Re: Interesting case of cervical cancer in pregnancy
From: Dr. Myer Bornstein (mbornstein@mortonhospital.org)
Fri Apr 28 13:21:45 2000
No radiation in MRI
Myer S. Bornstein, MD, CPE, FACOG
>----- Original Message -----
From: "Dr Sarita Bhalerao" <saritabhalerao@hotmail.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@forum.obgyn.net>
Sent: Friday, April 28, 2000 11:51 AM
Subject: Re: Interesting case of cervical cancer in pregnancy
> 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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