Kühling-von Kaisenberg, C. S. von Kaisenberg, K. Maass-Poppenhusen, W. Jonat
2005
Breast Cancer Online
A 36-year-old premenopausal patient was initially diagnosed with breast cancer presenting as a lump in the upper quadrant of the right breast at 35 weeks of pregnancy. Subsequently she spontaneously delivered a healthy girl following induction of labor. Lactation was suppressed using Bromocriptin. Breast cancer was treated using neoadjuvant administration of four cycles epirubicin and cyclophosphamid (EC) as well as lumpectomy and axillary lymphonodectomy (invasive ductal breast cancer, pT2,
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... , M0, G2). Subsequently, four cycles of cyclophosphamid, methotrexate and 5 fluouracil (CMF) were given and the affected breast was irradiated (50 Gy). Five years later, aged 41, the lady spontaneously conceived. First trimester screening for chromosomal abnormalities and second trimester anomaly scanning showed no abnormal findings. At 32 weeks, the patient asked for counselling regarding the possibility to breastfeed. At 35 weeks, there was spontaneous rupture of the membranes and uneventful spontaneous delivery with normal APGAR and pH scores. Before the onset of lactation, a routine mammogram was performed, which was normal. The psychological circumstances of mammography, reminding the patient of her disease, resulted in stress and agalactia. With the support of midwives and lactation counsellers, normal lactation developed in the unaffected breast over a period of several weeks and the lady was breast feeding for 8 months. There was no lactation in the irradiated breast. Case report 2 A 31-year-old patient was diagnosed with breast cancer after palpation of a nodule in the breast. The tumor was excised and axillary lymphonodectomy was performed (invasive ductal breast cancer, pT1, pN1 (2/11), M0, G2). Subsequently, 3 cycles of CMF were administered and irradiation therapy was performed (50 Gy). Six years later, aged 37, the patient received intracytoplasmic sperm injection (ICSI) for oligospermia of the husband due to malignancy of the testis, resulting in first trimester miscarriage. A further ICSI cycle lead to a normal pregnancy and delivery of a macrosomic healthy child through cesarean section. The patient also requested counselling regarding the possibility of breast feeding. Some days post partum, normal sufficient lactation developed in the healthy breast ( Fig. 1) , there was however no lactation in the irradiated side. Figure 1. Breast conserving surgical and irradiational therapy in breast cancer (right) and lactating breast (left). Surgical therapy was following functional and less cosmetic considerations to preserve the ducts, because at the time when the orientation of the skin cut was planned, there was no suspicion of malignancy. Therefore a radial rather than a circular cut was used. https://www.cambridge.org/core/terms. https://doi.
doi:10.1017/s147090310500413x
fatcat:pilyh2ixd5ekrjg63ljhkd5o5e