The current trend is to preserve pregnancy in women diagnosed with cervical or ovarian cancer whenever feasible, according to a recent review that explored the issues around gynecologic cancers (Lancet. 2012;379:558-569).
Gynecologic cancers are the most common malignancies diagnosed during pregnancy (mainly uterine or cervical and, less frequently, ovarian), note the review authors. The use of chemotherapy during pregnancy helps increase the chances of fetal preservation, and most case reports describing chemotherapy for gynecologic cancers during pregnancy show a good outcome for the newborn. Congenital anomalies, preterm deliveries, and growth restrictions do not appear to be any more common in children exposed to chemotherapy in utero after the first trimester than in unexposed children. However, few studies have looked at the long-term development of babies exposed to chemotherapy as fetuses.
In early-stage cervical cancer involving a small tumor and no nodal spread, postponing treatment until after the baby is born might be possible. Delaying treatment until after childbirth in women with stage 1A disease has an excellent prognosis and is now the standard of care. Another option is to remove the cervix by means of radical trachelectomy to preserve the uterus and the pregnancy.
Management of locally advanced cervical disease is more controversial, centering on neoadjuvant chemotherapy with preservation of the pregnancy, or chemotherapy and radiotherapy with termination of the pregnancy. These choices should be discussed based on tumor size, radiologic findings, trimester of pregnancy, and the patient’s wishes.
In ovarian disease, management depends on histologic subtype of the malignancy, tumor differentiation, nodal status, tumor stage, and trimester of pregnancy. Ovarian tumors of low malignant potential have an excellent prognosis and are treated surgically, without chemotherapy, in most patients. If the tumor is malignant, neoadjuvant chemotherapy with pregnancy preservation may be possible in a woman with peritoneal spread or high-risk, early-stage disease.
Epithelial ovarian cancer is the rarest ovarian cancer in pregnant women and has an overall low incidence. However, it is the most difficult form of ovarian cancer to treat and it has a worse overall prognosis than do nonepithelial tumors. In some early-stage cases, the pregnancy can be preserved. Other women may need to undergo a pregnancy-terminating hysterectomy.