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Review
. 2017 Mar;72(3):184-193.
doi: 10.1097/OGX.0000000000000407.

Gynecologic Malignancies in Pregnancy: Balancing Fetal Risks With Oncologic Safety

Christina N Cordeiro  1 , Mary L Gemignani  2
Affiliations
Review

Gynecologic Malignancies in Pregnancy: Balancing Fetal Risks With Oncologic Safety

Christina N Cordeiro et al. Obstet Gynecol Surv. 2017 Mar.

Abstract

Importance: Cancer occurs in 0.05% to 0.1% of all pregnancies. Despite literature reporting good oncologic and fetal outcomes in women treated for cancer during pregnancy, as many as 44% of gynecologists would offer termination, and 37% would not administer chemotherapy or radiotherapy in pregnancy.

Objectives: The aims of this study were to summarize current recommendations for the treatment of cervical and ovarian cancers in pregnancy and to review updates on existing knowledge regarding the safety of surgical and chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes.

Evidence acquisition: A detailed literature review was performed on PubMed.

Results: The treatment of gynecologic malignancies during pregnancy mirrors that outside pregnancy, with a balance between maternal versus fetal health. Fertility-sparing surgery can be offered to stage IA2 and low-risk IB1 cervical, stage I epithelial ovarian, germ cell ovarian, or sex-cord stromal ovarian tumors. Delayed treatment can be offered for stage IB1 cervical cancer. Neoadjuvant and/or adjuvant chemotherapy can be given for advanced gynecologic cancers with good disease-free survival without significant adverse neonatal outcomes.

Conclusions: A multidisciplinary approach and improved education of providers regarding the surgical and chemotherapeutic treatments in pregnancy are needed in order to fully inform patients regarding treatment options. Further research in women who are pregnant is needed to determine the safety of diagnostic and therapeutic procedures used in the nonpregnant woman.

Relevance: This article reviews and supports treatment of gynecologic cancer during pregnancy, calls for additional study and long-term follow-up, and justifies improved education of patients and providers regarding treatment options.

Target audience: Obstetricians and gynecologists, family physicians.

Learning objectives: After completing this activity, the learner should be better able to (1) review general principles in the management and treatment of gynecologic cancers in pregnancy, (2) review the diagnosis and treatment of cervical cancer in pregnancy, and (3) review the diagnosis and treatment of ovarian cancer in pregnancy.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to disclose.

References

    1. Han SN, Kesic VI, Van Calsteren K, et al. Cancer in pregnancy: a survey of current clinical practice. Eur J Obstet Gynecol Reprod Biol. 2013;167(1):18–23. - PubMed
    1. Amant F, Halaska MJ, Fumagalli M, et al. Gynecologic cancers in pregnancy: guidelines of a second international consensus meeting. Int J Gynecol Cancer. 2014;24(3):394–403. - PubMed
    1. Han SN, Verheecke M, Vandenbroucke T, et al. Management of gynecological cancers during pregnancy. Curr Oncol Rep. 2014;16(12):415. - PubMed
    1. Grimm D, Woelber L, Trillsch F, et al. Clinical management of epithelial ovarian cancer during pregnancy. Eur J Cancer. 2014;50(5):963–71. - PubMed
    1. Mazze RI, Kallen B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol. 1989;161(5):1178–85. - PubMed

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