임신과 합병된 자궁경부 상피내암과 침윤성 자궁경부암의임상적 고찰
Clinical Review of Cervical Carcinoma in Situ and Invasive Cervical Cancerin Pregnancy
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목적 : 임신과 합병된 자궁경부암은 그 빈도가 매우 낮아 1/2,200의 빈도로 보고되고 있으며 실제적으로 산부인과 의사가 경험하는 예는 매우 적으나 최근 13년 동안의 임신과 동반된 자궁경부 상피내암 및 자궁경부암의 임상양상, 병리조직학적 종류, DNA chip을 이용한 HPV아형 및 분만 후 5년 생존률에 대해 알아보고 향후 임신과 합병된 자궁경부암의 처치에 기여하고자 하였다. 연구 방법 : 1990년 1월부터 2002년 12월까지 13년간 순천향대학교 천안병원에서 진단 및 처치를 받은 임신과 합병된 침윤성 자궁경부암 5예와 상피내암 6예로 총 11예를 대상으로 후향적으로 임상정보, 병리조직학적 보고, 치료 및 산모와 신생아의 정보를 조사하였다. 모든 세포진검사는 cytobrush를 이용하여 얻었으며, 이상 시 colposcopy를 기본적으로 시행하여 조직검사를 시행하였다. 임상적 병기는 FIGO staging system에 따랐다. 결과 : 연령은 23세에서 41세까지 다양한 분포를 보였으며, 빈도는 상피내암 0.027%, 침윤성 자궁경부암 0.023%이며 이 두 경우를 합친 경우는 0.05%였다. 상피내암의 경우 6예로 23-38세의 분포를 보였으며 평균나이는 24.2세였다. 모두 임신초기에 질확대경 검사 하 조직생검으로 진단되었으며, 6예 모두 5년 이상 생존하였다. 진단 당시 모두 LEEP으로 치료하였으며 1예에서 조산으로 34주에 분만이 되었으며 나머지 5예는 만삭 분만하였다. HPV검사에 있어 mixed type이 2예, type 16 1예, 나머지 3예에서는 검출되지 않았다. 침윤성 자궁경부암의 경우 5예 진단되었으며, 2예는 임신 중기에 진단되었다. 진단 시 병기는 Ia가 1예, Ib가 3예, IIa가 1예였으며, 1예를 제외하고 모두 5년 이상 생존하였다. 4예는 편평상피세포암이였으며, 1예는 선암이었다. HPV검사에 있어 type 16 3예, type 18 1예, type 58 1예였다. Ia 1예와 Ib 3예는 제왕절개수술 후 근치적 자궁절제술 및 양측 골반 림프절 절제술을 시행하였으며 선암으로 판정된 1예는 임신 26주에 진단 받아 28주에 고식적 제왕절개술 후 근치적 자궁절제술 및 양측 골반 림프절 절제술 그리고 추가로 방사선치료를 시행하였다. 결론 : 임신 시 자궁경부세포진 검사의 이상은 산과나 부인과 의사에게 중요한 관점이 되어 왔으며, 비록 빈도가 낮을지라도 임신 시 산전 진찰에서 자궁경부암에 대한 선별검사가 이루어 져야 할 것으로 사료되며, 이에 따른 각 병기에 따라 철저한 진단 및 치료가 이루어져야 할 것으로 사료된다.
Abstract
Objective : Cervical cancer is the most common malignancy of the female genital tract in Korea. Recognized prognostic factors include FIGO stage, histologic grade, depth on invasion, primary cancer screening and age. However, prognosis of pregnant woman with cervical cancer is unclear. We reviewed our patients in an attempt to identify the best management options which resulted in long term survival for the mother. Methods : We retrospectively investigated the results of 11 patients with CIS and cervical cancer in pregnant patients who had been diagnosed and treated at Soonchunhyang University Medical center from January 1990 to December 2002. Results : The age range was 23-41 years. Six patients were CIS and performed LEEP conization during pregnancy. One patient had stage Ia disease and 3 patients had stage Ib with radical hysterectomy after Cesarean section. 4 cases were diagnosed as squamous cell cancer. One patient with stage Ib had been referred to our hospital at 28 gestational weeks. Another one patient with high risk histology (mucinous adenocarcinoma) pointed out polypectomy at 26 gestational weeks. One year later, the case died after treatment. All of 11 patients were treated surgically and two patients achieved pregnancy again with three live births. Preterm delivery after conization occured in one case at 34 gestational weeks. HPV infection was diagnosed in 82% of patients. The HPV type 16 was infected 4 patients, type 18 was one patient, type 58 was one patient, and mixed another type were 2 patients. Conclusion : We conclude that all pregnant women should have a Pap smear performed antenatally. Cone biopsy can be safely performed in pregnant women and may be adequate treatment for CIS. When cervical cancer complicates with pregnancy, decisions, management must include maternal and fetal consideration.
참고문헌 (43)
- Sedlacek T, "Colposcopy in pregnancy", 20, pp.153~16363 (1993)
- Bloch B, "Cervical carcinoma associated with pregnancy", 50, pp.220~232 (1995)
- Wiggins CL, "Cancer in western Washington state 1974-1991", pp.36~37 (1992)
- Bibbo M, "Dysplasia during pregnancy, a cytologic fellow-up study", 22, pp.66~72 (1981)
- Charles EH, "Carcinoma of the cervix associated with pregnancy", 59, pp.735~740 (1982)
- Shingleton HM, "Cancer in pregnancy in current problem" (1983), Year Book Medical
- Kim JP, "Cancer incidence in seoul, korea: result of the implementation study of the seoul cancer Registry", 10, pp.74~84 (1995)
- Putney FW, "Genital malignancy in pregnancy", 129, pp.536~542 (1977)
- Norstrom A, "Carcinoma of the uterine cervix in pregnancy. A study of the incidence and treatment in the western region of Sweden 1973-1992", 76, pp.583~589
- de Graaff J, "Marriage and childbearing in relation to cervical cancer", 7, pp.307~312 (1977)
- , 1993, 598~602
- Allen DG, "Invasive cervical cancer in pregnancy", 35, pp.408~412 (1995)
- Averette HE, "Cervical conization in pregnancy. Analysis of 180 operations", 106, pp.543~549 (1970)
- Whitehouse HH 3rd, "Cone Biopsy During Pregnancy", 60, pp.450~455 (1982)
- Lee RB, "Cervical carcinoma in pregnancy", 58, pp.584~589 (1981)
- Berman ML, "Pelvic malignancies, gestational trophoblastic neoplasia, and nonpelvic malignancies", pp.1112~1134 (1994)
- Benedet JL, "Colposcopic evaluation of abnormal papanicolaou smear in pregnancy", 157, pp.932~937 (1987)
- conomos K, "Abnormal cervical cytology in pregnancy, a 17-year experience", pp.915~918 (1993)
- Palle C, "Cervical intraepitherial neoplasia in pregnancy", 79, pp.306~310 (2000)
- Lee RB, "Cervical carcinoma in pregnancy", pp.584~589 (1981)
- Creasman WT, "Carcinoma of the cervix associated with pregnancy", 36, pp.495~501 (1970)
- Richart RM, "Causes and managemant of cervical intraepithelial neoplasia (Review)", 60(8), pp.1951~1959 (1987)
- Sherman ME, "Identifying women with cervical neoplasia: using human papilloma virus DNA testing for equivocal Papanicolaou results", 281(17), pp.1605~1610 (1999)
- Sherman ME, "Human papillomavirus testing by hybrid capture appears to be useful in triaging women with a cytologic diagnosis of atypical squamous cells of undetemined significance.", 172(3), pp.946~954 (1995)
- Schettino F, "Cervicography and HPV DNA testing as triage criteria for patients with abnormal pap smear", 71(3), pp.404~409 (1998)
- Allen MC, "The limits of viability-neonatal outcome of infants born at 22 to 25 weeks' gestation", 329, pp.1597~1601 (1993)
- Becker TM, "Effect of cervical Carcinoma In Situ and Its Mangement on Pregnancy Outcome", 93, pp.207~212 (1999)
- Robinson WR, "Management of cervical intraepitherial neoplasia during pregnancy with loop excision", 64, pp.153~155 (1997)
- Shingleton HM, "Cancer of the cervix", pp.193~209, Churchill Livingstone
- Burgess SP, "Implantation of a cervical carcinoma in an episiotomy site Case report", 94, pp.598~599 (1987)
- Gordon AN, "Squamous carcinoma of the cervix complicating pregnancy: Recurrence in episiotomy after vaginal delivery", 73, pp.850~852 (1989)
- Copeland LJ, "Cervical adenocarcinoma: Tumor implantation in the episiotomy sites of two patients", 28, pp.230~235 (1987)
- Cliby WA, "Cervical Cancer Complicating by Pregnancy: Episiotomy Site Recurrence Following Vaginal Delivery", 84, pp.179~182 (1994)
- Sorosky JI, "Stage IB cervical catcinoma in pregnancy: awaiting fetal maturity", 2, pp.155~158 (1996)
- Sood AK, "Surgical management of cervical cancer complicating pregnancy: a case- study", 63, pp.294~298 (1996)
- Anderson B, "Cervical Cancer diagnosed shortly after pregnancy: Progostic variable and delivery routes", 95, pp.832~838 (2000)
- Kanazawa K, "Management of invasive carcinoma of the Uterine cervix associated with pregnancy: Outcome of intentional delay in treatment", 87, pp.185~189 (2002)
- , 1996, 53~59
- , 1990, 872~882
- Morley GW, "The prognosis and management of Cervical Cancer Associated with pregnancy", 80, pp.9~13 (1992)
- Montz FJ, "Invasive cervical cancer complicating intrauterine pregnancy:treatment with radical hysterectomy", 80, pp.199~203 (1992)
- Panzarella T, "Maternal and fetal outcome after cervical cancer in pregnancy", 9, pp.1956~1961 (1991)
- Lee LCRB, "Cervical carcinoma in pregnancy", 58(5), pp.584~587 (1981)