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Published on: April 17, 2012
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Gynecologic cancer in pregnancy
Travis-Riley K Korenaga1, Krishnansu S Tewari1
1Division of Gynecologic Oncology, University of California, Irvine Medical Center, Orange, CA, USA.
Gynecologic Oncology
|April 10, 2020
Summary
Cancer during pregnancy requires multidisciplinary care. Management strategies vary by cancer type and stage, prioritizing maternal and fetal well-being, with specific considerations for treatment timing and delivery.
Area of Science:
- Gynecologic Oncology
- Maternal-Fetal Medicine
- Reproductive Endocrinology
Background:
- Cancer complicates approximately 1 in 1000 pregnancies, necessitating specialized multidisciplinary management.
- Pregnancy offers unique opportunities for early cervical cancer detection and tailored treatment approaches.
Purpose of the Study:
- To outline optimal management strategies for gynecologic malignancies diagnosed during pregnancy.
- To provide guidance on diagnostic modalities, treatment timing, and delivery considerations for pregnant patients with gynecologic cancers.
Main Methods:
- Review of current literature and consensus guidelines for managing gynecologic cancers in pregnancy.
- Discussion of multidisciplinary team involvement, including Gynecologic Oncology, Maternal Fetal Medicine, and Neonatology.
- Analysis of diagnostic tools (ultrasonography, MRI) and therapeutic options (surgery, chemotherapy, radiation) considering gestational stage.
Main Results:
- Cervical cancer management involves screening opportunities and potential treatment delays for early stages; radical hysterectomy with lymphadenectomy at cesarean delivery is recommended for gross lesions.
- Adnexal masses are often benign and managed conservatively, with surgery deferred if possible; chemotherapy can be administered post-organogenesis but withheld after 34 weeks.
- Specific agents like bevacizumab, immune checkpoint inhibitors, and PARP inhibitors are contraindicated during pregnancy.
Conclusions:
- Multidisciplinary consensus is crucial for optimal cancer care during pregnancy.
- Pregnancy does not inherently worsen the prognosis of gynecologic malignancies, allowing for tailored, stage-specific management.
- Careful consideration of treatment timing and modality is essential to balance maternal oncologic needs with fetal development and well-being.
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