The prognosis and management of cervical cancer associated with pregnancy.

OBJECTIVE: We sought to evaluate the prognosis of patients with stage IB cervical cancer related to pregnancy. METHODS: We reviewed 53 patients from the University of Michigan diagnosed with cervical cancer related to pregnancy between 1960-1989. Patients with stage IB disease were compared with a control group less than 46 years old to determine whether pregnancy influenced survival. RESULTS: The mean age of the patients was 30.5 years (range 22-45). The number of patients treated by 5-year periods decreased from a high of 17 during 1965-1969 to a low of three during 1985-1989. The following cell types and stages were treated: squamous cell stages IA (four), IB (35), and IIB (six); adenocarcinoma stages IB (five) and IIB (two); and small-cell stage IIB (one). The 35 patients with stage IB disease had a cumulative 5-year survival of 83%. Positive lymph nodes were present in eight of 24 patients. There was no significant difference in 5-year survival according to the time of therapy (P = .45): Ten second-trimester patients had 90% survival, five third-trimester patients had 75% survival, and 20 postpartum patients had 75% survival. Eighteen of 21 patients treated by radical hysterectomy survived: three of four treated at term, five of five treated in the second trimester, and ten of 12 treated postpartum. Seven of 12 patients treated by radiation therapy survived: one of one treated at term, five of six treated in the second trimester, and one of five treated postpartum. When we compared these patients with 170 nonpregnant women less than 46 years old with stage IB squamous cell cancer, pregnancy did not adversely influence survival (P = .13). CONCLUSIONS: The number of patients diagnosed with invasive cervical cancer related to pregnancy has decreased. Survival is not altered by pregnancy for stage IB disease.     

Advanced cervical carcinoma associated with pregnancy

Sixty-two patients with frankly invasive (FIGO stages IB–IV) cervical carcinoma were diagnosed during pregnancy or within the first post-partum year. Thirty four (54.8%) had advanced disease (stages IIB–IV), a proportion higher than reported in comparable studies. This group was studied and compared with a control group of patients with advanced cervical cancer not associated with pregnancy. 'Pregnant' patients were significantly younger but overall treatment modalities and survival were no different. Mode of delivery (vaginal vs. abdominal) did not influence the survival of study patients. Although not significant, there was a worse outcome for patients diagnosed antenatally (as opposed to post-partum). These results are pertinent to the management of advanced cervical carcinoma associated with pregnancy.     

妊娠期宫颈筛查异常的管理及妊娠结局

目的选用3种筛查方式：高危型HPV、HPV联合TCT和TCT对妊娠期宫颈病变患者的管理及妊娠结局的研究。方法对在首都医科大学宣武医院产科就诊的3300例孕妇。随机分成三组,TCT组,TCT＋HPV组和HPV组,每组1100例。HPV采用杂交捕获法检测。比较：宫颈病变的发生率、病理检查的阳性率、分娩方式的影响及产后的转归情况。结果①发病率：TCT组宫颈病变103例;TCT＋HPV组中HPV阳性的323例宫颈病变106例,其中合并HPV阳性的91例;HPV组HPV阳性的310例;②病理检查：ASCUS、ASC-H和LSIL孕期不作进一步检查。TCT组9例经阴道镜检查有7例异常;TCT＋HPV组10例经阴道镜检查有8异常;HPV组阳性者未行阴道镜检查;③产后复查：TCT组宫颈病变者103例,产后42d复查TCT24例异常,未治疗,产后3个月继续复查有9例异常,行阴道镜检查1例异常;TCT＋HPV组宫颈病变者106例,产后42d复查TCT23例异常,未治疗,产后3个月继续复查有10例异常,阴道镜检查有2例异常,HPV阳性者323例,产后3个月复查HPV阳性6例;HPV组有HPV阳性者310例,产后42d31例阳性,产后6个月复查HPV阳性者9例。结论本研究表明妊娠合并宫颈上皮内瘤样病变者产后病变的自然缓解很高,HPV阳性者产后转阴性率为90.6%～98.1%。不影响妊娠结局。     

妊娠合并宫颈病变的阴道镜检查

妊娠期阴道镜检查中宫颈暴露困难,活检易出血,妊娠期阴道镜宫颈图像的变化,使阴道镜评估的准确性较非孕期要低。妊娠各期均可行阴道镜检查,注意止血,活检是安全的。除非可疑宫颈浸润癌,否则不应施行诊断性切除。妊娠期不宜施行宫颈管搔刮术。     

Conservative management of cervical pregnancy with subsequent fertility

The reported incidence of cervical pregnancies with subsequent fertility is extremely low. We report a case managed conservatively that allowed for future fertility, and ultimately the delivery of a viable infant at term. The conservative management and a review of the literature are discussed.     

A case of invasive cervical carcinoma associated with pregnancy

The cervical cancer is the most usual neoplastic disease, which takes place during the pregnancy. The prognosis for the women depends mostly of the clinical stage and the presence of nodal metastasis. The principes of the treatment do not differ from the standard oncologic therapy in nonpregnant women. Differencies exist in the way and the time of the terminanation of the pregnancy. The authors present y case of pregnancy and invasive cervical adenocarcinoma diagnosticated in m. 1.X. immeadiately after cesarean section an extended hysterectomy y modo Piver 111 with pelvic nodal dissection is done.     

Recurrent cervical cancer: detection and prognosis

BACKGROUND: Only a small proportion of cervical cancer recurrences is detected during routine follow-up. We investigated which percentage of recurrences is detected during follow-up, which diagnostic tools are helpful to detect recurrent disease and which factors are of prognostic significance once recurrent disease has been established in patients treated for cervical cancer stage IB-IVA. METHODS: Characteristics of the primary tumor, characteristics of recurrent disease and follow-up were collected retrospectively from clinical records of 277 patients who achieved a complete remission of at least 3 months after primary treatment for cervical cancer in 1992, 1993 and 1994 in three university hospitals in the Netherlands. RESULTS: Of 277 patients, 47 (17%) developed recurrent disease; this was most often detected after self-referral (45%), and in 32% during routine follow-up. Survival did not differ significantly between these two groups. The presence of symptoms (87%) was the most important first abnormal test result leading to diagnosis of recurrence. In univariate analysis, disease-free interval (DFI) and treatment modality were significant prognostic factors for crude survival of recurrence. However, treatment modality varied considerably and the subgroups were small. Therefore, multivariate analysis was not feasible and clinically valid conclusions could not be drawn. CONCLUSIONS: In only 32% of all cases, recurrence was detected during a scheduled follow-up visit. In the majority of patients, recurrent cervical cancer was detected by symptoms (87%). In recurrent disease, DFI was a prognostic factor for survival.     

Recurrent cervical cancer: detection and prognosis

BACKGROUND: Only a small proportion of cervical cancer recurrences is detected during routine follow-up. We investigated which percentage of recurrences is detected during follow-up, which diagnostic tools are helpful to detect recurrent disease and which factors are of prognostic significance once recurrent disease has been established in patients treated for cervical cancer stage IB-IVA. METHODS: Characteristics of the primary tumor, characteristics of recurrent disease and follow-up were collected retrospectively from clinical records of 277 patients who achieved a complete remission of at least 3 months after primary treatment for cervical cancer in 1992, 1993 and 1994 in three university hospitals in the Netherlands. RESULTS: Of 277 patients, 47 (17%) developed recurrent disease; this was most often detected after self-referral (45%), and in 32% during routine follow-up. Survival did not differ significantly between these two groups. The presence of symptoms (87%) was the most important first abnormal test result leading to diagnosis of recurrence. In univariate analysis, disease-free interval (DFI) and treatment modality were significant prognostic factors for crude survival of recurrence. However, treatment modality varied considerably and the subgroups were small. Therefore, multivariate analysis was not feasible and clinically valid conclusions could not be drawn. CONCLUSIONS: In only 32% of all cases, recurrence was detected during a scheduled follow-up visit. In the majority of patients, recurrent cervical cancer was detected by symptoms (87%). In recurrent disease, DFI was a prognostic factor for survival.     

妊娠期宫颈癌处理中的相关问题

妊娠期宫颈癌的处理主要取决于肿瘤的分期、组织学类型、诊断的孕周、孕妇是否保留胎儿以及未来的生育要求。本文对妊娠期宫颈癌的诊断操作、分期及影像学检查方法使用、治疗选择、延迟治疗和分娩方式等问题进行了讨论。