9Ovarian cancer in pregnancy
Introduction
A small proportion of pregnant women (∼0.2–2%) are diagnosed with adnexal masses, mostly in the first trimester by routine obstetrical ultrasound. The vast majority are benign, pregnancy-related masses and will resolve spontaneous within the first 16 weeks of pregnancy. However, malignancy rate of adnexal masses in pregnancy is 1–6%, which makes ovarian cancer the fifth most common tumour in pregnancy [1], [2], [3]. Awareness on the possibility of ovarian cancer in pregnancy is important and careful evaluation of (persisting) adnexal masses in pregnancy is required to avoid delay in diagnosis.
This chapter will give an overview of the diagnostic and therapeutic possibilities in pregnant patients with adnexal masses and ovarian cancer.
Section snippets
Diagnosis
Adnexal masses in premenopausal women are often found incidentally and are mostly of little clinical relevance. Because of the extensive use of obstetrical ultrasound, the number of masses diagnosed in pregnancy has increased over the past decades and it is therefore important to identify those who need further evaluation. Adnexal masses in pregnancy can be categorized into ovarian and non-ovarian as well as pregnancy-related and non-pregnancy-related. Non-pregnancy related masses can change
Surgical treatment
Surgery can be seen as the least controversial type of oncologic treatment in pregnancy because of the frequent application of surgery for non-oncological reasons with no reported adverse effects. Non-obstetrical surgery is performed in one to four of 200 pregnant patients. Surgery can be performed throughout pregnancy, provided specific measures are taken. If the expected delivery date is forthcoming, the general condition of the patient good and disease is not quickly progressive, and one
Chemotherapy for epithelial ovarian cancers
Chemotherapy should be offered after primary surgery in all cases of epithelial ovarian cancer. As in non-pregnant patients, only stage IA, grade 1 and 2 patients can avoid chemotherapy and be carefully monitored. When the diagnosis of advanced epithelial ovarian cancer is made preoperatively, neoadjuvant chemotherapy could be proposed as complete cytoreduction including hysterectomy, which cannot be achieved if pregnancy has to be preserved.
To avoid maternal hematopoietic nadir and neonatal
Oncological outcome
Stensheim et al. [67] compared the cause-specific survival for patients diagnosed with cancer in pregnancy or lactation with the outcome in non-pregnant cancer patients. For ovarian cancer, pregnant patients seemed to have a reduced risk of cause-specific death (RR 0.46, CI 0.17–1.23). Physical examination and ultrasound investigation in pregnancy might imply early diagnosis of an ovarian tumour, similarly to incidentally detected tumours in caesarean delivery. A higher proportion (60%) was
Obstetrical outcome after ovarian cancer in pregnancy
Pregnancies complicated by maternal cancer are considered as high-risk pregnancies and should be followed in a multidisciplinary high-risk obstetric unit.
Comparing the obstetrical outcome of patients diagnosed with cancer in pregnancy to the outcome of normal pregnancies, three complications occur more commonly: prematurity, foetal growth restriction and foetal loss *[55], [70], [71]. Foetal losses are associated with higher rates of pregnancy terminations as well as infectious complications,
Summary
Malignant ovarian cancer diagnosis in pregnancy is an uncommon event, but it requires adequate treatment in order to obtain a good obstetrical and oncological outcome. Diagnosis is usually made by ultrasound, and the differentiation of suspicious ovarian masses from pregnancy-related functional cysts might be challenging, also because tumour markers, such as CA 125, are not reliable in pregnancy. When ultrasound is not conclusive, MRI can add value in characterizing ovarian masses. With regard
Conflict of interest statement
None.
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Cited by (43)
Germ cell cancer in pregnancy – Successfully treated with chemotherapy and surgery
2023, Gynecologic Oncology ReportsRare association of the ovarian adenocarcinoma with pregnancy: A case report
2022, Annals of Medicine and SurgeryCitation Excerpt :Unfortunately, the diagnosis of cancer during pregnancy is often delayed due to the difficulty in differentiating certain symptoms from those of the pregnant state; notably nausea, vomiting, breast changes, abdominal pain, anemia and fatigue [8]. These ovarian cancers are more frequently reported in primigravida, and the majority are diagnosed at an early stage by routine ultrasound routine ultrasound examinations [13,14]. Because of its high sensitivity and specificity in characterizing the morphology of abdominal masses, ultrasound examination is the optimal diagnostic tool during pregnancy, and it can also differentiate benign from malignant masses [12,15].
Enlarging ovarian cysts mimicking malignant or borderline tumors during pregnancy
2021, Gynecology and Obstetrics Clinical MedicineCitation Excerpt :In most cases, ovarian cysts present as benign or physiological cysts that generally regress spontaneously and seldomly cause severe symptoms. For persistent ovarian cysts during pregnancy, only about 1%–6% could finally be demonstrated as malignant 6, leading to an overall incidence of ovarian cancer being lower than 50 per million pregnancies.5,7 Among ovarian cancers during pregnancy, germ cell tumors were identified as the most common pathological type.8
Gynecological cancer during pregnancy—From a gyne-oncological perspective
2024, Acta Obstetricia et Gynecologica Scandinavica