Clinical and Translational Oncology

, Volume 15, Issue 4, pp 259–264 | Cite as

Therapeutic management of epithelial ovarian cancer during pregnancy

  • L. Minig
  • L. Otaño
  • I. Diaz-Padilla
  • R. Alvarez Gallego
  • M. G. PatronoEmail author
  • J. Valero de Bernabé
Educational Series – Red Series NEW TRENDS IN CLINICAL ONCOLOGY


Epithelial ovarian cancer (EOC) during pregnancy is a rare condition. The diagnosis and treatment strategies are therefore not well defined. The evidence is scarce and limited to small case reports or case series. In this review we describe the safety, utility and limitations of each diagnostic tool and surgical procedure in pregnant women with ovarian cancer. We also discuss the role of chemotherapy for ovarian cancer during pregnancy. Finally, we delineate different strategies of treatment according to the stage of the disease at diagnosis and gestational age. Due to the complexity of the management of EOC during pregnancy, patients should be referred to specialized centers. Gestational age at diagnosis, the initial surgical procedure, disease stage and patient’s preferences are the key factors in the decision-making process to establish the best treatment strategy for each individual case.


Ovarian cancer Pregnancy Adnexal mass Chemotherapy Laparoscopy Laparotomy 


Conflict of interest



  1. 1.
    Morice P, Uzan C, Gouy S, Verschraegen C, Haie-Meder C (2012) Gynaecological cancer in pregnancy. Lancet 379:558–569PubMedCrossRefGoogle Scholar
  2. 2.
    Malfetano JH, Goldkrand JW (1990) Cis-platinum combination chemotherapy during pregnancy for advanced epithelial ovarian carcinoma. Obstet Gynecol 75:545–547PubMedGoogle Scholar
  3. 3.
    Creasman WT, Rutledge F, Smith JP (1971) Carcinoma of the ovary associated with pregnancy. Obstet Gynecol 38:111–116PubMedGoogle Scholar
  4. 4.
    Copeland LJ, London MB (1996) Malignant disease in pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL (eds) Obstetrics, normal, and problem pregnancies, 3rd edn. Churchill Livingstone, New York, pp 1155–1181Google Scholar
  5. 5.
    Palmer J, Vatish M, Tidy J (2009) Epithelial ovarian cancer in pregnancy: a review of the literature. BJOG 116:480–491PubMedCrossRefGoogle Scholar
  6. 6.
    Kobayashi F, Sagawa N, Nakamura K, Nonogaki M, Ban C, Fujii S, Mori T (1989) Mechanism and clinical significance of elevated CA 125 levels in the sera of pregnant women. Am J Obstet Gynecol 160:563–566PubMedGoogle Scholar
  7. 7.
    Halila H, Stenman U, Seppalla M (1986) Ovarian cancer antigen CA 125 levels in pelvic inflammatory disease and pregnancy. Cancer 57:1327–1329PubMedCrossRefGoogle Scholar
  8. 8.
    American College of Obstetricians and Gynecologists. ACOG committee Opinion No 299 (2004) Guidelines for diagnostic imaging during pregnancy. Obstet Gynecol 104:647–651CrossRefGoogle Scholar
  9. 9.
    Amant F, Van Calsteren K, Halaska MJ, Beijnen J, Lagae L, Hanssens M et al (2009) Gynecologic cancers in pregnancy: guidelines of an international consensus meeting. Int J Gynecol Cancer 19(Suppl 1):S1–S12PubMedCrossRefGoogle Scholar
  10. 10.
    Brenner DJ, Hall EJ (2007) Computed tomography an increasing source of radiation exposure. N Engl J Med 357:2277–2284PubMedCrossRefGoogle Scholar
  11. 11.
    Zanotti-Fregonara P, Jan S, Taieb D et al (2010) Absorbed 18F-FDG dose to the fetus during early pregnancy. J Nucl Med 51:803–805PubMedCrossRefGoogle Scholar
  12. 12.
    Zanotti-Fregonara P, Champion C, Trébossen R, Maroy R, Devaux JY, Hindié E (2008) Stimulation of the beta+ dose to the embryo resulting from 18F-FDG administration during early pregnancy. J Nucl Med 49:679–682PubMedCrossRefGoogle Scholar
  13. 13.
    Reedy MB, Källén B, Kuehl TJ (1997) Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol 177:673–679PubMedCrossRefGoogle Scholar
  14. 14.
    Akira S, Yamanaka A, Ishihara T, Takeshita T, Araki T (1999) Gasless laparoscopic ovarian cystectomy during pregnancy: comparison with laparotomy. Am J Obstet Gynecol 180:554–557PubMedCrossRefGoogle Scholar
  15. 15.
    Friedman JD, Ramsey PS, Ramin KD et al (2002) Pneumoamnion and pregnancy loss after second-trimester laparoscopic surgery. Obstet Gynecol 299:512–513CrossRefGoogle Scholar
  16. 16.
    Sayedur Rahman M, Al-Sibai MH, Rahman J, Al-Suleiman SA, El-Yahia AR, Al-Mulhim AA et al (2002) Ovarian carcinoma associated with pregnancy. A review of 9 cases. Acta Obstet Gynecol Scand 81:260–264PubMedCrossRefGoogle Scholar
  17. 17.
    Ferrandina G, Distefano M, Testa A, De Vincenzo R, Scambia G (2005) Management of an advanced ovarian cancer at 15 weeks of gestation: case report and literature review. Gynecol Oncol 97:693–696PubMedCrossRefGoogle Scholar
  18. 18.
    Stuart GC, Kitchener H, Bacon M, duBois A, Friedlander M, Ledermann J, Marth C, Thigpen T, Trimble E, Participants of 4th Ovarian Cancer Consensus Conference (OCCC), Gynecologic Cancer Intergroup (2011) 2010 gynecologic cancer intergroup (GCIG) consensus statement on clinical trials in ovarian cancer: report from the fourth ovarian cancer consensus conference. Int J Gynecol Cancer 21(4):750–755Google Scholar
  19. 19.
    Mercer BM (2003) Preterm premature rupture of the membranes. Obstet Gynecol 101:178–193PubMedCrossRefGoogle Scholar
  20. 20.
    NIH (2000) Antenatal corticosteroids revisited: repeat courses. NIH consensus statement 2000 August 17–18. Am J Obstet Gynecol 17(2):1–18Google Scholar
  21. 21.
    Teratology Society Public Affairs Committee (1994) FDA classification of drugs for teratogenic risk. Teratology 49:446–447CrossRefGoogle Scholar
  22. 22.
    Brewer M, Kueck A, Runowicz C (2011) Chemotherapy in pregnancy. Clin Obstet Gynecol 54(4):602–618PubMedCrossRefGoogle Scholar
  23. 23.
    Cardonick E, Iacobucci A (2004) Use of chemotherapy during human pregnancy. Lancet Oncol 5:283–291PubMedCrossRefGoogle Scholar
  24. 24.
    Ebert U, Loffler H, Kirch W (1997) Cytotoxic therapy and pregnancy. Pharmacol Ther 74:207–220PubMedGoogle Scholar
  25. 25.
    Van Calsteren K, Heyns L, De Smet F, Van Eycken L, Gziri MM, Van Gemert W et al (2010) Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol 28:683–689PubMedCrossRefGoogle Scholar
  26. 26.
    Mir O, Berveiller P, Ropert S, Goffinet F, Goldwasser F (2008) Use of platinum derivatives during pregnancy. Cancer 113:3069–3074PubMedCrossRefGoogle Scholar
  27. 27.
    Li RH, Tam WH, Ng PC, Mok TS, Tam B, Lau TK (2007) Microphthalmos associated with Dartmouth combination chemotherapy in pregnancy: a case report. J Reprod Med 52:575–576PubMedGoogle Scholar
  28. 28.
    Henderson C, Elia G, Garfinkel D, Poirier MC, Shamkhani H, Runowicz CD (1993) Platinum chemotherapy during pregnancy for serous cystadenocarcinoma of the ovary. Gynecol Oncol 49:92–94PubMedCrossRefGoogle Scholar
  29. 29.
    Koc O, McFee M, Reed E, Gerson SL (1994) Detection of platinum-DNA adducts in cord blood lymphocytes following in utero platinum exposure. Eur J Cancer 30:716–717CrossRefGoogle Scholar
  30. 30.
    Picone O, Lhommé C, Tournaire M, Pautier P, Camatte S, Vacher-Lavenue MC et al (2004) Preservation of pregnancy in a patient with a stage IIIB ovarian epithelial carcinoma diagnosed at 22 weeks of gestation and treated with initial chemotherapy: case report and literature review. Gynecol Oncol 94:600–604PubMedCrossRefGoogle Scholar
  31. 31.
    Tabata T, Nishiura K, Tanida K, Kondo E, Okugawa T, Sagawa N (2008) Carboplatin chemotherapy in a pregnant patient with undifferentiated ovarian carcinoma: case report and review of the literature. Int J Gynecol Cancer 18:181–184PubMedCrossRefGoogle Scholar
  32. 32.
    Mir O, Berveiller P, Goffinet F, Treluyer JM, Serreau R, Goldwasser F et al (2010) Taxanes for breast cancer during pregnancy: a systematic review. Ann Oncol 21:425–426PubMedCrossRefGoogle Scholar
  33. 33.
    Cardonick E, Usmani A, Ghaffar S (2010) Perinatal outcomes of a pregnancy complicated by cancer, including neonatal follow-up after in utero exposure to chemotherapy: results of an international registry. Am J Clin Oncol 33:221–228PubMedGoogle Scholar
  34. 34.
    FIGO, Heintz AP, Odicino F, Maisonneuve P, Quinn MA, Benedet JL, Creasman WT, Ngan HY, Pecorelli S, Beller U (2006) Carcinoma of the ovary. FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet 95:S161–S192PubMedCrossRefGoogle Scholar
  35. 35.
    Tropé C, Kaern J (2007) Adjuvant chemotherapy for early-stage ovarian cancer: review of the literature. J Clin Oncol 25:2909–2920PubMedCrossRefGoogle Scholar
  36. 36.
    American College of Obstetricians and Gynecologists (2007) ACOG practice bulletin: management of adnexal masses. Obstet Gynecol 110:201–214CrossRefGoogle Scholar
  37. 37.
    Satoh T, Hatae M, Watanabe Y, Yaegashi N, Ishiko O, Kodama S et al (2010) Outcomes of fertility-sparing surgery for stage I epithelial ovarian cancer: a proposal for patient selection. J Clin Oncol 28:1727–1732PubMedCrossRefGoogle Scholar
  38. 38.
    Colombo N, Guthrie D, Chiari S, Parmar M, Qian W, Swart AM, International collaborative ovarian neoplasm (ICON) collaborators et al (2003) International collaborative ovarian neoplasm trial 1: a randomized trial of adjuvant chemotherapy in women with early-stage ovarian cancer. J Natl Cancer Inst 95:125–132PubMedCrossRefGoogle Scholar
  39. 39.
    Trimbos JB, Parmar M, Vergote I, Guthrie D, Bolis G, Colombo N, International Collaborative Ovarian Neoplasm 1, European Organisation for Research and Treatment of Cancer Collaborators–Adjuvant Chemotherapy in Ovarian Neoplasm et al (2003) Impact of adjuvant chemotherapy and surgical staging in early stage ovarian carcinoma: European organisation for research and treatment of cancer–adjuvant chemotherapy in ovarian neoplasm trial. J Natl Cancer Inst 95:113–125PubMedCrossRefGoogle Scholar
  40. 40.
    Marret H, Lhommé C, Lecuru F, Canis M, Lévèque J, Golfier F et al (2010) Guidelines for the management of ovarian cancer during pregnancy. Eur J Obstet Gynecol Reprod Biol 149:18–21PubMedCrossRefGoogle Scholar
  41. 41.
    Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol 20:1248–1259PubMedCrossRefGoogle Scholar
  42. 42.
    Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N et al, European Organization for Research and Treatment of Cancer-Gynaecological Cancer Group, NCIC Clinical Trials Group (2010) Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 363:943–953PubMedCrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2012

Authors and Affiliations

  • L. Minig
    • 1
  • L. Otaño
    • 2
  • I. Diaz-Padilla
    • 1
  • R. Alvarez Gallego
    • 1
  • M. G. Patrono
    • 1
    Email author
  • J. Valero de Bernabé
    • 1
  1. 1.Gynecology Oncology ProgramHospital Universitario Madrid Sanchinarro, Centro Integral Oncológico Clara Campal (CIOCC)MadridSpain
  2. 2.Division of ObstetricsHospital Italiano de Buenos AiresBuenos AiresArgentina

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