Gynecologic oncology in pregnancy

In this review current knowledge on prevalence, diagnosis, treatment and prognosis of gynaecological malignancies during pregnancy is discussed. After a general overview of surgery, chemotherapy and radiotherapy during pregnancy, tumor specific diagnosis and treatment options are described for breast, cervical, ovarian, endometrial and vulvar cancer. In contrast to previous belief, termination of pregnancy because of a concurrent malignancy does not result in an improved prognosis. Information on prognosis of cancer during pregnancy is often contradictory and evidence on the real influence of pregnancy on prognosis is weak. However, there is increasing belief that, the prognosis per stage is similar to that of the non-pregnant patient and that the risk for impaired prognosis is most likely due to suboptimal diagnosis and treatment. With the exception of pelvic surgery, most surgical techniques that are used in non-pregnant patients are also safe for pregnant patients. Radiotherapy proximal of the upper abdomen is frequently possible, while chemotherapy depending on pregnancy trimester and type of chemotherapy can usually be administered without much hazards. Indications for termination of pregnancy include an unwanted pregnancy and locally advanced cervical cancer. This group of patients is however very small, suggesting that mostly fetal life can be saved.