open access: Managing pregnant women with cancer: personal considerations and a review of the literature

selected section: 

Gynecological tumours

Cervical and less commonly ovarian cancers have been diagnosed in women during their pregnancy course. Given their anatomical location, their treatment represents a major challenge. Pelvic surgery remains very challenging during pregnancy as the access is impaired and thus an optimum oncological resection is technically very difficult to achieve [19]. Thus, surgery should not be considered outside centres with experience dealing with pregnant cancer patients. Pelvic radiotherapy should be avoided during gestation, as the risk of foetal loss or malformations are significant [8]. Elective abortion should thus be considered during the first trimester, if the clinical situation mandates a prompt treatment.

A recent systematic review has identified 16, 18, and 20 patients treated with chemotherapy for cervical, non-epithelial and epithelial ovarian cancer, respectively [8]. Concomitant cisplatin and radiotherapy was frequently considered in cervical cancer patients, but spontaneous abortion was encountered in all patients exposed to radiotherapy; cases treated with weekly cisplatin alone had a normal pregnancy outcome. For non-epithelial ovarian cancer, 15/18 cases did not show any signs of pregnancy complications. In the remaining three cases, pregnancy complications were successfully managed with no foetal abnormalities documented. The most frequently used regimen was BEP (bleomycin, etoposide, and cisplatin), which is also considered as the gold standard treatment for non-pregnant women. The combination of paclitaxel and carboplatin was also frequently reported in managing epithelial ovarian cancer during pregnancy, with no serious complications reported.