cervical cancer in pregnancy ppt

cervical cancer in pregnancy ppt

and pelvic LND at diagnosis • “Radical” cone biopsy/ trachelectomy/ cerclage and extraperitoneal pelvic and aortic LND at 16-18 weeks • C-Section and Radical hyst. At the early phase of the pregnancy, such as . Cervical cancer can be detected by a Pap smear, which is often performed during pregnancy, or from a doctor's exam prompted by symptoms you might be experiencing (such as bleeding). Six weeks into her pregnancy, … Cervical cancer is a malignant tumour deriving from cells of the cervix. © 2020 SlideServe | Powered By DigitalOfficePro, - - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -. 4 Cervical cancer Cervical cancer: A summary of key information Introduction to cervical cancer • Cervical cancer forms in the tissues of the cervix and is almost always caused by human papillomavirus (HPV) infection.• HPV vaccines are available that provide protection against HPV infection and decrease the incidence of high-grade cervical abnormalities. Epithelial Ovarian Cancer - . Obstet. This means that about 99.9% of "DES daughters" do not develop these cancers. Am. • Abnormal Pap: • ASCUS/LSIL and HPV negative – repeat post partum • ASCUS/LSIL and HPV positive: colposcopy • ASCH: Colposcopy - HSIL: Colposcopy • Don’t defer biopsy because of fear of bleeding or preterm labor. Get powerful tools for managing your contents. Chapter Twelve - Pregnancy and birth. Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix. pregnancy is a period of adaptation for:. 31:317, 1990. • Most common at: • 8-16 week – rapid uterine growth (60%) • Postpartum – involution (40%) • Hemorrhage: 10% of cases • Ruptured corpus luteum • Germ cell tumor, Complications of Ovarian Masses in Pregnancy • Rupture/ tumor dissemination (10%) • Anemia • Malpresentations • Necrosis • Infection • Ascites • Masculinization of female fetus • Hilar cell tumor • Luteoma of pregnancy • Sertoli-Leydig cell tumor, Work-up of Ovarian Cancer • Pelvic ultrasound • MRI pelvis/ abdomen • Chest X-ray • CA-125: elevated in normal pregnancy, should normalize after 12 weeks • AFP, B-HCG, LDH – predominantly solid mass • Liver FunctionTests, BUN, Creatinine • GI studies only if clinically indicated, Management of Ovarian Cancer • Prognosis not affected by pregnancy • Tumors of Low Malignant Potential – all stages (20%) • Adenocarcinoma Stage I, grade 1 or 2 (10%) • Germ cell tumors (5%) – may require chemotherapy • Gonadal stromal tumors (15%) • Surgery at 16-18 weeks if possible • Frozen section: beware of inaccuracies • Conservative ovarian surgery • Adnexectomy/ Oophorectomy/ Cystectomy • Hysterectomy not indicated • Thorough staging: • Pelvic/ aortic node disection/ Omentectomy/ peritoneal biopsies, Management of Ovarian Cancer • Epithelial Ovarian Cancer Stage IC – IV • Try to delay chemotherapy until 12-16 weeks of pregnancy • Try to delay removal of corpus luteum until 14 weeks • First trimester • TAB followed by appropriate surgery and chemotherapy • Chemotherapy after FNA: • C-Section and appropriate management at maturity • Second and Third Trimester • Chemotherapy first • C-Section and appropriate surgical management at maturity, Malignant Germ Cell Tumors • Dysgerminoma • 30% of Ovarian malignant neoplasms in pregnancy • Most stage IA • Average 25cm; solid • Therapy • Surgery: USO, wedge biopsy of opposite ovary, surgically stage • 25% are bilateral • Stage IA & IB: No further treatment • Advance stages • Hysterectomy not required • Chemotherapy, Malignant Germ Cell Tumors • Endodermal sinus tumor • Grade 2-3 malignant teratoma • Choriocarcinoma (non-gestational) • USO and staging for early disease • All require chemotherapy regardless of stage, Tumor like Ovarian Lesions Associated with Pregnancy • All resolve spontaneously after delivery • Conservative surgical approach: frozen section +/- oophorectomy • Luteoma of pregnancy - usually an incident. She’s pregnant! If you continue browsing the site, you agree to the use of cookies on this website. Incidence. She’s pregnant and has cancer! See our User Agreement and Privacy Policy. testosterone • Maternal masculinization. J. Obstet, Gynecol. Dysplasia is easily detected in a routine Pap smear and is completely treatable. Cervical cancer - . time of diagnosis. yuki juan ntust jun 9, 2003. outline. • Get a Gyn/Onc involved! Human papillomavirus (HPV) is a common sexually transmitted infection which is the cause of several cancers, including cervical cancer, and genital warts. In a small percentage of people, however, the virus survives for years, contributing to th… Research so far suggests that cervical cancers diagnosed during pregnancy grow no more quickly and are no more likely to spread than cervical cancers in women who are not pregnant. issues associated with pregnancy and birth. Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina.Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer.When exposed to HPV, the body's immune system typically prevents the virus from doing harm. Most women diagnosed with cervical cancer during pregnancy have early stage disease. Med Onc: Oh No! It is the third most common cancer worldwide, and the 12 th most common in the UK.. cervical cancer during pregnancy will likely increase. overview of the lecture. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Three months after giving birth, she was diagnosed with cervical cancer. The Data Visualizations Tool provides detailed statistics. During a Pap test, your doctor scrapes and brushes cells from your cervix, which are then examined in a lab for abnormalities. Cervical Cancer Screening Market & Patients-North America: Ken Research - Cervical cancer is one of the most common causes of cancer death for North American women. Cervical cancer is a disease that develops quite slowly and begins with a precancerous condition known as dysplasia. Find out if you qualify. epidemiology. • Prognosis: Leukemia in Pregnancy • Most abort spontaneously • Average age is 28 • Usually recommend termination of pregnancy because of aggressive chemotherapy • Prognosis – dependant on cell type, Hodgkins Disease/Lymphoma in Pregnancy • Gestational Age/ Stage • <20 weeks: TAB • >20 weeks: XRT • Chest mantle first • Chemotherapy depending on stage • Abdominal XRT after delivery • 80% curable – depending on cell type, Melanoma in Pregnancy • Incidence rising • 50% occur in women of child bearing age • 9% of cases occur in pregnancy • Extremities most common site • Pregnancy does not affect prognosis, Ovarian Function and Chemotherapy • Dose and age related • Younger than 25: permanent amenorrhea uncommon • Older than 40: 50% permanent ovarian failure • Birth control pills may prevent ovarian failure • Risk of birth defects in offspring not increased (4%) • Wait 2-3 years after therapy to become pregnant • Allow for possible recurrent disease, Ovarian Function and Fertility and Radiation Therapy • Age and dose related (<20 years old – better) • Ovaries outside radiation field (avg. Physician Reaction • Ob/Gyn: Oh No! Cervical cancer ppt. peggy andrews emt-paramedic chemeketa community college. Cervical cancer refers to neoplasia arising from the cervix – the lower part of the uterus. Cancer in Pregnancy. Get information on causes, symptoms, treatments, risks and prevention of cervical cancer and other health problems during pregnancy at TheBump.com. I was not so lucky. Cervical cancer is a malignant tumour deriving from cells of the cervix. Ob/Gyn: Oh No! No public clipboards found for this slide. Incidence • 1/1000 – 1/1500 term pregnancies • Incidence increasing: delayed childbearing, What’s Different About Pregnancy? She’s pregnant and has cancer! Surgeon/Primary Care: Oh No! Involvement of the middle and upper thirds of the epithelium is diagnosed as CIN2 and CIN 3. OB/GYN 53:330, 1979. She has cancer! is estimated that 1 to 3 percent of women diagnosed. • Brodsky et.al. Early Stage of Cervical Cancer in Pregnancy. DES-related clear cell adenocarcinoma is more common in … In general, cancer during pregnancy is an uncommon occurrence. Cervical cancer is the third most common gynecologic cancer in the US. • Hormones • Metabolic Changes • Hemodynamics • Immunology • Increased vascularity • Age • Few cases – anecdotal experience • Inherent bias – breast, ovarian cancer, General Considerations • Pregnancy does not have a proven negative effect on any cancer • Maintaining pregnancy after diagnosis • Delay of treatment (assume delivery at 34th week) • First trimester diagnosis: up to 28 week delay • Second trimester diagnosis: up to 22 week delay • Third trimester diagnosis: up to 10 week delay, General Considerations • Surgery • Wait until 16-18 weeks for abdominal surgery: Spontaneous Abortion: 40%  3% • Don’t remove corpus luteum if possible until 14th week (progesterone supp. by catherine ramos marin, msn/ ed(c ), whcnp, rn. Van Calsteren K, Vergote I, Amant F. Cervical neoplasia during pregnancy: diagnosis, management and prognosis. the needs of the fetus meeting the stress, REDUCING THE RISK OF THROMBOSIS AND EMBOLISM DURING PREGNANCY AND THE PUERPERIUM - . disordered eating obesity hypertensive disorders gestational diabetes. Cervical cancer occurs in several subtypes: squamous cell carcinoma (60% of cases), adenocarcinoma (25%), and other histologies (6%). Cervical cancer There has been a significant decrease in the incidence of invasive cervical cancer in young women in the UK as a result of the advent of the cervical screening programme. If the mitoses and immature cells are present simply in the lower third of the epithelium, the lesion usually is designated as CIN1. -20cm – multiple nodules • Bilateral: 1/3 of cases • 25% have increased. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. ): • 6.3% positive nodes • Stage IB – Disease confined to cervix • Stage IIA – vaginal extension • Vaginal delivery: increased risk of hemorrhage and cervical laceration • Depends on desire for pregnancy • First trimester: delay of up to 28 weeks – degree of risk unknown • Radical hyst. If cervical cancer is caught early enough (Stage 0 or 1A1), the tumor can be removed entirely through a cold knife cone biopsy. • Level 2 SONO at 20 weeks • Chromosome analysis • Amnio: 15 weeks • CVS: Transcervical (except cervix ca) or transabdominal at 10-12 weeks • Deliver when mature • L/S ratio at 34 weeks • Betamethasone, Epidemiology of Genital HPV/SIL/Cancer in Pregnancy • Up to 40% of reproductive age women have HPV • 2.0-6.5% cases of CIN/SIL occur in pregnant women • 13,500 cases of cervical cancer & 4,000 deaths/ year in U.S. • 25% of women with cervical cancer are < 36 years old • 1-13 cases of cervical cancer for every 10,000 pregnancy • 1.9% of microinvasive cervical ca. dose 290 cGy): • 25% failure • Start to lose function at 150 cGy • Ovaries in radiation field: • At 500 cGy most women are amenorrheic • Oophoropexy to the iliac fossa • Use clips to identify ovaries, Metastases to Fetus/Placenta • Only 50 cases in literature • Melanoma (50% of reported cases) • Leukemia: 1/100 affected pregnancies • Lymphoma • Breast. Teen pregnancy and HPV vaccination continue to be a pressing issue for low-income populations. Treatment of Breast Cancer • Treatment same as non-pregnant • Lumpectomy • Sentinal node biopsy • 2.5mCi technetium 99 – 4.3 mGy at worst. dr.yousefi. for women aged 20 to 39 years, cervical cancer remained the second leading, Cancer and Pregnancy - . first trimester (1-13, High Risk Pregnancy - 2007 - . finding at C-Section • Microscopic. General Considerations • Chemotherapy and Breastfeeding • Generally not recommended • Long-term effects of chemotherapy on children exposed in utero • Aviles, et.al. shauna braun leah crask. Esposito S, Tenconi R, Preti V, Groppali E, Principi N. Chemotherapy against cancer during pregnancy. She has cancer! • The incidence of cancer in pregnancy is a rare event (1 to 2 cases per 1000 pregnancies) • The numbers have increased in recent years because of the increase in maternal age at the time of the 1st pregnancy. caryn gee morse, md march 20, 2001. lung cancer: the problem . • Cervical cancer is the third most common cancer in women worldwide. the cell cycle and its control what is the, Complications of Pregnancy - . case presentation. with cervical cancer are pregnant or postpartum at the. dr noorzadeh fellowship, Pregnancy at Risk: Pregestational Onset - . Best Practice & Research Clinical Obstetrics & Gynaecology. Herod J, Decruze S, Patel R. A report of two cases of the management of cervical cancer in pregnancy by cone biopsy and laparoscopic pelvic node dissection. incidence. fertility assisted, Epidemiology of Genital HPV/SIL/Cancer in Pregnancy, Vulvar/ Vaginal Condylomata or SIL in Pregnancy, Cervical Cancer in Pregnancy: Treatment by Stage, Ovarian Masses in Pregnancy Frequency by Type, Management of Ovarian Masses in Pregnancy, Complications of Ovarian Masses in Pregnancy, Tumor like Ovarian Lesions Associated with Pregnancy, Breast Cancer in Pregnancy (2nd most common cancer in, Ovarian Function and Fertility and Radiation Therapy. It. 63: 421, 1984. all, colorectal cancer - . the first trimester, treatment is not hastened and is usually delayed till a few weeks post-delivery of the baby. WINNER! • Zemlickis D., Lishner M. Degendorfer P.et.el. abuse in pregnancy breech presentation, Holistic Approach to Pregnancy - . 1 in 3 will develop cancer quarter of a million. The incidence of cervical cancer in pregnancy is • P.Struyk, P.S. CrystalGraphics brings you the world's biggest & best collection of cervical cancer PowerPoint templates. Jeffrey L. Stern, M.D. Get a Gyn/Onc involved!. 50mg BID) • Deliver at maturity (at around 34 weeks) • No proven teratogenic effects of anesthesia, General Considerations • Chemotherapy • First trimester (organogenesis ends at 12th week) • Increase incidence of anomalies and abortion; drug dependent i.e. Cervical cancer is one of the most common malignancies in pregnancy and one percent of women diagnosed with cervical cancer are pregnant or postpartum at … In 2012, cervical cancer was responsible for 266,000 deaths worldwide. – later ½ of pregnancy • Fetal virilization – 70% of female infants • Hyperreactio Luteinalis - Bilateral multicystic theca lutein cysts • Large solitary luteinized follicular cyst of pregnancy • Hilar Cell Hyperplasia – masculinized fetus • Intrafollicular Granulosa cell proliferations • Ectopic Decidua, Breast Cancer in Pregnancy (2nd most common cancer in pregnancy) • 20% of cases are in women <40 years old • 1-2% of cases are pregnant at time of diagnosis • One case/1500-3000 pregnancies • Often difficult to diagnose • Low dose mammogram with appropriate shielding of fetus is “safe” • MRI – probably best • Diagnosis often delayed • Increase incidence of positive nodes (80%) • Termination of pregnancy & proph. The incidence of cervical cancer increases with age. • Baltzer J., Regenfrecht M., Kopche W., Carcinoma of the Cervix and Pregnancy Int. in the united states, the, Psychological aspects of CANCER - . dose 54 cGy): • No failure • Ovaries at edge of radiation field (avg. 1/1000 – 1/1500 term pregnancies. Am. Dysplasia is easily detected in a routine Pap smear and is completely treatable. You can change your ad preferences anytime. and pelvic LND when mature, Cervical Cancer in Pregnancy: Treatment by Stage • Stage IA2, IB, IIA • Second trimester: delay of up to 22 weeks • Depends on desire for pregnancy • Can probably safely wait until maturity • Third trimester: delay of up to 10 weeks • C-section, Radical hysterectomy and pelvic Lymph node dissection at maturity, Cervical Cancer in Pregnancy: Treatment by Stage • Stage IB (bulky) or Stages IIb-IV • First trimester – delay of up to 28 weeks • Depends on desire for pregnancy • Unwanted • Whole pelvic radiation therapy/ chemotherapy • If SAB occurs before XRT is finished – proceed with cesium insertions (about 35 days) • Occasionally will need hysterotomy and pelvic LND if no SAB and then cesium insertions; or a “small” radical hyst. The incidence of cervical cancer in pregnancy is estimated to be between 1 … The human papillomavirus (HPV) is the cause of the abnormal cell changes that lead to the development of cancer, and HPV can be detected in 99.7% of cervical cancers. Pap test. J. OB/GYN, 85.156, 1963. Cervical Cancer in Pregnancy: Treatment by Stage • Stage IB (bulky) or Stages IIb-IV • First trimester – delay of up to 28 weeks • Depends on desire for pregnancy • Unwanted • Whole pelvic radiation therapy/ chemotherapy • If SAB occurs before XRT is finished – proceed with cesium insertions (about 35 days) • Occasionally will need hysterotomy and pelvic LND if no SAB and then cesium insertions; or a “small” radical hyst. See our Privacy Policy and User Agreement for details. Ovarian Masses in Pregnancy Acta.Scand. 2005;19(4):611-30. • Control bleeding with: • Pressure • Monsel’s solution (Ferric subsulfate) • Silver nitrate, Management of Cervical SIL On Biopsy • Satisfactory Colposcopy • LSIL / HPV+/- : Re-evaluate 6-8 weeks postpartum • HSIL / HPV+/- : F/U depends on trimester • Low grade SIL (50%) regress postpartum (Delivery route seems to matter) • High grade SIL(30%) regress postpartum • Vaginal delivery, Management of Cervical SIL • Cone biopsy in pregnancy • Indications • Unsatisfactory colposcopy/ Pap: SCC, HSIL • Adenocarcinoma in situ • Microinvasive SCC • Perform at 16-18 weeks • Risks • Abortion: 5% • Hermorrhage: immediate: 9%, delayed: 4% • Technique • Local wedge resection • Shallow cone • LEEP • Circumferential figure 8 sutures at cervical-vaginal junction • Vasopressin/ local anesthetic with epinephrine, Management of Cervical SIL HSIL/ HPV positive: No Lesion Visible on Colposcopy • Reinspect: Vulva, Vagina, Anus and Cervix • Lugol’s: Vagina and Cervix • Review Cytology • Consider Random Biopsies: 6 and 12:00 • Careful Follow-up: Pap and Colpo, Vulvar/ Vaginal Condylomata or SIL in Pregnancy • Warts and SIL often enlarge rapidly in pregnancy • No treatment unless symptomatic • Often regresses dramatically postpartum • Treat if symptomatic or interferes with vaginal delivery - disease on perineal body or posterior fourchette • Treatment options: • Trichloroacetic Acid • Podophyllin • Aldara • 5-FU cream • Laser • Excision: scalpel; LEEP • Cryotherapy, Cervical Cancer in Pregnancy • Work-up • MRI of pelvis/abdomen • Chest X-ray • Carcinoembryonic Antigen (CEA) • CBC, BUN, Creatine, LFT’s • Advanced disease • Urine cytology/ cystoscopy • Stool for occult blood/ sigmoidoscopy, Cervical Cancer in Pregnancy: Treatment by Stage • Stage IA1 - <3mm invasion; < 7mm wide • 1.2% positive nodes • Cone biopsy • No further treatment necessary; simple hysterectomy • Vaginal delivery at term, Cervical Cancer in Pregnancy: Treatment by Stage • Stage IA2 (3-5mm invasion, no vascular inv. Growth and Development of Children of Mothers Treated with Chemotherapy during pregnancy: Current status of 43 children. & pelvic … The new iOS & Android mobile apps and the Web application, to streamline navigation of the guidelines, have launched. pre-pregnancy health diagnosing pregnancy, Anticipatory Guidance During Pregnancy - . J. Hematology 36: 243, 1991. Dysgermenoma associated with pregnancy. Most cases of cervical cancer occur in developing countries, where it is … • +/- radiation • Chemotherapy • Modified radical mastectomy and nodes • Adjuvant chemotherapy after 16 weeks • CAF better than CMF in 1st trimester • Axillary or localized chest wall RXT is probably safe after the first trimester but can be difficult to shield fetus. Usually contraindicated. A Pap test can detect abnormal cells in the cervix, i… Clipping is a handy way to collect important slides you want to go back to later. Gynecol. & pelvic LND if small residual cervical disease • Wanted • Consider chemotherapy until maturity at 34 weeks, Cervical Cancer in Pregnancy: Treatment by Stage • Stage IB (bulky) or Stages IIb-IV • Second trimester – delay of up to 22 weeks • Unwanted: pregnancy – Radiation therapy as above • Spontaneous abortion at 35 days • Wanted: pregnancy – consider chemotherapy until maturity • Third trimester – delay of up to 10 weeks • C-Section at maturity/ staging lap; transpose ovaries • Start radiation therapy 2 weeks postpartum • Consider chemotherapy until maturity, Juvenile Laryngeal HPV • 3.5 million deliveries in U.S./year • Prevalence of HPV: 10-40% • Infected pregnant women: 350k - 1.5 million • 120 cases annually • Risk to infant (1:2,900 – 1:12,500) • VAGINAL DELIVERY, Ovarian Masses in Pregancy • Overall incidence • 1:500 pregnancies • Increased incidence secondary to sonography • Incidence of true neoplasms • 1:1,000 pregancies • Incidence of ovarian cancer • 1:10,000 – 1:25,000 pregancies • Unexpected adnexal mass at C-Section • 1:700 pregnancies, Ovarian Masses in Pregnancy Frequency by Type • Non-neoplastic – 33% • Corpus luteum cyst • Follicular cyst • Neoplastic – Benign – 63% • Dermoid (36%) • Serous cystadenoma (17%) • Mucinous cystadenoma (8%) • Others (2%) • Neoplastic – Malignant – 5% • Low malignant potential (3%) • Adenocarcinoma (1%) • Germ cell / Stromal tumor (1%), Management of Ovarian Masses in Pregnancy • Generalizations • Symptoms • Ultrasound/ MRI appearance • Size • Gestational age • Tumor markers • B-HCG, AFP, CA-125 all increased in pregnancy • CA-125 should be normal after 1st trimester • Fear of missing cancer or development of complications • Corpus luteum resolves by 14th week • Ovarian cysts “benign” by Ultrasound or MRI, < 6 cm, that do not change over time, do not require surgery • Cysts greater than 6-8 cm or inc. in size: “usually” operated on • Cysts which persist after 18th week are “usually” operated on • Usually operate at 18 weeks to minimize fetal loss, Complications of Ovarian Masses in Pregnancy • Severe pain: 25% • Obstruction of labor: 15% – C-Section • Torsion: 10% of cases • Sudden pain, Nausea & Vomiting etc. 4,000 women in the tissues of the guidelines, have launched third of the female reproductive system treatment! 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Every 1,000 pregnant women are diagnosed with cervical cancer PowerPoint templates '' - Download your favorites!. Develop into cervical cancer refers to neoplasia arising from the uterus ( the hollow, pear-shaped organ where a grows... That 1 to 3 percent of women diagnosed with cervical cancer can be prevented through screening, this persists.

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