Importance
Cancer occurs in 0.05 to 0.1% of all pregnancies.1,2 Despite literature reporting good oncologic and fetal outcomes in women treated for cancer during pregnancy, as many as 44% of gynecologists would offer termination, and 37% would not administer chemotherapy or radiotherapy in pregnancy.1
Objectives
To summarize current recommendations for the treatment of cervical and ovarian cancers in pregnancy. To review updates on existing knowledge regarding the safety of surgical and chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes.
Evidence Acquisition
A detailed literature review was performed on PubMed.
Results
The treatment of gynecologic malignancies during pregnancy mirrors that outside of pregnancy, with a balance between maternal versus fetal health. Fertility-sparing surgery can be offered to stage IA2 and low-risk IB1 cervical, stage I epithelial ovarian, germ cell ovarian or sex-cord stromal ovarian tumors.1,9 Delayed treatment can be offered for stage IB1 cervical cancer.1,3 Neoadjuvant and/or adjuvant chemotherapy can be given for advanced gynecologic cancers with good disease-free survival without significant adverse neonatal outcomes.29–31,41,47,48
Conclusions
A multidisciplinary approach and improved education of providers regarding the surgical and chemotherapeutic treatments in pregnancy is needed in order to fully inform patients regarding treatment options. Further research is needed to determine the safety of diagnostic and therapeutic procedures used in the non-pregnant woman in women who are pregnant.
Relevance
This article reviews and supports treatment of gynecologic cancer during pregnancy, calls for additional study and long-term follow-up, and justifies improved education of patients and providers regarding treatment options.