Treating Cervical Cancer If You've Been Diagnosed with Cervical Cancer, Your Cancer Care Team Will Talk with You About Treatment Options
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Curative Pelvic Exenteration for Recurrent Cervical Carcinoma in the Era of Concurrent Chemotherapy and Radiation Therapy
Available online at www.sciencedirect.com ScienceDirect EJSO xx (2015) 1e11 www.ejso.com Review Curative pelvic exenteration for recurrent cervical carcinoma in the era of concurrent chemotherapy and radiation therapy. A systematic review H. Sardain a,b, V. Lavoue a,b,c,*, M. Redpath d, N. Bertheuil b,e, F. Foucher a,J.Lev^eque a,b,c a CHU de Rennes, Gynecology Department, Tertiary Surgery Center, Teaching Hospital of Rennes, Hopital^ Sud, 16, Bd de Bulgarie, 35000 Rennes, France b Universite de Rennes, Faculty of Medicine, 2 Henry Guilloux, 35000 Rennes, France c INSERM, ER440, Oncogenesis, Stress and Signaling (OSS), Rennes, France d McGill University, Department of Pathology, Jewish General Hospital, Cote^ Sainte Catherine, Montreal, QC, Canada e CHU de Rennes, Department of Plastic, Reconstructive and Aesthetic Surgery, Tertiary Surgery Center, Teaching Hospital of Rennes, Hopital^ Sud, 16, Bd de Bulgarie, 35000 Rennes, France Accepted 26 March 2015 Available online --- Abstract Objective: Pelvic exenteration requires complete resection of the tumor with negative margins to be considered a curative surgery. The pur- pose of this review is to assess the optimal preoperative evaluation and surgical approach in patients with recurrent cervical cancer to in- crease the chances of achieving a curative surgery with decreased morbidity and mortality in the era of concurrent chemoradiotherapy. Methods: Review of English publications pertaining to cervical cancer within the last 25 years were included using PubMed and Cochrane Library searches. Results: Modern imaging (MRI and PET-CT) does not accurately identify local extension of microscopic disease and is inadequate for pre- operative planning of extent of resection. -
Updates in Uterine and Vulvar Cancer
Management of GYN Malignancies Junzo Chino MD Duke Cancer Center ASTRO Refresher 2015 Disclosures • None Learning Objectives • Review the diagnosis, workup, and management of: – Cervical Cancers – Uterine Cancers – Vulvar Cancers Cervical Cancer Cervical Cancer • 3rd most common malignancy in the World • 2nd most common malignancy in women • The Leading cause of cancer deaths in women for the developing world • In the US however… – 12th most common malignancy in women – Underserved populations disproportionately affected > 6 million lives saved by the Pap Test “Diagnosis of Uterine Cancer by the Vaginal Smear” Published Pap Test • Start screening within 3 years of onset of sexual activity, or at age 21 • Annual testing till age 30 • If no history of abnormal paps, risk factors, reduce screening to Q2-3 years. • Stop at 65-70 years • 5-7% of all pap tests are abnormal – Majority are ASCUS Pap-test Interpretation • ASCUS or LSIL –> reflex HPV -> If HPV + then Colposcopy, If – Repeat in 1 year • HSIL -> Colposcopy • Cannot diagnose cancer on Pap test alone CIN • CIN 1 – low grade dysplasia confined to the basal 1/3 of epithelium – HPV negative: repeat cytology at 12 months – HPV positive: Colposcopy • CIN 2-3 – 2/3 or greater of the epithelial thickness – Cold Knife Cone or LEEP • CIS – full thickness involvement. – Cold Knife Cone or LEEP Epidemiology • 12,900 women expected to be diagnosed in 2015 – 4,100 deaths due to disease • Median Age at diagnosis 48 years Cancer Statistics, ACS 2015 Risk Factors: Cervical Cancer • Early onset sexual activity • Multiple sexual partners • Hx of STDs • Multiple pregnancy • Immune suppression (s/p transplant, HIV) • Tobacco HPV • The human papilloma virus is a double stranded DNA virus • The most common oncogenic strains are 16, 18, 31, 33 and 45. -
Pelvic Exenteration for the Management of Pelvic Malignancies
Chapter 7 Pelvic Exenteration for the Management of Pelvic Malignancies Daniel Paramythiotis, Konstantinia Kofina and Antonios Michalopoulos Additional information is available at the end of the chapter http://dx.doi.org/10.5772/61083 Abstract Pelvic exenteration is a surgical procedure first described by Brunschwig in 1948 as a curative or palliative treatment for pelvic and perineal tumors. It is actually a radical operation, involving en bloc resection of pelvic organs, including reproductive structures, bladder, and rectosigmoid. In patients with recurrent cervical and vaginal malignancy, it is associated with a 5-year survival of more than 50%. In spite of advances in surgical management, consequences such as stomas, are still frequently unavoidable for radical tumor excision. Most candidates for this procedure have been diagnosed with recurrent cervical cancer that has previously been treated with surgery and radiation, or radiation alone. Complications of pelvic exenteration are more severe than those of standard resection of a colorectal carcinoma, so it is not commonly performed, including wound infection, wound dehiscence (also described as burst abdomen) the creation of fistulae (perineal-fecal, uretero-vaginal, between conduit and perineal wound), urinary tract infections, perineal hernias and intestinal obstruction. Patients need to be carefully selected and counseled about risks and long-term issues related to the surgery. A comprehensive evaluation is required in order to exclude unresectable or metastatic disease. Evolution of the technique through laparoscopy and minimally invasive surgery may result in a reduction of morbidity and mortality. Keywords: Pelvic exenteration, gynecologic cancer 1. Introduction Pelvic exenteration was first described by Brunschwig and his colleagues of New York’s Memorial Hospital in 1948 [1] and was initially performed as a palliative surgical intervention © 2015 The Author(s). -
Once in a Lifetime Procedures Code List 2019 Effective: 11/14/2010
Policy Name: Once in a Lifetime Procedures Once in a Lifetime Procedures Code List 2019 Effective: 11/14/2010 Family Rhinectomy Code Description 30160 Rhinectomy; total Family Laryngectomy Code Description 31360 Laryngectomy; total, without radical neck dissection 31365 Laryngectomy; total, with radical neck dissection Family Pneumonectomy Code Description 32440 Removal of lung, pneumonectomy; Removal of lung, pneumonectomy; with resection of segment of trachea followed by 32442 broncho-tracheal anastomosis (sleeve pneumonectomy) 32445 Removal of lung, pneumonectomy; extrapleural Family Splenectomy Code Description 38100 Splenectomy; total (separate procedure) Splenectomy; total, en bloc for extensive disease, in conjunction with other procedure (List 38102 in addition to code for primary procedure) Family Glossectomy Code Description Glossectomy; complete or total, with or without tracheostomy, without radical neck 41140 dissection Glossectomy; complete or total, with or without tracheostomy, with unilateral radical neck 41145 dissection Family Uvulectomy Code Description 42140 Uvulectomy, excision of uvula Family Gastrectomy Code Description 43620 Gastrectomy, total; with esophagoenterostomy 43621 Gastrectomy, total; with Roux-en-Y reconstruction 43622 Gastrectomy, total; with formation of intestinal pouch, any type Family Colectomy Code Description 44150 Colectomy, total, abdominal, without proctectomy; with ileostomy or ileoproctostomy 44151 Colectomy, total, abdominal, without proctectomy; with continent ileostomy 44155 Colectomy, -
Pelvic Exenteration As Ultimate Ratio for Gynecologic Cancers: Single‑Center Analyses of 37 Cases
Archives of Gynecology and Obstetrics (2019) 300:161–168 https://doi.org/10.1007/s00404-019-05154-4 GYNECOLOGIC ONCOLOGY Pelvic exenteration as ultimate ratio for gynecologic cancers: single‑center analyses of 37 cases N. de Gregorio1 · A. de Gregorio1 · F. Ebner2 · T. W. P. Friedl1 · J. Huober1 · R. Hefty3 · M. Wittau4 · W. Janni1 · P. Widschwendter1 Received: 5 February 2019 / Accepted: 5 April 2019 / Published online: 22 April 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Background Pelvic exenterations are a last resort procedure for advanced gynecologic malignancies with elevated risks in terms of patients’ morbidity. Methods This single-center analysis reports surgical details, outcome and survival of all patients treated with exenteration for non-ovarian gynecologic malignancies at our university hospital during a 13-year time period. We collected data regarding patients and tumor characteristics, surgical procedures, peri- and postoperative management, transfusions, complications, and analyzed the impact on survival outcomes. Results We identifed 37 patients between 2005 and 2013 with primary or relapsed cervical cancer (59.5%), vulvar cancer (24.3%) or endometrial cancer (16.2%). Median age was 60 years and most patients (73%) had squamous cell carcinomas. Median progression-free survival was 26.2 months and median overall survival was 49.9 months. The 5-year survival rates were 34.4% for progression-free survival and 46.4% for overall survival. There were no signifcant diferences in progres- sion-free survival and overall survival with regard to disease entity. Patients with tumor at the resection margins (R1) had a nearly signifcantly worse progression-free survival (median: 28.5 vs. -
WHO Guidelines for Treatment of Cervical Intraepithelial Neoplasia 2–3 and Adenocarcinoma in Situ
WHO guidelines WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ Cryotherapy Large loop excision of the transformation zone Cold knife conization WHO guidelines WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ: cryotherapy, large loop excision of the transformation zone, and cold knife conization Catalogage à la source : Bibliothèque de l’OMS WHO guidelines for treatment of cervical intraepithelial neoplasia 2–3 and adenocarcinoma in situ: cryotherapy, large loop excision of the transformation zone, and cold knife conization. 1.Cervical Intraepithelial Neoplasia – diagnosis. 2.Cervical Intraepithelial Neoplasia – therapy. 3.Cervical Intraepithelial Neoplasia – surgery. 4.Adenocarcinoma – diagnosis. 5.Adenocarcinoma – therapy. 6.Cryotherapy – utilization. 7.Conization – methods. 8.Uterine Cervical Neoplasms – prevention and control. 9.Guideline. I.World Health Organization. ISBN 978 92 4 150677 9 (Classification NLM : WP 480) © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for non-commercial distribution – should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. -
Seer Program Code Manual
THE SEER PROGRAM CODE MANUAL Revised Edition June 1992 CANCER STATISTICS BRANCH SURVEILLANCE PROGRAM DIVISION OF CANCER PREVENTION AND CONTROL NATIONAL CANCER INSTITUTE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE NATIONAL INSTITUTES OF HEALTH Effective Date: Cases Diagnosed January 1, 1992 The SEER Program Code Manual Revised Edition June 1992 Editors Jack Cunningham Lynn Ries Benjamin Hankey Jennifer Seiffert Barbara Lyles Evelyn Shambaugh Constance Percy Valerie Van Holten Acknowledgements The editors wish to acknowledge the assistance of Terry Swenson, Maureen Troublefield, Diane Licitra, and Jerome Felix of Information Management Services, Inc., in the preparation of the SEER Program Code Manual. The editors also wish to acknowledge the assistance of Dr. John Berg in preparation of the section on multiple primary determination for lymphatic and hematopoietic diseases. TABLE OF CONTENTS PREFACE TO THE REVISED EDITION ....................................... vii COMPUTER RECORD FORMAT ............................................ 1 INTRODUCTION AND GENERAL INSTRUCTIONS .............................. 5 REFERENCES .......................................................... 37 SEER CODE SUMMARY .................................................. 39 I BASIC RECORD IDENTIFICATION ...................................... 57 1.01 SEER Participant ........................................... 58 1.02 Case Number .............................................. 59 1.03 Record Number ............................................ 60 -
Cervical Cancer
Cervical Cancer Ritu Salani, M.D., M.B.A. Assistant Professor, Dept. of Obstetrics & Gynecology Division of Gynecologic Oncology The Ohio State University Estimated gynecologic cancer cases United States 2010 Jemal, A. et al. CA Cancer J Clin 2010; 60:277-300 1 Estimated gynecologic cancer deaths United States 2010 Jemal, A. et al. CA Cancer J Clin 2010; 60:277-300 Decreasing Trends of Cervical Cancer Incidence in the U.S. • With the advent of the Pap smear, the incidence of cervical cancer has dramatically declined. • The curve has been stable for the past decade because we are not reaching the unscreened population. Reprinted by permission of the American Cancer Society, Inc. 2 Cancer incidence worldwide GLOBOCAN 2008 Cervical Cancer New cases Deaths United States 12,200 4,210 Developing nations 530,000 275,000 • 85% of cases occur in developing nations ¹Jemal, CA Cancer J Clin 2010 GLOBOCAN 2008 3 Cervical Cancer • Histology – Squamous cell carcinoma (80%) – Adenocarcinoma (15%) – Adenosquamous carcinoma (3 to 5%) – Neuroendocrine or small cell carcinoma (rare) Human Papillomavirus (HPV) • Etiologic agent of cervical cancer • HPV DNA sequences detected is more than 99% of invasive cervical carcinomas • High risk types: 16, 18, 45, and 56 • Intermediate types: 31, 33, 35, 39, 51, 52, 55, 58, 59, 66, 68 HPV 16 accounts for ~80% of cases HPV 18 accounts for 25% of cases Walboomers JM, Jacobs MV, Manos MM, et al. J Pathol 1999;189(1):12-9. 4 Viral persistence and Precancerous progression Normal lesion cervix Regression/ clearance Invasive cancer Risk factors • Early age of sexual activity • Cigggarette smoking • Infection by other microbial agents • Immunosuppression – Transplant medications – HIV infection • Oral contraceptive use • Dietary factors – Deficiencies in vitamin A and beta carotene 5 Multi-Stage Cervical Carcinogenesis Rosenthal AN, Ryan A, Al-Jehani RM, et al. -
Primary Pelvic Exenteration: Our Experience with 23 Patients from a Single Institution
EXPERIMENTAL AND THERAPEUTIC MEDICINE 22: 1060, 2021 Primary pelvic exenteration: Our experience with 23 patients from a single institution MIHAI GHEORGHE1, ALEXANDRA LAVINIA COZLEA1, SZILARD LEO KISS1, MIHAI STANCA1, MIHAI EMIL CĂPÎLNA1, NICOLAE BACALBAȘA2 and ANDREEA ANAMARIA MOLDOVAN3 1First Obstetrics and Gynecology Clinic, ‘George Emil Palade’ University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mureș; 2Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020022 Bucharest; 3Department of Infectious Diseases, Brașov County Emergency Hospital, 500326 Brașov, Romania Received May 24, 2021; Accepted June 23, 2021 DOI: 10.3892/etm.2021.10494 Abstract. This study was designed with an aim to share our Introduction experience of primary pelvic exenterations. The study included 23 patients with different types of pelvic cancer enrolled at a In patients with advanced primary or recurrent gyneco‑ single institution between November 2011 and July 2020. The logic (1), urologic or rectal cancers without metastatic disease, patient mean age was 55 years (range, 43‑72 years) and the extensive aggressive surgery such as pelvic exenteration may oncological indications included: Stage IVa cervical cancer be necessary for curative intent treatment (2). (11 cases, 48.9%), stage IVa endometrial cancer (1 case, 4.3%), Brunschwig was the first to describe pelvic exentera‑ stage IVa vaginal cancer (6 cases, 26%), stage IIIb bladder tion in the 1940s (3). Exenteration was initially considered cancer (3 cases, 13%), stage IIIc rectal cancer (1 case, 4.3%) as a palliative procedure for patients with extensive pelvic and undifferentiated pelvic sarcoma (1 case, 4.3%). Total, cancers, with an extremely high perioperative mortality rate anterior, and posterior pelvic exenterations were performed of 23%. -
Colposcopy of the Uterine Cervix
THE CERVIX: Colposcopy of the Uterine Cervix • I. Introduction • V. Invasive Cancer of the Cervix • II. Anatomy of the Uterine Cervix • VI. Colposcopy • III. Histology of the Normal Cervix • VII: Cervical Cancer Screening and Colposcopy During Pregnancy • IV. Premalignant Lesions of the Cervix The material that follows was developed by the 2002-04 ASCCP Section on the Cervix for use by physicians and healthcare providers. Special thanks to Section members: Edward J. Mayeaux, Jr, MD, Co-Chair Claudia Werner, MD, Co-Chair Raheela Ashfaq, MD Deborah Bartholomew, MD Lisa Flowers, MD Francisco Garcia, MD, MPH Luis Padilla, MD Diane Solomon, MD Dennis O'Connor, MD Please use this material freely. This material is an educational resource and as such does not define a standard of care, nor is intended to dictate an exclusive course of treatment or procedure to be followed. It presents methods and techniques of clinical practice that are acceptable and used by recognized authorities, for consideration by licensed physicians and healthcare providers to incorporate into their practice. Variations of practice, taking into account the needs of the individual patient, resources, and limitation unique to the institution or type of practice, may be appropriate. I. AN INTRODUCTION TO THE NORMAL CERVIX, NEOPLASIA, AND COLPOSCOPY The uterine cervix presents a unique opportunity to clinicians in that it is physically and visually accessible for evaluation. It demonstrates a well-described spectrum of histological and colposcopic findings from health to premalignancy to invasive cancer. Since nearly all cervical neoplasia occurs in the presence of human papillomavirus infection, the cervix provides the best-defined model of virus-mediated carcinogenesis in humans to date. -
Introduction to Pelvic Obstetric and Gynaecology Physiotherapy
INTRODUCTION TO PELVIC OBSTETRIC AND GYNAECOLOGY PHYSIOTHERAPY An Educational Resource Published by the Pelvic, Obstetric and Gynaecology Physiotherapy Contact: POGP Administration, Fitwise Management Ltd., Drumcross Hall, Bathgate, West Lothian EH48 4JT T: 01506 811077 E: [email protected] or visit the POGP website www.pogp.org.uk for further information. ©POGP 2015 for review 2018 Contents CCCCC Introduction .........................................................................................................3 Core skill framework.............................................................................................4 Obstetrics..............................................................................................................5 Urology, Gynaecology and Colorectal..................................................................8 Breast Oncology……………………………………………………..………...………………..….……..17 Appendices 1. Obstetric abbreviations ..........................................................................19 2. Obstetric terminology ............................................................................20 3. Urology/ Gynaecology terminology……………………………………..……………..26 4. Gynaecology surgery terminology…………………………………………..………....29 5. Colorectal terminology…………………………………………………..………………..…31 6. Advanced clinical objectives for performing internal examinations…….34 C o n t e n t s 1 T H R E Introduction It is acknowledged that physiotherapists may become involved in the management of pelvic, obstetric and gynaecology patients -
UNMH Obstetrics and Gynecology Clinical Privileges Name
UNMH Obstetrics and Gynecology Clinical Privileges Name:____________________________ Effective Dates: From __________ To ___________ All new applicants must meet the following requirements as approved by the UNMH Board of Trustees, effective April 28, 2017: Initial Privileges (initial appointment) Renewal of Privileges (reappointment) Expansion of Privileges (modification) INSTRUCTIONS: Applicant: Check off the “requested” box for each privilege requested. Applicants have the burden of producing information deemed adequate by the Hospital for a proper evaluation of current competence, current clinical activity, and other qualifications and for resolving any doubts related to qualifications for requested privileges. Department Chair: Check the appropriate box for recommendation on the last page of this form. If recommended with conditions or not recommended, provide condition or explanation. OTHER REQUIREMENTS: 1. Note that privileges granted may only be exercised at UNM Hospitals and clinics that have the appropriate equipment, license, beds, staff, and other support required to provide the services defined in this document. Site-specific services may be defined in hospital or department policy. 2. This document defines qualifications to exercise clinical privileges. The applicant must also adhere to any additional organizational, regulatory, or accreditation requirements that the organization is obligated to meet. ---------------------------------------------------------------------------------------------------------------------------------------