Management of ovarian cancer in pregnant woman

Management of ovarian cancer in pregnancy Charuwan M.D.

Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Epidemiology ,[object Object],[object Object],1 – 6 % malignancy

[object Object],[object Object],[object Object],[object Object],[object Object],Leiserowitz GS et al:Gynecol Oncology2006

Review of publications (1958 – 2007 ) ,[object Object],[object Object],[object Object],[object Object],[object Object],Palmer J et al:BJOG2009

Clinical manifestations ,[object Object],[object Object],Retrospective series: 8330 C/S 68 incidental adnexal masses > 5 cm 1 malignancy Dede M, et al:Int J Gynecol Cancer 2007

U/S + Cesarean section Incidental detection of asymptomatic adnexal mass

Clinical manifestation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

U/S ,[object Object],Risk of malignancy Yen CF, et al: Risk analysis of torsion and malignancy for adnexal masses during pregnancy, Fertil Steri 2009.

U/S ,[object Object],[object Object]

MRI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

CT ,[object Object],[object Object],[object Object],[object Object]

DDx ,[object Object],[object Object],[object Object]

Diagnosis ,[object Object],[object Object]

Tumor marker in pregnancy ,[object Object],[object Object],[object Object]

Tumor marker in pregnancy ,[object Object],[object Object]

CA 125 ,[object Object],[object Object],[object Object],[object Object],Suggest cancer 75 – 150 could be pregnancy or ovarian cancer

Alpha - fetoprotein ,[object Object],[object Object],[object Object],[object Object]

Alpha – fetoprotein ,[object Object],[object Object],[object Object],[object Object],[object Object]

Lactate dehydrogenase ,[object Object],[object Object],[object Object]

Inhibin A ,[object Object],[object Object],Early pregnancy Sonographer should evaluate ovaries if abnormal serum down screening test

Epithelial ovarian tumor ,[object Object],[object Object],[object Object],[object Object],Informed pathologist + pathologist skill

Germ cell tumor ,[object Object],[object Object]

Sex cord- stromal tumors ,[object Object],[object Object],[object Object],[object Object],[object Object]

Management ,[object Object],[object Object],[object Object],[object Object],[object Object]

I/C for surgery ,[object Object],[object Object],[object Object],For early stage and to prevent adnexal torsion, rupture or obstruction of labor

Time to surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Laparoscopy with adnexal mass during pregnancy ,[object Object],- Fetal hypotension, hypoxia - Uterine perforation by trocar or Veress needle - Fetal acidosis by CO2 absorption

Surgical approach ,[object Object],[object Object],[object Object],[object Object],[object Object],cystectomy / USO

Surgical approach ,[object Object],[object Object]

Surgical approach ,[object Object],[object Object],[object Object],LMP: adequate surgery

Extent of surgery ,[object Object],[object Object],[object Object],[object Object]

Termination of pregnancy ,[object Object]

Early stage ,[object Object],[object Object],[object Object],[object Object]

Early stage ,[object Object],[object Object],[object Object],[object Object],[object Object],Delay chemotherapy Until after delivery No difference of OS Bolis G: Ann Oncol 1995

Early stage ,[object Object],[object Object]

Chemotherapy during pregnancy ,[object Object],[object Object]

Chemotherapy ,[object Object],[object Object],fetus The risk of spontaneous abortion, fetal death and major malformation depend on drug agent and gestational age.

Chemotherapy ,[object Object],[object Object]

Chemotherapy and breastfeeding ,[object Object],[object Object],[object Object],American Academy of Pediatrics

Chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Limited data, uncommon clinical problem in pregnancy . Less data on long-term outcomes in offspring

Epithelial ovarian cancer ,[object Object],[object Object]

Platinum derivatives during pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Chemotherapy and breastfeeding ,[object Object],[object Object],[object Object],[object Object]

Taxane ,[object Object],[object Object]

Chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],50 %

Chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Chemotherapy in EOC ,[object Object],[object Object]

Summary of EOC ,[object Object],[object Object],[object Object],[object Object],[object Object]

Germ cell tumor ,[object Object],[object Object],[object Object],[object Object],Except

Germ cell tumor ,[object Object],Chemotherapy should be delayed until after first trimester, but not longer

Chemotherapy and breastfeeding ,[object Object],[object Object],[object Object]

Summary of Germ cell tumor ,[object Object],[object Object],[object Object],[object Object]

Sex cord stromal tumor ,[object Object],[object Object],[object Object]

Chemotherapy Preterm(36) Preterm(36) Term E C/S (34) E C/S (32) Term Term Preterm(33) Term PC PC PC PC PVB VAC VAC VAC BEP 20 16 16 24 26 16 17 23 20 Serous Serous Serous Sertoli-L EST EST EST EST EST/Imma Henderson CE,(1993) King LA (1991) Malfetano JH (1990) Tomlinson MW(1997) Malone JM (1986) Kim DS (1989) Metz SA (1989) Weed JC (1979) Hobelt D (1994) Outcome Chemo GA at treat Cell type Reference

Timing of delivery ,[object Object]

Prognosis ,[object Object],[object Object],[object Object]

Adnexal mass in C/S ,[object Object],[object Object]

Summary and recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Summary and recommendations ,[object Object],[object Object]

Management of ovarian cancer in pregnant woman

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