NEOPLASTIC DISORDERS IN PREGNANCY

Question 1

incidence of Neoplastic Disorders Pregnancy

Answer 1

1 per 1000 pregnancies

Question 2

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

Answer 2

Radiation Therapy

Question 3

malformations (0.1 -0.2 Gy)

Answer 3

Weeks 2-8

Question 4

fetal CNS

Answer 4

Weeks 8-25

Question 5

less susceptible

Answer 5

After week 25

Question 6

-Improves long term maternal outcomes

-

Answer 6

CHemotherapy

Question 7

Fetal effect of chemotherapy

Answer 7

-malformations, intellectual disability, risk for future childhood malignancies

Question 8

Hold chemotherapy 3 weeks before delivery

Answer 8

-pancytopenia, neutropenia

Question 9

• Tumors infrequently metastasize to the Placenta

- Malignant melanoma, Leukemia, Lymphoma and Breast cancer

Answer 9

Placental metastases

Question 10

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

Answer 10

Cervix – Endocervical Polyp

Question 11

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

Answer 11

Cervix: Epithelial Neoplasia

Question 12

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

Answer 12

15%

Question 13

-Incidence same as non-pregnant

Answer 13

ABNORMAL CYTOLOGY

Question 14

-Cytologic abnormality

Answer 14

colposcopy

Question 15

-Lesions suspicious of ca

Answer 15

cervical punch biopsy

Question 16

-re-evaluate Post partum

Answer 16

CIN 1-

Question 17

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

Answer 17

CIN 2 or 3

Question 18

• abnormality in women aged 25+ years

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

Answer 18

NILM/HPV POSITIVE

Question 19

(+) invasive lesion detected

-avoided during pregnancy

Answer 19

CERVICAL CONIZATION

Question 20

CIN prior to pregnancy

Answer 20

-cervical stenosis, preterm birth, cervical insufficiency

Question 21

-diagnosis of invasive cervical ca

Answer 21

-biopsy, colposcopy, removal of mass lesion

Question 22

• pregnancy continuation is safe, may allow vaginal delivery, definitive therapy is at 6 weeks postpartum

Answer 22

Stage 1A1

Question 23

• pregnancy can be continued until the fetus reaches lung maturity

Answer 23

Invasive CA

Question 24

-rad hys + pelvic lypmphadenectomy

Answer 24

Stage I to Iia

Question 25

- Stage 1B1 1B2 - Can be done before 20 weeks aog - Delivery is done through Classical CS

Answer 25

Radical Trachelectomy

Question 26

- risk abortion, preterm birth | - survival outcomes for pregnant are similar to non-pregnant women

Answer 26

Late stage CA

Question 27

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

Answer 27

LEIOMYOMA

Question 28

-complications in pregnancy

Answer 28

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

Question 29

-Endometriosis after delivery

Answer 29

episiotomy, CS scar

Question 30

- Endometrial CA; rarely seen in pregnancy | - Develops age 40

Answer 30

ENDOMETRIAL LESIONS

Question 31

-no need to remove or survey

Answer 31

<5cm

Question 32

-surgical removal is reasonable

Answer 32

>10cm

Question 33

-USG with DOPPLER

Answer 33

5-10cm

Question 34

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

Answer 34

Pregnancy luteoma

Question 35

- First trimester - Leutenization of follicular theca layer - Assoc with high Bhcg

Answer 35

HYPERREACTION LUTEINALIS

Question 36

- 75% detected during pregnancy is early stage | - -management similar to non-pregnant women

Answer 36

OVARIAN CA

Question 37

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

Answer 37

Breast Cancer

Question 38

- Palpable nodules in 47% - 10% malignant - USG, TSH , FT4

Answer 38

THYROID CA

Question 39

-contraindicated in pregnancy _ fetal hypothyroidism

Answer 39

RADIOIODINE

Question 40

Primary TX

Answer 40

thyroidectomy (2nd trimester)

Question 41

- derived from B cells | - common in pregnancy

Answer 41

Hodgkin’s disease

Question 42

-staging in Hodgkin’s disease

Answer 42

chest x-ray, Bone marrow Biopsy, abdominal imaging

Question 43

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

Answer 43

NON Hodgkin’s Lymphoma

Question 44

-Causes marked peripheral WBC count abnormalities

Answer 44

LEUKEMIA

Question 45

Definitive Dx

Answer 45

-bone marrow biopsy

Question 46

TX

Answer 46

-chemo+ stem cell transplant

Question 47

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

Answer 47

MELANOMA

Question 48

Treatment for melanoma

Answer 48

-wide local excision + LND

Question 49

-Increased incidence in pregnancy because of delayed childbearing

Answer 49

COLON and RECTAL CA

Question 50

colorectal level of ca arise from the rectum

Answer 50

-80%

Question 51

DX of Colon and Rectal CA

Answer 51

DRE, FOBT, colonoscopy, sigmoidoscopy