Ovarian Cancer and Pregnancy-A Current Problem in Perinatal Medicine: A Comprehensive Review

Abstract

The frequency of concomitant adnexal tumors in pregnancy is reported to be at 0.15-5.7%, while ovarian cancer complicates 1 in 15,000 to 1 in 32,000 pregnancies, being the second most common gynecologic cancer diagnosed during pregnancy. The aim of this review is to discuss the problem of ovarian cancer complicating pregnancy and the current recommendations for diagnostics and treatment, with an emphasis on the risk to the fetus. A detailed analysis of the literature found in the PubMed and MEDLINE databases using the keywords "ovarian cancer", "ovarian malignancy", "adnexal masses", "ovarian tumor" and "pregnancy" was performed. There were no studies on a large series of pregnant women treated for ovarian malignancies and the management has not been well established. The diagnostics and therapeutic procedures need to be individualized with respect to the histopathology of the tumor, its progression, the gestational age at the time of diagnosis and the mother's decisions regarding pregnancy preservation. The multidisciplinary cooperation of specialists in perinatal medicine, gynecological oncology, chemotherapy, neonatology and psychology seems crucial in order to obtain the best possible maternal and neonatal outcomes.

Keywords: adnexal masses; management in pregnancy; ovarian cancer; ovarian malignancy; ovarian tumor; pregnancy.

Figure 1

Scheme for the management of epithelial ovarian cancer tumors. According to ESMO guidelines. Staging refers to surgical staging. CT, chemotherapy; gw, gestational weeks [53].

Figure 2

Scheme for the management of nonepithelial ovarian cancer tumors. Staging refers to surgical staging. CT, chemotherapy; gw, gestational weeks. * According to ESMO guidelines; ** CT administered according to restaging surgery findings (Reprinted with permission from Amant, F.; Berveiller, P.; Boere, I.A.; Cardonick, E.; Fruscio, R.; Fumagalli, M.; Halaska, M.J.; Hasenburg, A.; Johansson, A.L.V.; Lambertini, M.; et al. Gynecologic cancers in pregnancy: Guidelines based on a third international consensus meeting. Ann. Oncol. 2019, 30, 1601–1612. Copyright Elsevier 2020) [53].