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NEOPLASTIC DISORDERS IN PREGNANCY Flashcards

1
Q

incidence of Neoplastic Disorders Pregnancy

A

1 per 1000 pregnancies

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2
Q
  • significant Fetal exposure
  • the amount depends on the dose, tumor location, and field size
  • adverse fetal malformation , intellectual disability, growth restriction, sterility
A

Radiation Therapy

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3
Q

malformations (0.1 -0.2 Gy)

A

Weeks 2-8

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4
Q

fetal CNS

A

Weeks 8-25

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5
Q

less susceptible

A

After week 25

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6
Q

-Improves long term maternal outcomes

-

A

CHemotherapy

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7
Q

Fetal effect of chemotherapy

A

-malformations, intellectual disability, risk for future childhood malignancies

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8
Q

Hold chemotherapy 3 weeks before delivery

A

-pancytopenia, neutropenia

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9
Q
  • Tumors infrequently metastasize to the Placenta

- Malignant melanoma, Leukemia, Lymphoma and Breast cancer

A

Placental metastases

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10
Q
  • Overgrowth of endocervical stroma, lined by epithelium
  • Benign, can bleed
  • Pap smear; AGUS
A

Cervix – Endocervical Polyp

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11
Q
  1. no screening until the age of 21 ;
  2. Cytology alone every 3 years for 21-29 years
  3. cytology alone every 3 years for older than 30 HPP
A

Cervix: Epithelial Neoplasia

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12
Q

-prevalence in pregnant women with Human papilloma virus 16 and 18

A

15%

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13
Q

-Incidence same as non-pregnant

A

ABNORMAL CYTOLOGY

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14
Q

-Cytologic abnormality

A

colposcopy

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15
Q

-Lesions suspicious of ca

A

cervical punch biopsy

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16
Q

-re-evaluate Post partum

A

CIN 1-

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17
Q

-if (-) invasive disease, defer re-evaluation until 6 weeks post partum

A

CIN 2 or 3

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18
Q
  • abnormality in women aged 25+ years

- repeat pap in 1 year; colposcopy if current pap is 2nd

A

NILM/HPV POSITIVE

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19
Q

(+) invasive lesion detected

-avoided during pregnancy

A

CERVICAL CONIZATION

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20
Q

CIN prior to pregnancy

A

-cervical stenosis, preterm birth, cervical insufficiency

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21
Q

-diagnosis of invasive cervical ca

A

-biopsy, colposcopy, removal of mass lesion

22
Q
  • pregnancy continuation is safe, may allow vaginal delivery, definitive therapy is at 6 weeks postpartum
23
Q
  • pregnancy can be continued until the fetus reaches lung maturity
A

Invasive CA

24
Q

-rad hys + pelvic lypmphadenectomy

A

Stage I to Iia

25
Q
  • Stage 1B1 1B2
  • Can be done before 20 weeks aog
  • Delivery is done through Classical CS
A

Radical Trachelectomy

26
Q
  • risk abortion, preterm birth

- survival outcomes for pregnant are similar to non-pregnant women

A

Late stage CA

27
Q
  • Benign smooth muscle tumor
  • Incidence: 2%
  • Subserous, submucous intramural, cervical, broad ligament
  • Grow, regress or remain unchanged during pregnancy
  • DX: sonography
28
Q

-complications in pregnancy

A

-Preterm delivery, malpresentation, obstructed labor, PPH, placental abruption, fetal IUGR

29
Q

-Endometriosis after delivery

A

episiotomy, CS scar

30
Q
  • Endometrial CA; rarely seen in pregnancy

- Develops age 40

A

ENDOMETRIAL LESIONS

31
Q

-no need to remove or survey

32
Q

-surgical removal is reasonable

33
Q

-USG with DOPPLER

34
Q
  • From leutenized stromal cells
  • May cause inc. testosterone -> virilizing
  • Solid tumor
  • No intervention unless with complications
  • Spontaneously regress postpartum
A

Pregnancy luteoma

35
Q
  • First trimester
  • Leutenization of follicular theca layer
  • Assoc with high Bhcg
A

HYPERREACTION LUTEINALIS

36
Q
  • 75% detected during pregnancy is early stage

- -management similar to non-pregnant women

A

OVARIAN CA

37
Q
  • Most frequent ca found in gravidas
  • Found at an advanced stage in pregnancy
  • Postponed childbearing increased the risk or pregnancy-associated breast ca
A

Breast Cancer

38
Q
  • Palpable nodules in 47%
  • 10% malignant
  • USG, TSH , FT4
A

THYROID CA

39
Q

-contraindicated in pregnancy _ fetal hypothyroidism

A

RADIOIODINE

40
Q

Primary TX

A

thyroidectomy (2nd trimester)

41
Q
  • derived from B cells

- common in pregnancy

A

Hodgkin’s disease

42
Q

-staging in Hodgkin’s disease

A

chest x-ray, Bone marrow Biopsy, abdominal imaging

43
Q
  • Infrequent during pregnancy
  • 10% coexist with HIV
  • pregnancy termination + chemo for very early disease
  • After 1st trimester: chemotherapy
A

NON Hodgkin’s Lymphoma

44
Q

-Causes marked peripheral WBC count abnormalities

45
Q

Definitive Dx

A

-bone marrow biopsy

46
Q

TX

A

-chemo+ stem cell transplant

47
Q
  • Originate from a pre-existent nevus
  • Pigmented lesions that show changes in contour, elevation
  • Most frequent malignancy complicating pregnancy
48
Q

Treatment for melanoma

A

-wide local excision + LND

49
Q

-Increased incidence in pregnancy because of delayed childbearing

A

COLON and RECTAL CA

50
Q

colorectal level of ca arise from the rectum

51
Q

DX of Colon and Rectal CA

A

DRE, FOBT, colonoscopy, sigmoidoscopy

OB (9 decks)

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