EASO2011 PanArab 2 Halaska

Gynecologic Cancer in Pregnancy. Michael J. Halaska Oncogynecology unit Dept. Of Obstetrics and Gynecology 2 nd Medical Faculty, Charles University in Prague Czech Republic

Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],Pavlidis, NA, Oncologist, 2002 Rob,L , in textbook Gynaecological Oncology, 2009

Stensheim,H., J Clin Oncol, 2009 Statistical yearbook, Czech Republic, 2005 Epidemiology

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

Pregnancy and treatment modalities 0 40 20 28 12 viable fetus fetus „ready for d.“ 24 34 first trimester second trimester third trimester termination delay till 1st trimestr delay till delivery termination surgery lung maturation neoadjuvant/adjuvant chemotherapy radiotherapy

Pregnancy and treatment modalities 0 40 20 28 12 viable fetus fetus „ready for d.“ 24 34 first trimester second trimester third trimester termination delay till 1st trimestr delay till delivery termination surgery lung maturation neoadjuvant/adjuvant chemotherapy radiotherapy oncogynecologist perinatologist pathologist.. patient and her partner

Cervical cancer during pregnancy

Cervical cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnostics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cervical ca during pregnancy

Diagnostics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cervical ca during pregnancy

Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cervical ca during pregnancy

Management- pregnancy non-preserving ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cervical ca during pregnancy

Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cervical ca during pregnancy

Management - pregnancy preserving ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SURGERY – literature cervical ca during pregnancy

Management - pregnancy preserving ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NEOADJUVANT CHEMOTHERAPY cervical ca during pregnancy day 0 day 10 day 20 day 30

Management - pregnancy preserving NEOADJUVANT CHEMOTHERAPY - literature cervical ca during pregnancy NED 35 4x PA (2w) IB1 25 Rob,L, unpublished NED 37 3x PT (2w) IB2 27 Rob,L, unpublished DOD 32 3 x P IB2 27 Rabaiotti,E.,2010 NED 37 2x PT (3w) IB2 27 Chun,K, 2010 AWD 34 1x TC IIA 32 Chun,K, 2010 DOD 36 3x PT (3w) IB1 27 Chun,K, 2010 NED 31 6x VP IIA 30 Seamon, 2009 NED 32 3x P IB1 35 Marnitz,S, 2009 NED 35 3x P IIB 26 Boyd, 2009 NED 33 6x P IB2 28 Karam, 2007 NED 33 4x VP IIA 38 Bader, 2007 NED 35 3x P IIB 30 Palaia, 2007 DOD 28 2x P IIIB 30 Benhaim, 2006 NED 38 6x P (3w) IB1 28 Caluwaerts, 2006 DOD 38 2x BP (3w) IIB 26 Marana, 2001 NED 32 4x VP (3w) IB2 36 Tewari, 1998 DOD 34 6x VP (3w) IIA 34 Tewari, 1998 NED 32 3x P (3w) IB1 34 Giacalone, 1996 outcome surgery chemo stage age author

Management - pregnancy preserving ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DELAY cervical ca during pregnancy delay (in weeks) follow-up (month) maternal outcome fetal outcome Sorosky,JI, 1995 15, 22, 29,16, 7, 3, 19 33 (13-68) NED 1xpneumothorax Takushi,M, 2002 13, 15, 6 97 (84-108) NED normal Ishioka,Y, 2009 19, 9, 6, 3 64 (10-111) NED normal

Delivery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cervical ca during pregnancy

Ovarian cancer during pregnancy

Ovarian cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ovarian ca during pregnancy

Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ovarian ca during pregnancy

Endometrial cancer during pregnancy

Endometrial cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Vulvar cancer during pregnancy

Vulvar cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],www.cancerinpregnancy.org

Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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

[object Object],[object Object],www.cancerinpregnancy.org

Case - trachelectomy + LAP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case - trachelectomy + LAP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case - NAC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cervical ca during pregancy

Case - NAC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cervical ca during pregancy

Case - NAC Before 1st chemotherapy (29+0) Before 2nd chemotherapy (31+0) Before 3rd chemotherapy (33+0) After radical hysterectomy cervical ca during pregancy

Case - delay ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cervical ca during pregancy

Case - delay ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],cervical ca during pregancy

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