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Gynäkologische Krebserkrankungen in der Schwangerschaft

Gynecological cancer during pregnancy

  • Leitthema
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Zusammenfassung

Eine gynäkologische Krebserkrankung während der Schwangerschaft ist ein große Herausforderung und es ist ein multidisziplinäres Behandlungskonzept notwendig. Diagnostik und Therapie sollten soweit wie möglich der Standardbehandlung der jeweiligen Karzinome entsprechen. Bei Zervix-, Ovarial- und Vulvakarzinomen kann ein modifiziertes chirurgisches Vorgehen versucht werden. Durch eine Chemotherapie während des 2. und 3. Trimenons wird wahrscheinlich die Rate an fetalen Missbildungen nicht erhöht. Die Geburt sollte, wenn möglich, erst nach der 35. Schwangerschaftswoche erfolgen.

Abstract

Gynecological cancer during pregnancy is a great challenge and a multidisciplinary treatment approach is necessary. Staging and treatment should follow the standard treatment of the respective type of cancer as much as possible. For cervical, ovarian and vulvar cancer a modified surgical approach should be considered. Chemotherapy during the second and third trimester probably does not increase the rate of fetal malformation. Delivery should be postponed preferably until 35 weeks of gestation are reached.

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Literatur

  1. Alexander A, Harris Rm, Grossman D et al (2004) Vulvar melanoma: diffuse melanosis and metastasis to the placenta. J Am Acad Dermatol 50:293–298

    Article  PubMed  Google Scholar 

  2. Amant F, Brepoels L, Halaska MJ et al (2010) Gynaecologic cancer complicating pregnancy: an overview. Best Pract Res 24:61–79

    Google Scholar 

  3. Amant F, Van Calsteren K, Halaska MJ et al (2009) Gynecologic cancers in pregnancy: guidelines of an international consensus meeting. Int J Gynecol Cancer 19(Suppl 1):S1–12

    Article  PubMed  Google Scholar 

  4. Bernhard Lm, Klebba Pk, Gray Dl et al (1999) Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol 93:585–589

    Article  PubMed  CAS  Google Scholar 

  5. Coles Ce, Burgess L, Tan LT (2003) An audit of delays before and during radical radiotherapy for cervical cancer – effect on tumour cure probability. Clin Oncol (R Coll Radiol, Great Britain) 15:47–54

  6. Dalrymple Jl, Gilbert WM, Leiserowitz GS et al (2005) Pregnancy-associated cervical cancer: obstetric outcomes. J Matern Fetal Neonatal Med 17:269–276

    Article  PubMed  Google Scholar 

  7. Douvier S, Filipuzzi L, Sagot P (2003) Management of cervical intra-epithelial neoplasm during pregnancy. Gynecol Obstet Fertil 31:851–855

    Article  PubMed  CAS  Google Scholar 

  8. Duggan B, Muderspach LI, Roman LD et al (1993) Cervical cancer in pregnancy: reporting on planned delay in therapy. Obstet Gynecol 82:598–602

    Article  PubMed  CAS  Google Scholar 

  9. Economos K, Perez Veridiano N, Delke I et al (1993) Abnormal cervical cytology in pregnancy: a 17-year experience. Obstet Gynecol 81:915–918

    PubMed  CAS  Google Scholar 

  10. Gao Jz (1985) Carcinoma of the uterine cervix associated with pregnancy–analysis of 458 cases. Zhonghua zhong liu za zhi (Chinese journal of oncology) 7:366–369

    Google Scholar 

  11. Gitsch G, Van Eijkeren M, Hacker NF (1995) Surgical therapy of vulvar cancer in pregnancy. Gynecol Oncol 56:312–315

    Article  PubMed  CAS  Google Scholar 

  12. Giuntoli Rl II, Vang RS, Bristow RE (2006) Evaluation and management of adnexal masses during pregnancy. Clin Obstet Gynecol 49:492–505

    Article  PubMed  Google Scholar 

  13. Goldberg Gl, Altaras MM, Block B (1991) Cone cerclage in pregnancy. Obstet Gynecol 77:315–317

    Article  PubMed  CAS  Google Scholar 

  14. Goncalves CV, Duarte G, Costa JS et al (2009) Diagnosis and treatment of cervical cancer during pregnancy. Sao Paulo Med J  127:359–365

    Article  PubMed  Google Scholar 

  15. Hannigan EV (1990) Cervical cancer in pregnancy. Clin Obstet Gynecol 33:837–845

    Article  PubMed  CAS  Google Scholar 

  16. Hoellen F, Reibke R, Hornemann K et al (2011) Cancer in pregnancy. Part I: basic diagnostic and therapeutic principles and treatment of gynecological malignancies. Arch Gynecol Obstet 285:195–205

    Article  PubMed  Google Scholar 

  17. Hunter MI, Monk BJ, Tewari KS (2008) Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease. Am J Obstet Gynecol 199:3–9

    Article  PubMed  Google Scholar 

  18. Hunter MI, Tewari K, Monk BJ (2008) Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease. Am J Obstet Gynecol 199:10–18

    Article  PubMed  Google Scholar 

  19. Ishioka S, Hayashi T, Endo T et al (2007) Advanced epithelial ovarian carcinoma during pregnancy. Int J Clin Oncol/Japan Society of Clinical Oncology 12:375–378

    Google Scholar 

  20. Kobayashi F, Sagawa N, Nakamura K et al (1989) Mechanism and clinical significance of elevated CA 125 levels in the sera of pregnant women. Am J Obstet Gynecol 160:563–566

    PubMed  CAS  Google Scholar 

  21. Lee GS, Hur SY, Shin JC et al (2004) Elective vs. conservative management of ovarian tumors in pregnancy. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 85:250–254

  22. Lee RB, Neglia W, Park RC (1981) Cervical carcinoma in pregnancy. Obstet Gynecol 58:584–589

    PubMed  CAS  Google Scholar 

  23. Lowe SA (2004) Diagnostic radiography in pregnancy: risks and reality. Aust N Z J Obstet Gynaecol 44:191–196

    Article  PubMed  Google Scholar 

  24. Machado F, Vegas C, Leon J et al (2007) Ovarian cancer during pregnancy: analysis of 15 cases. Gynecol Oncol 105:446–450

    Article  PubMed  Google Scholar 

  25. Madeleine MM, Daling JR, Carter JJ et al. (1997) Cofactors with human papillomavirus in a population-based study of vulvar cancer. J Natl Cancer Inst 89:1516–1523

    Article  PubMed  CAS  Google Scholar 

  26. Mccollough CH, Schueler BA, Atwell TD et al (2007) Radiation exposure and pregnancy: when should we be concerned? Radiographics 27:909–917 (discussion 917–908)

    Article  PubMed  Google Scholar 

  27. Milad MP, Olson E (1999) Factors that increase the risk of leakage during surgical removal of benign cystic teratomas. Hum Reprod (Oxford, England) 14:2264–2267

    Google Scholar 

  28. Monk BJ, Montz FJ (1992) Invasive cervical cancer complicating intrauterine pregnancy: treatment with radical hysterectomy. Obstet Gynecol 80:199–203

    PubMed  CAS  Google Scholar 

  29. Moran BJ, Yano H, Al Zahir N et al (2007) Conflicting priorities in surgical intervention for cancer in pregnancy. Lancet Oncol 8:536–544

    Article  PubMed  Google Scholar 

  30. Muller CY, Smith HO (2005) Cervical neoplasia complicating pregnancy. Obstet Gynecol Clin North Am 32:533–546

    Article  PubMed  Google Scholar 

  31. Nagayama M, Watanabe Y, Okumura A et al (2002) Fast MR imaging in obstetrics. Radiographics 22:563–580 (discussion 580–562)

    PubMed  Google Scholar 

  32. Nguyen C, Montz FJ, Bristow RE (2000) Management of stage I cervical cancer in pregnancy. Obstet Gynecol Surv 55:633–643

    Article  PubMed  CAS  Google Scholar 

  33. Ni Mhuireachtaigh R, O’gorman Da (2006) Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth 18:60–66

    Article  Google Scholar 

  34. Niloff Jm, Knapp RC, Schaetzl E et al (1984) CA125 antigen levels in obstetric and gynecologic patients. Obstet Gynecol 64:703–707

    PubMed  CAS  Google Scholar 

  35. Oehler MK, Wain GV, Brand A (2003) Gynaecological malignancies in pregnancy: a review. Aust N Z J Obstet Gynaecol 43:414–420

    Article  PubMed  Google Scholar 

  36. Ogunleye D, Lewin SN, Huettner P et al (2004) Recurrent vulvar carcinoma in pregnancy. Gynecol Oncol 95:400–401

    Article  PubMed  Google Scholar 

  37. Palle C, Bangsboll S, Andreasson B (2000) Cervical intraepithelial neoplasia in pregnancy. Acta Obstet Gynecol Scand 79:306–310

    Article  PubMed  CAS  Google Scholar 

  38. Palmer J, Vatish M, Tidy J (2009) Epithelial ovarian cancer in pregnancy: a review of the literature. BJOG 116:480–491

    Article  PubMed  CAS  Google Scholar 

  39. Pavlidis NA (2002) Coexistence of pregnancy and malignancy. Oncologist 7:279–287

    Article  PubMed  Google Scholar 

  40. Pereg D, Koren G, Lishner M (2008) Cancer in pregnancy: gaps, challenges and solutions. Cancer Treat Rev 34:302–312

    Article  PubMed  Google Scholar 

  41. Plante M, Lau S, Brydon L et al (2006) Neoadjuvant chemotherapy followed by vaginal radical trachelectomy in bulky stage IB1 cervical cancer: case report. Gynecol Oncol 101:367–370

    Article  PubMed  Google Scholar 

  42. Platek DN, Henderson CE, Goldberg GL (1995) The management of a persistent adnexal mass in pregnancy. Am J Obstet Gynecol 173:1236–1240

    Article  PubMed  CAS  Google Scholar 

  43. Prem KA, Makowski EL, Mckelvey JL (1966) Carcinoma of the cervix associated with pregnancy. Am J Obstet Gynecol 95:99–108

    PubMed  CAS  Google Scholar 

  44. Robinson WR, Webb S, Tirpack J et al (1997) Management of cervical intraepithelial neoplasia during pregnancy with LOOP excision. Gynecol Oncol 64:153–155

    Article  PubMed  CAS  Google Scholar 

  45. Robova H, Pluta M, Hrehorcak M et al (2008) High-dose density chemotherapy followed by simple trachelectomy: full-term pregnancy. Int J Gynecol Cancer 18:1367–1371

    Article  PubMed  CAS  Google Scholar 

  46. Serati M, Uccella S, Laterza RM et al (2008) Natural history of cervical intraepithelial neoplasia during pregnancy. Acta Obstet Gynecol Scand 87:1296–1300

    Article  PubMed  Google Scholar 

  47. Shibahara H, Shigeta M, Toji H et al (1999) Successful pregnancy in an infertile patient with conservatively treated endometrial adenocarcinoma after transfer of embryos obtained by intracytoplasmic sperm injection. Hum Reprod (Oxford, England) 14:1908–1911

    Google Scholar 

  48. Siristatidis C, Vitoratos N, Michailidis E et al (2002) The role of the mode of delivery in the alteration of intrapartum pathological cervical cytologic findings during the postpartum period. Eur J Gynaecol Oncol 23:358–360

    PubMed  Google Scholar 

  49. Smith LH, Dalrymple JL, Leiserowitz GS et al (2001) Obstetrical deliveries associated with maternal malignancy in California, 1992 through 1997. Am J Obstet Gynecol 184:1504–1512 (discussion 1512–1503)

    Article  PubMed  CAS  Google Scholar 

  50. Sood AK, Shahin MS, Sorosky JI (2001) Paclitaxel and platinum chemotherapy for ovarian carcinoma during pregnancy. Gynecol Oncol 83:599–600

    Article  PubMed  CAS  Google Scholar 

  51. Sood AK, Sorosky JI, Mayr N et al (1997) Radiotherapeutic management of cervical carcinoma that complicates pregnancy. Cancer 80:1073–1078

    Article  PubMed  CAS  Google Scholar 

  52. Stensheim H, Moller B, Van Dijk T et al (2009) Cause-specific survival for women diagnosed with cancer during pregnancy or lactation: a registry-based cohort study. J Clin Oncol 27:45–51

    Article  PubMed  Google Scholar 

  53. Stroup AM, Harlan LC, Trimble EL (2008) Demographic, clinical, and treatment trends among women diagnosed with vulvar cancer in the United States. Gynecol Oncol 108:577–583

    Article  PubMed  CAS  Google Scholar 

  54. Takushi M, Moromizato H, Sakumoto K et al (2002) Management of invasive carcinoma of the uterine cervix associated with pregnancy: outcome of intentional delay in treatment. Gynecol Oncol 87:185–189

    Article  PubMed  Google Scholar 

  55. Tewari K, Brewer C, Cappuccini F et al (1997) Advanced-stage small cell carcinoma of the ovary in pregnancy: long-term survival after surgical debulking and multiagent chemotherapy. Gynecol Oncol 66:531–534

    Article  PubMed  CAS  Google Scholar 

  56. Ungar L, Smith JR, Palfalvi L et al (2006) Abdominal radical trachelectomy during pregnancy to preserve pregnancy and fertility. Obstet Gynecol 108:811–814

    Article  PubMed  Google Scholar 

  57. Vaccarello L, Apte SM, Copeland LJ et al (1999) Endometrial carcinoma associated with pregnancy: a report of three cases and review of the literature. Gynecol Oncol 74:118–122

    Article  PubMed  CAS  Google Scholar 

  58. Van Calsteren K, Vergote I, Amant F (2005) Cervical neoplasia during pregnancy: diagnosis, management and prognosis. Best Pract Res 19:611–630

    Article  Google Scholar 

  59. Van De Nieuwenhof HP, Van Ham MA, Lotgering FK et al (2008) First case of vaginal radical trachelectomy in a pregnant patient. Int J Gynecol Cancer 18:1381–1385

    Article  Google Scholar 

  60. Van Den Broek NR, Lopes AD, Ansink A et al (1995) „Microinvasive“ adenocarcinoma of the cervix implanting in an episiotomy scar. Gynecol Oncol 59:297–299

    Article  Google Scholar 

  61. Van Vliet W, Van Loon AJ, Ten Hoor KA et al (1998) Cervical carcinoma during pregnancy: outcome of planned delay in treatment. Eur J Obstet Gynecol Reprod Biol 79:153–157

    Article  Google Scholar 

  62. Wall JA, Lucci JA Jr (1953) Adenocarcinoma of the corpus uteri and pelvic tuberculosis complicating pregnancy; report of case with delivery of live infant and successful recovery. Obstet Gynecol 2:629–635

    PubMed  CAS  Google Scholar 

  63. Webb JA, Thomsen HS, Morcos SK (2005) The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 15:1234–1240

    Article  PubMed  Google Scholar 

  64. Whitecar MP, Turner S, Higby MK (1999) Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol 181:19–24

    Article  PubMed  CAS  Google Scholar 

  65. Wright TC Jr, Massad LS, Dunton CJ et al (2007) 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 197:346–355

    Article  PubMed  Google Scholar 

  66. Wyatt RM, Beddoe AH, Dale RG (2003) The effects of delays in radiotherapy treatment on tumour control. Phys Med Biol 48:139–155

    Article  PubMed  CAS  Google Scholar 

  67. Yaghoobi M, Koren G, Nulman I (2009) Challenges to diagnosing colorectal cancer during pregnancy. Can Fam Physician 55:881–885

    PubMed  Google Scholar 

  68. Yahata T, Numata M, Kashima K et al (2008) Conservative treatment of stage IA1 adenocarcinoma of the cervix during pregnancy. Gynecol Oncol 109:49–52

    Article  PubMed  Google Scholar 

  69. Yost NP, Santoso JT, Mcintire DD et al (1999) Postpartum regression rates of antepartum cervical intraepithelial neoplasia II and III lesions. Obstet Gynecol 93:359–362

    Article  PubMed  CAS  Google Scholar 

  70. Zemlickis D, Lishner M, Degendorfer P et al (1991) Maternal and fetal outcome after invasive cervical cancer in pregnancy. J Clin Oncol 9:1956–1961

    PubMed  CAS  Google Scholar 

  71. Zhao XY, Huang HF, Lian LJ et al (2006) Ovarian cancer in pregnancy: a clinicopathologic analysis of 22 cases and review of the literature. Int J Gynecol Cancer 16:8–15

    Article  PubMed  CAS  Google Scholar 

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  1. Allgemeine Gynäkologie/Gynäkologische Onkologie, Universitäts-Frauenklinik, Hugstetter Straße 55, 79106, Freiburg, Deutschland

    A. Hasenburg & B. Rautenberg

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  1. A. Hasenburg
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  2. B. Rautenberg
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Correspondence to A. Hasenburg.

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Hasenburg, A., Rautenberg, B. Gynäkologische Krebserkrankungen in der Schwangerschaft. Onkologe 18, 330–337 (2012). https://doi.org/10.1007/s00761-012-2217-y

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