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Re: Interesting case of cervical cancer in pregnancyFrom: Dr Sarita Bhalerao (saritabhalerao@hotmail.com)Fri Apr 28 10:49:11 2000
At Thu, 27 Apr 2000, A.C. Evans wrote: > >On Wed, 26 Apr 2000 10:13:35 -0500, saritabhalerao@hotmail.com (Dr Sarita >Bhalerao) wrote: > >>A 28 year old lady, para 2 is presently 29 weeks pregnant. She reported >>with per vaginal bleeding. On examination she was found to have a >>polypoid growth arising from the cervix. >>Biopsy of the growth reveals a high grade adenocarcinoma. Clinical >>examination reveals induration in the left parametrium,right parametrium >>is free.Parametrial involvement is thus doubtful. >>I would like to ask the forum how best to manage this case. > >Induration in the parametrium is very suspicious in most cases. Would be very >hesitant to say there is no invasion if there is induration there. If available >and radiologists are willing....I would recommend MRI to assess the parametria >and to define the extent of the lesion. > >How big is the lesion? How small or large is the patient? Any other medical >issues with her? > >This patient may not be a good candidate for Cesarean radical hysterectomy. > >Reasons not to do it: > >Minimal invasion >Large lesion (more than 4 cm) >Parametrial spread >Poor surgical candidate/obesity >Limited availability of blood products (would not use cell saver) > >Note that cervical cancer is not surgically staged. If patients have surgery, >surgical information is utilized in planning therapy, but this cancer continues >to be staged clinically. > >If the lesion is not growing alarmingly fast, would wait until fetal lung >maturity before delivering (there is no contraindication to use of steroids in >these cases). If going to have radiation, can deliver vaginally unless there is >a risk of hemorrhage from a large tumor. If risk of hemorrhage is high or if >rad hyst is planned, Cesarean delivery would be appropriate. > >If the lesion is very small, conization should be done prior to assess depth of >invasion...rad hyst may be unnecessary. > >Hope this is helpful, > >Craig Evans, MD, PhD >Director, Gynecologic Oncology >Vince Lombardi Cancer Clinics >Milwaukee, WI
-- The patient is thin, with no other medical problems. She is bleeding continuously and so she needs to be treated soon.It is a bulky growth.Would MRI be able to differentiate between inflammation of the parametrium and malignant involvement and what is the radiation risk?
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