Advertisement

Current Oncology Reports

, 16:415 | Cite as

Management of Gynecological Cancers During Pregnancy

  • Sileny N. Han
  • Magali Verheecke
  • Tineke Vandenbroucke
  • Mina Mhallem Gziri
  • Kristel Van Calsteren
  • Frédéric AmantEmail author
Gynecologic Cancers (NS Reed, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Gynecologic Cancers

Abstract

The diagnosis of a gynecological malignancy during pregnancy is rare but not uncommon. Cancer treatment during pregnancy is possible, but both maternal and fetal interests need to be respected. Different treatment plans may be justifiable and multidisciplinary treatment is advised. Clinical trials are virtually impossible, and current evidence is mainly based on small case series and expert opinion. Individualization of treatment is necessary and based on tumor type, stage, and gestational age at time of diagnosis. Termination of pregnancy is not necessary in most cases. Surgery and chemotherapy (second trimester and onwards) are possible types of treatment during pregnancy. Radiotherapy of the pelvic area is not compatible with an ongoing pregnancy. This article discusses the current recommendations for the management of gynecological malignancies (cervical, ovarian, and vulvar cancers) during pregnancy.

Keywords

Gynecologic Pregnancy Chemotherapy Surgery Cervical Ovarian Vulvar Cancer 

Notes

Acknowledgments

FA is senior clinical researcher for the Research Fund Flanders (F.W.O.). This research is supported by the Research Fund Flanders (F.W.O.), the Belgian Cancer Plan, Ministry of Health, Belgium, and the Clinical Research Fund UZ Leuven (KOF). The authors are grateful to Marie-Astrid Van Hoorick for the administrative support.

Compliance with Ethics Guidelines

Conflict of Interest

Sileny N. Han, Magali Verheecke, Tineke Vandenbroucke, Mina Mhallem Gziri, Kristel Van Calsteren, and Frédéric Amant declare that they have no conflict of interest

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;121:829–46.PubMedCrossRefGoogle Scholar
  2. 2.
    Aggarwal P., Kehoe S. Ovarian tumours in pregnancy: a literature review. Eur J Obstet Gynecol Reprod Biol. 2010.Google Scholar
  3. 3.
    Leiserowitz GS, Xing G, Cress R, Brahmbhatt B, Dalrymple JL, Smith LH. Adnexal masses in pregnancy: how often are they malignant? Gynecol Oncol. 2006;101:315–21.PubMedCrossRefGoogle Scholar
  4. 4.
    Turkcuoglu I, Meydanli MM, Engin-Ustun Y, Ustun Y, Kafkasli A. Evaluation of histopathological features and pregnancy outcomes of pregnancy associated adnexal masses. J Obstet Gynaecol. 2009;29:107–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Giuntoli RL, Vang RS, Bristow RE. Evaluation and management of adnexal masses during pregnancy. Clin Obstet Gynecol. 2006;49:492–505.PubMedCrossRefGoogle Scholar
  6. 6.•
    Morice P, Uzan C, Gouy S, Verschraegen C, Haie-Meder C. Gynaecological cancers in pregnancy. Lancet. 2012;379:558–69. Comprehensive review on treatment of gynaecological cancers in pregnancy. This paper is part of a Series of three papers about malignancies in pregnancy.PubMedCrossRefGoogle Scholar
  7. 7.••
    Amant F., Halaska M.J., Fumagalli M., Dahl S.K., Lok C., Van C.K. et al. Gynecologic Cancers in Pregnancy: Guidelines of a Second International Consensus Meeting. Int J Gynecol Cancer. 2014. Most recent consensus guidelines composed by a multidisciplinary team of physicians specialized in treatment of cancer in pregnancy.Google Scholar
  8. 8.
    Nguyen C, Montz FJ, Bristow RE. Management of stage I cervical cancer in pregnancy. Obstet Gynecol Surv. 2000;55:633–43.PubMedCrossRefGoogle Scholar
  9. 9.
    Han SN, Lotgerink A, Gziri MM, Van CK, Hanssens M, Amant F. Physiologic variations of serum tumor markers in gynecological malignancies during pregnancy: a systematic review. BMC Med. 2012;10:86.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Moore RG, Miller MC, Eklund EE, Lu KH, Bast Jr RC, Lambert-Messerlian G. Serum levels of the ovarian cancer biomarker HE4 are decreased in pregnancy and increase with age. Am J Obstet Gynecol. 2012;206:349.e1–7.Google Scholar
  11. 11.
    Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley Jr WG, Froelich JW, et al. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol. 2007;188:1447–74.PubMedCrossRefGoogle Scholar
  12. 12.
    Balleyguier C, Fournet C, Ben HW, Zareski E, Morice P, Haie-Meder C, et al. Management of cervical cancer detected during pregnancy: role of magnetic resonance imaging. Clin Imaging. 2013;37:70–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Nijman T, Schutter E, Amant F. Sentinel node procedure in vulvar carcinoma during pregnancy: a case report. Gynecol Oncol Rep. 2012;2:63–4.CrossRefGoogle Scholar
  14. 14.
    Van Calsteren K, Heyns L, De Smet F, Van Eycken L, Gziri MM, Van Gemert W, et al. Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol. 2010;28:683–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Augustin G, Majerovic M. Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2007;131:4–12.PubMedCrossRefGoogle Scholar
  16. 16.
    Moreno-Sanz C, Pascual-Pedreno A, Picazo-Yeste JS, Seoane-Gonzalez JB. Laparoscopic appendectomy during pregnancy: between personal experiences and scientific evidence. J Am Coll Surg. 2007;205:37–42.PubMedCrossRefGoogle Scholar
  17. 17.
    Grimm D., Woelber L., Trillsch F., Keller V., Mahner S. Clinical management of epithelial ovarian cancer during pregnancy. Eur J Cancer. 2014.Google Scholar
  18. 18.
    Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A. Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg. 2012;99:1470–8.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Schmeler KM, Frumovitz M, Ramirez PT. Conservative management of early stage cervical cancer: is there a role for less radical surgery? Gynecol Oncol. 2011;120:321–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Benedet JL, Bender H, Jones III H, Ngan HY, Pecorelli S. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet. 2000;70:209–62.PubMedCrossRefGoogle Scholar
  21. 21.•
    Matsuo K., Whitman S.A., Blake E.A., Conturie C.L., Ciccone M.A., Jung C.E. et al. Feto-maternal outcome of pregnancy complicated by vulvar cancer: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol. 2014. Recent systematic review on vulvar cancer during pregnancy.Google Scholar
  22. 22.
    Kuczkowski KM. Advances in obstetric anesthesia: anesthesia for fetal intrapartum operations on placental support. J Anesth. 2007;21:243–51.PubMedCrossRefGoogle Scholar
  23. 23.
    S.C. Hughes, G. Levinson, M.A. Rosen. Shnider and Levinson’s Anesthesia for Obstetrics. 2002.Google Scholar
  24. 24.
    Evans SR, Sarani B, Bhanot P, Feldman E. Surgery in pregnancy. Curr Probl Surg. 2012;49:333–88.PubMedCrossRefGoogle Scholar
  25. 25.
    Yumi H. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy: this statement was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), September 2007. It was prepared by the SAGES Guidelines Committee. Surg Endosc. 2008;22:849–61.PubMedCrossRefGoogle Scholar
  26. 26.
    Anderka M, Mitchell AA, Louik C, Werler MM, Hernandez-Diaz S, Rasmussen SA. Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects. Birth Defects Res A Clin Mol Teratol. 2012;94:22–30.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.•
    Pasternak B, Svanstrom H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med. 2013;368:814–23. Annotation: safety of ondasetron for the fetus is studied in the largest cohort to date.PubMedCrossRefGoogle Scholar
  28. 28.
    Hernandez RK, Werler MM, Romitti P, Sun L, Anderka M. Nonsteroidal antiinflammatory drug use among women and the risk of birth defects. Am J Obstet Gynecol. 2012;206:228.PubMedCrossRefGoogle Scholar
  29. 29.
    Koren G, Florescu A, Costei AM, Boskovic R, Moretti ME. Nonsteroidal antiinflammatory drugs during third trimester and the risk of premature closure of the ductus arteriosus: a meta-analysis. Ann Pharmacother. 2006;40:824–9.PubMedCrossRefGoogle Scholar
  30. 30.•
    van Hasselt J.G., Van Calsteren K., Heyns L., Han S.N., Mhallem G.M., Schellens J.H. et al. Optimizing anti-cancer drug treatment in pregnant cancer patients: pharmacokinetic analysis of gestation-induced changes for doxorubicin, epirubicin, docetaxel and paclitaxel. Ann Oncol. 2014. Pharmacokinetics of chemotherapy during pregnancy (doxorubicin, epirubicin, docetaxel and paclitaxel), showed a decrease in drug exposure during pregnancy when compared to the nonpregnant patient.Google Scholar
  31. 31.
    Loibl S, Han SN, von Minckwitz G, Bontenbal M, Ring A, Giermek J, et al. Treatment of breast cancer during pregnancy: an observational study. Lancet Oncol. 2012;13:887–96.PubMedCrossRefGoogle Scholar
  32. 32.
    Amant F, von Minckwitz G, Han SN, Bontenbal M, Ring AE, Giermek J, et al. Prognosis of women with primary breast cancer diagnosed during pregnancy: results from an international collaborative study. J Clin Oncol. 2013;31:2532–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Ni Z, Mao Q. ATP-binding cassette efflux transporters in human placenta. Curr Pharm Biotechnol. 2011;12:674–85.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Ceckova-Novotna M, Pavek P, Staud F. P-glycoprotein in the placenta: expression, localization, regulation and function. Reprod Toxicol. 2006;22:400–10.PubMedCrossRefGoogle Scholar
  35. 35.
    Van Calsteren K, Verbesselt R, Devlieger R, De Catte L, Chai DC, Van Bree R, et al. Transplacental transfer of paclitaxel, docetaxel, carboplatin, and Trastuzumab in a baboon model. Int J Gynecol Cancer. 2010;20:1456–64.PubMedGoogle Scholar
  36. 36.
    Van Calsteren K, Verbesselt R, Ottevanger N, Halaska M, Heyns L, Van Bree R, et al. Pharmacokinetics of chemotherapeutic agents in pregnancy: a preclinical and clinical study. Acta Obstet Gynecol Scand. 2010;89:1338–45.PubMedCrossRefGoogle Scholar
  37. 37.
    Aviles A, Niz J. Long-term follow-up of children born to mothers with acute leukemia during pregnancy. Med Pediatr Oncol. 1988;16:3–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Amant F, Van Calsteren K, Halaska MJ, Gziri MM, Hui W, Lagae L, et al. Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: an observational study. Lancet Oncol. 2012;13:256–64.PubMedCrossRefGoogle Scholar
  39. 39.
    Cardonick E, Gilmandyar D, Somer RA. Maternal and neonatal outcomes of dose-dense chemotherapy for breast cancer in pregnancy. Obstet Gynecol. 2012;120:1267–72.PubMedGoogle Scholar
  40. 40.
    Abdel-Hady E, Hemida RA, Gamal A, El-Zafarany M, Toson E, El-Bayoumi MA. Cancer during pregnancy: perinatal outcome after in utero exposure to chemotherapy. Arch Gynecol Obstet. 2012;286:283–6.CrossRefGoogle Scholar
  41. 41.
    Cardonick E, Bhat A, Gilmandyar D, Somer R. Maternal and fetal outcomes of taxane chemotherapy in breast and ovarian cancer during pregnancy: case series and review of the literature. Ann Oncol. 2012;23:3016–23.PubMedCrossRefGoogle Scholar
  42. 42.
    Aviles A, Neri N. Hematological malignancies and pregnancy: a final report of 84 children who received chemotherapy in utero. Clin Lymphoma. 2001;2:173–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Hahn KM, Johnson PH, Gordon N, Kuerer H, Middleton L, Ramirez M, et al. Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer. 2006;107:1219–26.PubMedCrossRefGoogle Scholar
  44. 44.
    Aviles A, Neri N, Nambo MJ. Long-term evaluation of cardiac function in children who received anthracyclines during pregnancy. Ann Oncol. 2006;17:286–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Gziri MM, Debieve F, De Catte L, Mertens L, Barrea C, Van Calsteren K, et al. Chemotherapy during pregnancy: effect of anthracyclines on fetal and maternal cardiac function. Acta Obstet Gynecol Scand. 2012;91:1465–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Gziri MM, Hui W, Amant F, Van CK, Ottevanger N, Kapusta L, et al. Myocardial function in children after fetal chemotherapy exposure. A tissue Doppler and myocardial deformation imaging study. Eur J Pediatr. 2013;172:163–70.PubMedCrossRefGoogle Scholar
  47. 47.
    Zagouri F, Sergentanis TN, Chrysikos D, Bartsch R. Platinum derivatives during pregnancy in cervical cancer: a systematic review and meta-analysis. Obstet Gynecol. 2013;121:337–43.PubMedGoogle Scholar
  48. 48.
    Mir O, Berveiller P, Ropert S, Goffinet F, Pons G, Treluyer JM, et al. Emerging therapeutic options for breast cancer chemotherapy during pregnancy. Ann Oncol. 2008;19:607–13.PubMedCrossRefGoogle Scholar
  49. 49.
    Han SN, Amant F. Trastuzumab, lapatinib and bevacizumab during pregnancy. Breast Cancer Manag. 2014;2:5–7.CrossRefGoogle Scholar
  50. 50.
    Petrou P, Georgalas I, Giavaras G, Anastasiou E, Ntana Z, Petrou C. Early loss of pregnancy after intravitreal bevacizumab injection. Acta Ophthalmol. 2010;88:e136.PubMedCrossRefGoogle Scholar
  51. 51.
    Stensheim H, Moller B, van Dijk T, Fossa SD. Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol. 2009;27:45–51.PubMedCrossRefGoogle Scholar
  52. 52.
    Blake EA, Carter CM, Kashani BN, Kodama M, Mabuchi S, Yoshino K, et al. Feto-maternal outcomes of pregnancy complicated by ovarian sex-cord stromal tumor: a systematic review of literature. Eur J Obstet Gynecol Reprod Biol. 2014;175C:1–7.CrossRefGoogle Scholar
  53. 53.
    Chervenak FA, McCullough LB, Knapp RC, Caputo TA, Barber HR. A clinically comprehensive ethical framework for offering and recommending cancer treatment before and during pregnancy. Cancer. 2004;100:215–22.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sileny N. Han
    • 1
  • Magali Verheecke
    • 1
  • Tineke Vandenbroucke
    • 1
  • Mina Mhallem Gziri
    • 2
  • Kristel Van Calsteren
    • 3
  • Frédéric Amant
    • 1
    Email author
  1. 1.Gynecologic Oncology, University Hospitals Leuven, and Division of OncologyKU LeuvenLeuvenBelgium
  2. 2.ObstetricsCliniques Universitaires St LucBrusselsBelgium
  3. 3.PerinatalogyUniversity Hospitals LeuvenLeuvenBelgium

Personalised recommendations