Ovarian Cancer in Pregnancy

Abstract

Ovarian cancer is extremely rare in pregnancy, but should be always considered when complex cysts are present and persist, especially when ascites and extra-ovarian nodularity are present. While epithelial cancer of the ovary is most common, germ cell and stromal cancers may also arise. In the absence of a true emergency, such as torsion, surgery should be delayed until the second trimester. If a cancer is discovered, a full staging should be carried out unless, in the opinion of the surgeon, certain procedures would be too dangerous at that time. The additional surgery can always be done if a cesarean section is indicated, or electively after a vaginal delivery and following the conclusion of chemotherapy. If chemotherapy is indicated, it should be started during the pregnancy, using the same regimen and doses that would be given in the nonpregnant state. Carboplatin and paclitaxel are the drugs most often used, and complications of these drugs are not more common in patients who are pregnant. Although there are case reports of the harmful effects of chemotherapy on the fetus, most of the time the drugs are well tolerated by the baby, who is usually born without any side effects secondary to chemotherapy.

It is not uncommon for a woman who develops ovarian cancer during her pregnancy to suffer from a form of post-traumatic stress disorder. This condition should be anticipated by the health-care team, and appropriate counseling must be provided. Pregnancy does not augur for a poorer outcome; indeed, the common use of ultrasound early in pregnancy may allow for earlier detection and a more favorable outcome.