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Cervical Cancer Screening And Management In Pregnancy
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Vaidehi Mujumdar, Scott D. Richard
Conization is recommended for both treatment and diagnosis in patients with evidence of stage IA1 cancer [22]. To minimize the risk of spontaneous abortion, is it optimal to perform conization in the early second trimester [21].
Chemotherapy in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Surgical options for the treatment of women with cervical cancer include cold knife conization and extrafascial hysterectomy for microinvasive disease, and radical hysterectomy for more advanced stages. Although conization has been performed safely in pregnancy, it has also been associated with severe bleeding and preterm labor, and is generally discouraged (17). It may be appropriate to delay treatment until after the completion of pregnancy for patients with microinvasive disease. It is recommended that these patients then undergo cesarean section, with or without hysterectomy. Hysterectomy can be performed at the time of diagnosis with the fetus in utero if pregnancy termination is desired.
Principles of the Laser and Applications
Published in Sujoy K. Guba, Bioengineering in Reproductive Medicine, 2020
The alternative is excision, which is comparable to knife conization and provides tissue for further investigation.7 Tissue specimen satisfactory for pathologic interpretation can only be supplied if thermally induced artifacts are minimal. Damage to the stromal side of the cone specimen is not of great importance but the morphology of the tissue around the cervical canal must be preserved. To achieve this objective, the energy density needed is high being in the range of 1000-2000 W/cm2 and above. Spot diameter has to be small of the order of 1.5 mm to have a “scalpel effect”. Total power remains about 30 W. So as to have a neat cut the beam is moved rapidly with a circular stroke keeping the beam inclined to the cervical canal axis.7 Injury to the apex of the cone may be avoided by excising the narrow endocervical canal link with a scalpel. Following the cone removal the entire cone bed is thoroughly coagulated with a low power density diffuse spot beam to check bleeding. Overall blood loss in the entire procedure does not normally exceed 5 ml. Cervical stenosis is rare.
Upregulation of miRNA-10a-5p promotes tumor progression in cervical cancer by suppressing UBE2I signaling
Published in Journal of Obstetrics and Gynaecology, 2023
Yannan Gu, Xiaodan Feng, Yanqi Jin, Yuanlin Liu, Li Zeng, Dachun Zhou, Yuling Feng
Cervical cancer has long been the greatest threat to women’s health and quality of life, frequently occurring among patients aged between 40 and 60 years old (Waggoner 2003). In recent years, however, statistics have shown that the age of disease onset tends to be younger (He and Li 2021). The mortality of cervical cancer has been reduced to some extent due to therapeutic advancement (D’Oria et al.2022). However, tumor metastasis and recurrence are still the primary inducements affecting prognosis. Pre-operative conization before radical hysterectomy could reduce early cervical cancer recurrence rate (Bizzarri et al.2021b; Casarin et al.2021), whereas the postoperative complications may impair urinary bladder function (Kietpeerakool et al.2019). Therefore, exploring the mechanisms related to CC initiation and progression is imperative for finding promising therapeutic regimens.
Association of lesion area measured by colposcopy and cervical neoplasia
Published in Journal of Obstetrics and Gynaecology, 2022
Priscila Thais S. Mantoani, Millena P. Jammal, Juliana M. Caixeta, Nayara A. Cordeiro, Ana Cristina M. Barcelos, Eddie Fernando C. Murta, Rosekeila S. Nomelini
Women treated with cold conization and LEEP are usually of reproductive age, and these treatments can compromise future pregnancies because they increase the risks of cervical canal stenosis (Kiuchi et al. 2016), prematurity, premature rupture of membranes, chorioamnionitis, low birth weight, hospitalisation in the neonatal intensive care unit, and perinatal mortality (Kyrgiou et al. 2016; Sjøborg et al. 2007; Arbyn et al. 2008). The frequency and severity of adverse events following these procedures increase with the depth of conization. Risks are also greater with excision procedures than with ablation (Kyrgiou et al. 2016). Thus, other treatments for grade 3 CIN that avoid surgical treatment and its possible complications, especially in women who still wish to become pregnant, have been developed. The finding of this study suggests that lesion size should be considered in CIN management. This approach is also less expensive and less invasive. Small lesions have the best prognosis and should be treated more conservatively, resulting in greater patient comfort and fewer complications.
Factors Correlated with the Accuracy of Colposcopy-Directed Biopsy: A Systematic Review and Meta-Analysis
Published in Journal of Investigative Surgery, 2022
Hongyan Ren, Mengzhe Jia, Shujun Zhao, Hongyu Li, Suzhen Fan
Diagnosis and treatment of cervical intraepithelial neoplasia are the key steps to prevent cancer. If the biopsy results in high-grade lesions, conization or ablation may be performed. However, according to the latest guidelines, the treatment of CIN 2 is not always surgical treatment [14–17]. Conization has risks and complications [27]. Suspicious lesions could be detected using colposcopy [39]. Colposcopy guided biopsy is very important for the diagnosis of high-grade lesions [40]. However, colposcopy may not always represent the true condition of the entire cervix [41]. The accuracy of colposcopy-guided cervical biopsy in the identification of severe lesions has been controversial. One study suggested that among the patients with low-grade lesions in preoperative biopsy, 18% of them came back CIN 2/3 in the cone histology [35]. Stoler, M.H et al. suggested that the overall underdiagnosis of CIN3/AIS (adenocarcinoma in situ) was 42% [42]. Biopsy may be inadequate to judge the severity of cervical dysplasia [33].