Cancer during pregnancy: 10-year experience at a regional cancer reference center in Mexico.

INTRODUCTION: Cancer during pregnancy is uncommon. However, recent trends in the prolongation of the childbearing age have made cancer-associated pregnancies more frequent. The objective of our study was to describe the frequency, types of cancer, and treatment with this association in our institution. MATERIAL AND METHODS: The clinical records of 36 patients who presented to a regional reference center in Mexico over 10 years were reviewed collecting demographics, pregnancy characteristics and outcomes, type of cancer, clinical stage, treatment, and oncological outcome. RESULTS: The following tumors were observed: Uterine cervix (20), breast (7), ovary (3), non-Hodgkin Lymphoma (2), and other malignancies (4). The mean age of the patients was 30 (range 20-39) years. Mean follow up was 17.8 (range 1-74) months. The pregnancies were synchronous in 23 cases and 13 were diagnosed in the following 12 months after birth. Mean gestational age of the product was of 37.4 weeks, resulting in 15 deliveries with healthy products, four abortions and four deaths. The majority of patients had advanced clinical stages. Overall survival was 36.4%. DISCUSSION: Cancer during pregnancy appears to have a worse outcome when compared to the results reported in the literature of non-pregnant women with the same conditions. This may be related to the advanced clinical stages we found. Cancer during pregnancy requires specialized attention to improve both fetal and maternal outcomes.

Cancer during pregnancy: 10-year experience at a regional cancer reference center in Mexico.

INTRODUCTION: Cancer during pregnancy is uncommon. However, recent trends in the prolongation of the childbearing age have made cancer-associated pregnancies more frequent. The objective of our study was to describe the frequency, types of cancer, and treatment with this association in our institution. MATERIAL AND METHODS: The clinical records of 36 patients, who presented to a regional reference center in Mexico over 10 years were reviewed collecting demographics, pregnancy characteristics and outcomes, type of cancer, clinical stage, treatment, and oncological outcome. RESULTS: The following tumors were observed: Uterine cervix (20), breast (7), ovary (3), non-Hodgkin Lymphoma (2), and other malignancies (4). The mean age of the patients was 30 (range 20-39) years. Mean follow up was 17.8 (range 1-74) months. The pregnancies were synchronous in 23 cases and 13 were diagnosed in the following 12 months after birth. Mean gestational age of the product was of 37.4 weeks, resulting in 15 deliveries with healthy products, four abortions, and four deaths. The majority of patients had advanced clinical stages. Overall survival was 36.4%. DISCUSSION: Cancer during pregnancy appears to have a worse outcome when compared to the results reported in the literature of non-pregnant women with the same conditions. This may be related to the advanced clinical stages we found. Cancer during pregnancy requires specialized attention to improve both fetal and maternal outcomes.

Pelvic exenteration for recurrent or persistent cervical cancer: experience of five years at the National Cancer Institute in Mexico.

Cervical cancer constitutes a major health problem in Mexico and other developing countries. The purpose of our study was to assess the experience of a comprehensive national oncological reference center on pelvic exenteration for post-radiotherapy recurrent or persistent cervical cancer, describing the prognostic value of time to recurrence, procedure complications, and survival. Medical records from 42 patients with post-radiotherapy recurrent or persistent cervical cancer who underwent a pelvic exenteration with curative purposes from 1984 to 1989 were retrospectively reviewed. Histological diagnoses were squamous cell carcinoma (32 patients), adenosquamous carcinoma (9 patients), and adenocarcinoma (1 patient). Average follow up was of 56.3 mo after the procedure and global survival at 5 yr was 65.8%. Survival for patients with early recurrence was 56.9% vs 78% for patients with late recurrence (p = 0.05). Complications were observed in 65.3% of the cases with a surgical mortality of 4.8%. Pelvic exenteration is a surgical procedure with high morbidity in spite of the recent medical advances. Pelvic exenteration should not be indicated with palliative purposes owing to the high rate of complications. Patients with tumor persistence or early recurrence have a worse prognosis. In well-selected cases, exenteration may provide a survival benefit.

[Experience with 14 cases of pancreatic pseudocyst]. / Experiencia con 14 casos de pseudoquiste pancreático.

INTRODUCTION: Pseudocyst of the pancreas (PP) develops in 2 to 5% the cases of acute pancreatitis (AP). Most cases of PP regress spontaneously. PP has been misdiagnosed as a malignant pancreatic cyst neoplasm, reason why the patients are referred to specialized institutions. OBJECTIVE: To describe the cases of PP treated in a 15 year-period. MATERIAL AND METHODS: Review of clinical records of 14 cases treated from 1975 to 1989. RESULTS: There were 5 men (36%) and 9 women (64%) Mean age was 41 years (range 18 to 77). In 50% of the cases the patient had a history of severe alcoholic abuse, cholelithiasis in 28% and abdominal trauma in 15%. Five patients (35%) had AP. The period between AP symptoms and the diagnosis of PP was a mean of 5.7 months. Abdominal pain and abdominal mass were present in all of the cases, in all cases, ultrasonography and CT scan made the diagnosis of PP. Thirteen cases were treated by surgery, 12 with internal drainage, one by resection and one by external drainage. An enterocutaneous fistula (7%) was recorded in one case. There were no operative mortality. The mean follow-up time was of 10 years and 4 months. CONCLUSIONS: PP is a uncommon pathology in oncologic centers. Internal drainage was the most frequent treatment. The diagnosis of cystic neoplasms of the pancreas should be ruled out.

[Tumors of the small intestine]. / Tumores de intestino delgado.

Small bowel tumors (SBT) are rare neoplasms and represent less than 10% of all gastrointestinal tumors. The majority of them are benign and discovered at the time of autopsy. However of those who present symptoms the majority belong to the group of malignant tumors and require of treatment. The most common histological variety are the adenocarcinoma and the carcinoid tumors. Abdominal pain, intestinal obstruction or gastrointestinal bleeding are the most common clinical complaints. Endoscopy or contrast X-ray examination are the most common forms of diagnosis and surgery remain the best way of treatment chemotherapy or radiotherapy are used in combination with surgery according to the histological diagnosis, the survival depends to the final histological report. A review of the experience at the National Institute of Cancer in Mexico city was performed and 34 patients were found with the diagnosis of SBT of which the majority presented with abdominal pain, nausea, vomiting and abdominal distension. The most common histological diagnosis were the adenocarcinoma (52%) and the leiomyosarcoma (32%). Surgery was the most common form of treatment (73%) of which in 20% distant metastasis was diagnosed. Only nine are alive at the time of the report without recurrent disease with a mean follow up of 7 months. Our experience shows that SBT are rare neoplasms, the majority are diagnosed late but surgery remain the best way of treatment because it can offer the possibility of cure or adequate palliation with derivative procedures.