Management of gynaecology cancers in pregnancy TOG 2017

Question 1

Incidence of malignancy in pregnancy

Answer 1

1/1000

Question 2

Most common gynaecological cancer in pregnancy

Answer 2

Cervical cancer

Question 3

Incidence of cervical cancer in pergnnay

Answer 3

1-10/10,000

Question 4

If see suspicious cervical lesion in pregnancy?

Answer 4

Refer to coloposcopy
Directed biopthy from most dysplastic area
Can cause bleeding but no increased bleeding
Do not perform smear

Question 5

What stage cervical cancer can be managed with LLETZ/Cone, when can this be performed?

Answer 5

Stage 1A1
Early in prengnacy

Risk bleeding, preg loss, PPROM, PTL - increased with increased gestation

Question 6

Can Lap pelvic lymphadenecotmy by performed in pregnancy

Answer 6

Yes in 1st trimester, very challenging after 15 weeks

Question 7

What are the most common ovarian malignancies in young women>

Answer 7

Borderline
Non-epthielial (germ cell and sec cord stroll)
Epithelial)

Question 8

Is CA125 accurate in pregnancy?

Answer 8

No

Question 9

If surgery for ovarian mass is performed, when is the best time to do this surgery in pregnancy? Up to what gestation can lap management be offered?

Answer 9

12-27 weeks

Lap 20-22 weeks

Question 10

Which women with early ovarian cancer do not need chemotherapy?

Answer 10

Stage 1a or 1 b (limited to both ovaries with no spill) who have had optimal staging surgery

If not optimal staging consider chemo

Question 11

How to manage women with state II - IIIb (Ovarian spill to macroscopic peritoneal mets beyond pelvic brim <2cm +/- retroperitoneal lymph nodes)

Answer 11

Offer debunking surgery asap
Termination + hysterectomy

If women wishes to continue with pregnancy needs neoadjuvent chemo until fetal maturity then cyttoreductive surgery

Question 12

If previous ovarian cancer and suspect recurrence (based on clinical Sx), which investigations?

Answer 12

CA125
MRI

Question 13

What % of endometrial cancers are diagnosed in women under the age of 40?

Answer 13

4%

Question 14

In women with endometrial hyperplasia with no myometrial invasion treated with progesterone
- what proportion respond to hormonal treatment
- What proportion become pregnancy resulting in liver birth?

Answer 14

66% respond to treatment
42% live birth

Question 15

In women with grade 1 endometrial carcinoma with no myometrial invasion treated with progesterone
- what proportion respond to hormonal treatment
- What proportion become pregnancy resulting in liver birth?

Answer 15

48% responded to treatment
35% live birth

Question 16

What % of vulval cancers are under the age of 40

Answer 16

5%