Current management of gynecologic cancer in pregnancy

Abstract

Cancer during pregnancy is a particularly challenging complication. The incidence has increased in recent years due to childbearing at advanced maternal ages due to career choices and/or the development of reproductive technology. Approximately two thirds of cancer cases during pregnancy comprise invasive cervical cancers and breast cancer. Cancer during gestation is characterized by a need for specialized treatment due to major changes in the hormonal profile (estrogen-progesterone), metabolism (enhancement of anabolism), hemodynamic changes (hyperdynamic circulation), immunologic changes (cell-mediated and humoral immunity), and increased angiogenesis (increased blood flow towards the uterus). Moreover, the management of such patients is based on the trimester of pregnancy, type and stage of cancer, and informed consent of the mother based on her wishes. The optimal treatment of cancer during pregnancy remains elusive because there are limited data from retrospective studies with small samples. As a result, it is crucial that data regarding survival of the women and long-term follow-up of the children from different cancer centers and registries are shared. This need is dictated by the fact that the incidence of cancer during pregnancy will continue to rise as child-bearing age continues to increase.

Advanced Ovarian Cancer during Pregnancy. Tumour Evolution Analysis and Treatment Approach

“…Surgery allows to perform diagnosis, staging and cytoreduction and is indicated after the second trimester [ 2 , 5 , 6 , 12 , 13 ]. Given the high level of difficulty attached to this procedure, it should be performed by experts in surgery or gynaecological oncology [ 1 , 5 ].…”

Primary intestinal type mucinous adenocarcinoma of the ovary diagnosed during pregnancy – Maternal and neonatal treatment and outcomes: A case report

“…As our initial suspicion was not ovarian carcinoma, a unilateral salpingo-oophorectomy was performed in view of the giant adnexal tumor (>10 cm), difficulty in preserving the ovary and adnexa, and the need to maintain pregnancy. After conservative surgery for the diagnosis of carcinoma, some authors have recommended using antineoplastic chemotherapy drugs during pregnancy to prevent the spread of malignant cells and eliminate possible tumor cells ( 9 ). After the result of the pathology examination, and due to the patient’s desire to maintain pregnancy, a conservative approach was adopted, without preponing the delivery and preservation of the uterus.…”

“…Treatment should include attention to the stage of the disease, gestational age, and the wishes of the patient (4)(5)(6)(7)(8). In general, this also involves conservative surgery with unilateral adnexectomy and fetal preservation (5,9). After conservative surgery, some authors have recommended the use of antineoplastic chemotherapy drugs during pregnancy to prevent the spread of malignant cells and to eliminate possible tumor cells.…”

Manejo do câncer cervical durante a gestação: uma revisão integrativa

“…No Brasil, a estimativa de novos casos para cada ano no período de 2020-2022 é de 625 mil casos novos de câncer, dentre eles, o risco estimado para o câncer de colo de útero é de 15,43 casos por 100 mil mulheres, ou seja, a estimativa é de 16.590 novos casos esperados (INCA, 2019). Esta situação tornou-se um desafio no atual panorama social devido à gravidez em idade materna avançada propiciada por escolhas em relação à carreira profissional, em conjunto ao desenvolvimento de diferenciadas tecnologias reprodutivo, ocasionando maior incidência de câncer em período gestacional (IAVAZZO C, et al, 2018).…”

“…O câncer cervical invasivo juntamente com o câncer de mama representa cerca de dois terços dos casos de câncer nesse período (IAVAZZO C, et al, 2018). Constata-se que entre as mulheres com diagnóstico de câncer do colo do útero, cerca de 30% estão em idade reprodutiva e 3% são gestantes ou mulheres que estão no período pós-parto, evidenciando a importância de conhecer o manejo adequado neste contexto (MORENO-LUNA E, et al, 2016).…”