Archives of Gynecology and Obstetrics

, Volume 285, Issue 1, pp 195–205 | Cite as

Cancer in pregnancy. Part I: basic diagnostic and therapeutic principles and treatment of gynecological malignancies

  • Friederike Hoellen
  • Roland Reibke
  • Katrin Hornemann
  • Marc Thill
  • Doerte W. Luedders
  • Katharina Kelling
  • Amadeus Hornemann
  • Michael K. Bohlmann
Gynecologic Oncology



Cancer in pregnancy is a rare circumstance. However, the coincidence of pregnancy and malignancy is supposed to increase due to a general tendency of postponing childbearing to older age. To date, clinical guidelines are scarce and experience regarding therapeutic management is limited to case reports.


This review focuses on general diagnostic and therapeutic principles including systemic therapy for malignancies in pregnancy.


In part I, we report on diagnosis and therapy of gynecological tumors.


The diagnosis of gestational cancer faces both oncologist and obstetrician to the dilemma of applying appropriate diagnostic techniques and adequate local and systemic therapy to an expectant mother without harming the fetus.


Cancer Malignancy Pregnancy Chemotherapy Radiotherapy Fetus 


  1. 1.
    Azim HA Jr, Azim H, Peccatori FA (2010) Treatment of cancer during pregnancy with monoclonal antibodies: a real challenge. Expert Rev Clin Immunol 6(6):821–826PubMedCrossRefGoogle Scholar
  2. 2.
    Surbone A, Peccatori F, Pavlidis N (2008) Why is the topic of cancer and pregnancy so important? Why and how to read this book. Recent Results Cancer Res 178:1–2PubMedCrossRefGoogle Scholar
  3. 3.
    Pavlidis NA (2000) Cancer and pregnancy. Ann Oncol 11(Suppl 3):247–253PubMedCrossRefGoogle Scholar
  4. 4.
    Pentheroudakis G (2008) Cancer and pregnancy. Ann Oncol 19(Suppl 5):v38–v39PubMedCrossRefGoogle Scholar
  5. 5.
    Pentheroudakis G et al (2010) Cancer, fertility and pregnancy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v266–v273PubMedCrossRefGoogle Scholar
  6. 6.
    Sarandakou A, Protonotariou E, Rizos D (2007) Tumor markers in biological fluids associated with pregnancy. Crit Rev Clin Lab Sci 44(2):151–178PubMedCrossRefGoogle Scholar
  7. 7.
    Patel SJ et al (2007) Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 27(6):1705–1722PubMedCrossRefGoogle Scholar
  8. 8.
    Luis SA et al (2009) Pregnancy and radiotherapy: management options for minimising risk, case series and comprehensive literature review. J Med Imaging Radiat Oncol 53(6):559–568PubMedCrossRefGoogle Scholar
  9. 9.
    Azim HA Jr, Peccatori FA, Pavlidis N (2010) Treatment of the pregnant mother with cancer: a systematic review on the use of cytotoxic, endocrine, targeted agents and immunotherapy during pregnancy. Part I: solid tumors. Cancer Treat Rev 36(2):101–109PubMedCrossRefGoogle Scholar
  10. 10.
    Doll DC, Ringenberg QS, Yarbro JW (1989) Antineoplastic agents and pregnancy. Semin Oncol 16(5):337–346PubMedGoogle Scholar
  11. 11.
    Rizack T et al (2009) Management of hematological malignancies during pregnancy. Am J Hematol 84(12):830–841PubMedCrossRefGoogle Scholar
  12. 12.
    Peccatori F et al (2004) Chemotherapy during pregnancy: what is really safe? Lancet Oncol 5(7):398PubMedCrossRefGoogle Scholar
  13. 13.
    Loibl S et al (2006) Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer 106(2):237–246PubMedCrossRefGoogle Scholar
  14. 14.
    Pereg D, Koren G, Lishner M (2007) The treatment of Hodgkin’s and non-Hodgkin’s lymphoma in pregnancy. Haematologica 92(9):1230–1237PubMedCrossRefGoogle Scholar
  15. 15.
    Azim HA Jr, Peccatori FA, Pavlidis N (2010) Lung cancer in the pregnant woman: to treat or not to treat, that is the question. Lung Cancer 67(3):251–256PubMedCrossRefGoogle Scholar
  16. 16.
    Abellar RG et al (2009) Effects of chemotherapy during pregnancy on the placenta. Pediatr Dev Pathol 12(1):35–41PubMedCrossRefGoogle Scholar
  17. 17.
    Van Calsteren K et al (2010) Pharmacokinetics of chemotherapeutic agents in pregnancy: a preclinical and clinical study. Acta Obstet Gynecol Scand 89(10):1338–1345PubMedCrossRefGoogle Scholar
  18. 18.
    Schönborn I (2009) Malignant diseases in pregnancy Gynakol Geburtsmed Gynakol. Endokrinol 5(2):114–125Google Scholar
  19. 19.
    Germann N, Goffinet F, Goldwasser F (2004) Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients. Ann Oncol 15(1):146–150PubMedCrossRefGoogle Scholar
  20. 20.
    Grohard P et al (1989) Transplacental passage of doxorubicin. J Gynecol Obstet Biol Reprod (Paris) 18(5):595–600Google Scholar
  21. 21.
    Mir O et al (2008) Chemotherapy for breast cancer during pregnancy: is epirubicin safe? Ann Oncol 19(10):1814–1815PubMedCrossRefGoogle Scholar
  22. 22.
    Espie M, Cuvier C (1998) Treating breast cancer during pregnancy. What can be taken safely? Drug Saf 18(2):135–142PubMedCrossRefGoogle Scholar
  23. 23.
    Mir O et al (2008) Use of platinum derivatives during pregnancy. Cancer 113(11):3069–3074PubMedCrossRefGoogle Scholar
  24. 24.
    Serkies K, Wegrzynowicz E, and Jassem E (2011) Paclitaxel and cisplatin chemotherapy for ovarian cancer during pregnancy: case report and review of the literature. Arch Gynecol ObstetGoogle Scholar
  25. 25.
    Hahn KM et al (2006) Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer 107(6):1219–1226PubMedCrossRefGoogle Scholar
  26. 26.
    Mir O et al (2008) Emerging therapeutic options for breast cancer chemotherapy during pregnancy. Ann Oncol 19(4):607–613PubMedCrossRefGoogle Scholar
  27. 27.
    Pigeau H et al (2005) Management of rectal cancer in pregnant women. Bull Cancer 92(11):953–958PubMedGoogle Scholar
  28. 28.
    Enns GM et al (1999) Apparent cyclophosphamide (cytoxan) embryopathy: a distinct phenotype? Am J Med Genet 86(3):237–241PubMedCrossRefGoogle Scholar
  29. 29.
    Ghaemmaghami F, Abbasi F, Abadi AG (2009) A favorable maternal and neonatal outcome following chemotherapy with etoposide, bleomycin, and cisplatin for management of grade 3 immature teratoma of the ovary. J Gynecol Oncol 20(4):257–259PubMedCrossRefGoogle Scholar
  30. 30.
    Rosen E, Rubowitz A, Ferencz JR (2009) Exposure to verteporfin and bevacizumab therapy for choroidal neovascularization secondary to punctate inner choroidopathy during pregnancy. Eye (Lond) 23(6):1479CrossRefGoogle Scholar
  31. 31.
    Wu Z, Huang J, Sadda S (2010) Inadvertent use of bevacizumab to treat choroidal neovascularisation during pregnancy: a case report. Ann Acad Med Singapore 39(2):143–145PubMedGoogle Scholar
  32. 32.
    Zambelli A et al (2008) Erlotinib administration for advanced non-small cell lung cancer during the first 2 months of unrecognized pregnancy. Lung Cancer 60(3):455–457PubMedCrossRefGoogle Scholar
  33. 33.
    Pye SM et al (2008) The effects of imatinib on pregnancy outcome. Blood 111(12):5505–5508PubMedCrossRefGoogle Scholar
  34. 34.
    Cleator SJ et al (2009) A 2009 update on the treatment of patients with hormone receptor-positive breast cancer. Clin Breast Cancer 9(Suppl 1):S6–S17PubMedCrossRefGoogle Scholar
  35. 35.
    Illidge TM, Hussey M, Godden CW (1996) Malignant hypercalcaemia in pregnancy and antenatal administration of intravenous pamidronate. Clin Oncol (R Coll Radiol) 8(4):257–258CrossRefGoogle Scholar
  36. 36.
    Culbert EC, Schfirin BS (2006) Malignant hypercalcemia in pregnancy: effect of pamidronate on uterine contractions. Obstet Gynecol 108(3 Pt 2):789–791PubMedCrossRefGoogle Scholar
  37. 37.
    Yaghoobi M, Koren G, Nulman I (2009) Challenges to diagnosing colorectal cancer during pregnancy. Can Fam Physician 55(9):881–885PubMedGoogle Scholar
  38. 38.
    Stensheim H (2009) Malignant melanoma and pregnancy. Onkologie 32(12):715–716PubMedCrossRefGoogle Scholar
  39. 39.
    Vannucchi G et al (2010) Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy. Eur J Endocrinol 162(1):145–151PubMedCrossRefGoogle Scholar
  40. 40.
    Khochikar MV (2010) Management of urological cancers during pregnancy. Nat Rev Urol 7(4):195–205PubMedCrossRefGoogle Scholar
  41. 41.
    Merimsky O et al (1999) Management of cancer in pregnancy: a case of Ewing’s sarcoma of the pelvis in the third trimester. Ann Oncol 10(3):345–350PubMedCrossRefGoogle Scholar
  42. 42.
    Goncalves CV et al (2009) Diagnosis and treatment of cervical cancer during pregnancy. Sao Paulo Med J 127(6):359–365PubMedCrossRefGoogle Scholar
  43. 43.
    Morice P et al (2009) French recommendations on the management of invasive cervical cancer during pregnancy. Int J Gynecol Cancer 19(9):1638–1641PubMedCrossRefGoogle Scholar
  44. 44.
    Marret H et al (2010) Guidelines for the management of ovarian cancer during pregnancy. Eur J Obstet Gynecol Reprod Biol 149(1):18–21PubMedCrossRefGoogle Scholar
  45. 45.
    Pentheroudakis G, Pavlidis N (2006) Cancer and pregnancy: poena magna, not anymore. Eur J Cancer 42(2):126–140PubMedCrossRefGoogle Scholar
  46. 46.
    Sayedur Rahman M et al (2002) Ovarian carcinoma associated with pregnancy. A review of 9 cases. Acta Obstet Gynecol Scand 81(3):260–264PubMedGoogle Scholar
  47. 47.
    Zanotti KM, Belinson JL, Kennedy AW (2000) Treatment of gynecologic cancers in pregnancy. Semin Oncol 27(6):686–698PubMedGoogle Scholar
  48. 48.
    Dgani R et al (1989) Ovarian carcinoma during pregnancy: a study of 23 cases in Israel between the years 1960 and 1984. Gynecol Oncol 33(3):326–331PubMedCrossRefGoogle Scholar
  49. 49.
    Zhao XY et al (2006) Ovarian cancer in pregnancy: a clinicopathologic analysis of 22 cases and review of the literature. Int J Gynecol Cancer 16(1):8–15PubMedCrossRefGoogle Scholar
  50. 50.
    Boulay R, Podczaski E (1998) Ovarian cancer complicating pregnancy. Obstet Gynecol Clin North Am 25(2):385–399PubMedCrossRefGoogle Scholar
  51. 51.
    Hermans RH et al (2003) Adnexal masses in pregnancy. Onkologie 26(2):167–172PubMedCrossRefGoogle Scholar
  52. 52.
    Cardonick E, Iacobucci A (2004) Use of chemotherapy during human pregnancy. Lancet Oncol 5(5):283–291PubMedCrossRefGoogle Scholar
  53. 53.
    Sood AK, Shahin MS, Sorosky JI (2001) Paclitaxel and platinum chemotherapy for ovarian carcinoma during pregnancy. Gynecol Oncol 83(3):599–600PubMedCrossRefGoogle Scholar
  54. 54.
  55. 55.
    Vaccarello L et al (1999) Endometrial carcinoma associated with pregnancy: a report of three cases and review of the literature. Gynecol Oncol 74(1):118–122PubMedCrossRefGoogle Scholar
  56. 56.
    Schammel DP et al (1998) Endometrial adenocarcinoma associated with intrauterine pregnancy. A report of five cases and a review of the literature. Int J Gynecol Pathol 17(4):327–335PubMedCrossRefGoogle Scholar
  57. 57.
    Ayhan A et al (1999) Endometrial adenocarcinoma in pregnancy. Gynecol Oncol 75(2):298–299PubMedCrossRefGoogle Scholar
  58. 58.
    Schneller JA, Nicastri AD (1994) Intrauterine pregnancy coincident with endometrial carcinoma: a case study and review of the literature. Gynecol Oncol 54(1):87–90PubMedCrossRefGoogle Scholar
  59. 59.
    Zirkin HJ, Krugliak L, Katz M (1983) Endometrial adenocarcinoma coincident with intrauterine pregnancy. A case report. J Reprod Med 28(9):624–626PubMedGoogle Scholar
  60. 60.
    Regan MA, Rosenzweig BA (1993) Vulvar carcinoma in pregnancy: a case report and literature review. Am J Perinatol 10(4):334–335PubMedCrossRefGoogle Scholar
  61. 61.
    Heller DS et al (2000) Pregnancy-associated invasive squamous cell carcinoma of the vulva in a 28 year-old, HIV-negative woman. A case report. J Reprod Med 45(8):659–661PubMedGoogle Scholar
  62. 62.
    Ogunleye D et al (2004) Recurrent vulvar carcinoma in pregnancy. Gynecol Oncol 95(2):400–401PubMedCrossRefGoogle Scholar
  63. 63.
    Couvreux-Dif D et al (2003) Cancer of the vulva and pregnancy: two cases and review of the literature. J Gynecol Obstet Biol Reprod (Paris) 32(1):46–50Google Scholar
  64. 64.
    Gitsch G, van Eijkeren M, Hacker NF (1995) Surgical therapy of vulvar cancer in pregnancy. Gynecol Oncol 56(2):312–315PubMedCrossRefGoogle Scholar
  65. 65.
    Creasman WT (2005) Vaginal cancers. Curr Opin Obstet Gynecol 17(1):71–76PubMedGoogle Scholar
  66. 66.
    Baruah N, Sangupta S (1973) Primary carcinoma of vagina complicating pregnancy. J Indian Med Assoc 60(12):469–470PubMedGoogle Scholar
  67. 67.
    Church E et al (2010) An unusual case of vaginal leiomyosarcoma in pregnancy. J Obstet Gynaecol 30(7):736–737PubMedCrossRefGoogle Scholar
  68. 68.
    Collins CG, Barclay DL (1963) Cancer of the vulva, and cancer of the vagina in pregnancy. Clin Obstet Gynecol 30:927–942PubMedCrossRefGoogle Scholar
  69. 69.
    Giordano G et al (2010) Primary adenocarcinoma of the rectovaginal septum arising in pregnancy in the absence of endometriosis. Eur J Gynaecol Oncol 31(2):211–213PubMedGoogle Scholar
  70. 70.
    Lutz MH et al (1977) Genital malignancy in pregnancy. Am J Obstet Gynecol 129(5):536–542PubMedGoogle Scholar
  71. 71.
    Palumbo L Jr et al (1969) Primary carcinoma of the vagina. South Med J 62(9):1048–1053PubMedCrossRefGoogle Scholar
  72. 72.
    Steed HL et al (2002) Invasive squamous cell carcinoma of the vagina during pregnancy. Obstet Gynecol 100(5 Pt 2):1105–1108PubMedCrossRefGoogle Scholar
  73. 73.
    Roth GLU (2004) Vaginal cancer during pregnancy. Gynäkologe 37:514–518Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Friederike Hoellen
    • 1
  • Roland Reibke
    • 2
  • Katrin Hornemann
    • 3
  • Marc Thill
    • 1
  • Doerte W. Luedders
    • 1
  • Katharina Kelling
    • 1
  • Amadeus Hornemann
    • 4
  • Michael K. Bohlmann
    • 1
  1. 1.Department of Obstetrics and GynecologyUniversity Hospital of Schleswig–HolsteinLuebeckGermany
  2. 2.Department of Internal Medicine III; Klinikum GrosshadernLudwigs-Maximilians-University of MunichMunichGermany
  3. 3.Department of Thoracic Surgery, ThoraxklinikUniversity of HeidelbergHeidelbergGermany
  4. 4.Department of Obstetrics and GynecologyUniversity Medical Center Mannheim, University of HeidelbergMannheimGermany

Personalised recommendations