Skip to main content

Advertisement

SpringerLink
Log in

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

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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

Results

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

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  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):821–826

    Article  PubMed  Google Scholar 

  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 178:1–2

    Article  PubMed  CAS  Google Scholar 

  3. Pavlidis NA (2000) Cancer and pregnancy. Ann Oncol 11(Suppl 3):247–253

    Article  PubMed  Google Scholar 

  4. Pentheroudakis G (2008) Cancer and pregnancy. Ann Oncol 19(Suppl 5):v38–v39

    Article  PubMed  Google Scholar 

  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–v273

    Article  PubMed  Google Scholar 

  6. Sarandakou A, Protonotariou E, Rizos D (2007) Tumor markers in biological fluids associated with pregnancy. Crit Rev Clin Lab Sci 44(2):151–178

    Article  PubMed  CAS  Google Scholar 

  7. Patel SJ et al (2007) Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 27(6):1705–1722

    Article  PubMed  Google Scholar 

  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):559–568

    Article  PubMed  CAS  Google Scholar 

  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):101–109

    Article  PubMed  CAS  Google Scholar 

  10. Doll DC, Ringenberg QS, Yarbro JW (1989) Antineoplastic agents and pregnancy. Semin Oncol 16(5):337–346

    PubMed  CAS  Google Scholar 

  11. Rizack T et al (2009) Management of hematological malignancies during pregnancy. Am J Hematol 84(12):830–841

    Article  PubMed  Google Scholar 

  12. Peccatori F et al (2004) Chemotherapy during pregnancy: what is really safe? Lancet Oncol 5(7):398

    Article  PubMed  Google Scholar 

  13. Loibl S et al (2006) Breast carcinoma during pregnancy. International recommendations from an expert meeting. Cancer 106(2):237–246

    Article  PubMed  Google Scholar 

  14. Pereg D, Koren G, Lishner M (2007) The treatment of Hodgkin’s and non-Hodgkin’s lymphoma in pregnancy. Haematologica 92(9):1230–1237

    Article  PubMed  Google Scholar 

  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):251–256

    Article  PubMed  Google Scholar 

  16. Abellar RG et al (2009) Effects of chemotherapy during pregnancy on the placenta. Pediatr Dev Pathol 12(1):35–41

    Article  PubMed  Google Scholar 

  17. Van Calsteren K et al (2010) Pharmacokinetics of chemotherapeutic agents in pregnancy: a preclinical and clinical study. Acta Obstet Gynecol Scand 89(10):1338–1345

    Article  PubMed  Google Scholar 

  18. Schönborn I (2009) Malignant diseases in pregnancy Gynakol Geburtsmed Gynakol. Endokrinol 5(2):114–125

    Google Scholar 

  19. Germann N, Goffinet F, Goldwasser F (2004) Anthracyclines during pregnancy: embryo-fetal outcome in 160 patients. Ann Oncol 15(1):146–150

    Article  PubMed  CAS  Google Scholar 

  20. Grohard P et al (1989) Transplacental passage of doxorubicin. J Gynecol Obstet Biol Reprod (Paris) 18(5):595–600

    CAS  Google Scholar 

  21. Mir O et al (2008) Chemotherapy for breast cancer during pregnancy: is epirubicin safe? Ann Oncol 19(10):1814–1815

    Article  PubMed  CAS  Google Scholar 

  22. Espie M, Cuvier C (1998) Treating breast cancer during pregnancy. What can be taken safely? Drug Saf 18(2):135–142

    Article  PubMed  CAS  Google Scholar 

  23. Mir O et al (2008) Use of platinum derivatives during pregnancy. Cancer 113(11):3069–3074

    Article  PubMed  CAS  Google Scholar 

  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 Obstet

  25. Hahn KM et al (2006) Treatment of pregnant breast cancer patients and outcomes of children exposed to chemotherapy in utero. Cancer 107(6):1219–1226

    Article  PubMed  Google Scholar 

  26. Mir O et al (2008) Emerging therapeutic options for breast cancer chemotherapy during pregnancy. Ann Oncol 19(4):607–613

    Article  PubMed  CAS  Google Scholar 

  27. Pigeau H et al (2005) Management of rectal cancer in pregnant women. Bull Cancer 92(11):953–958

    PubMed  Google Scholar 

  28. Enns GM et al (1999) Apparent cyclophosphamide (cytoxan) embryopathy: a distinct phenotype? Am J Med Genet 86(3):237–241

    Article  PubMed  CAS  Google Scholar 

  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):257–259

    Article  PubMed  Google Scholar 

  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):1479

    Article  CAS  Google Scholar 

  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):143–145

    PubMed  Google Scholar 

  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):455–457

    Article  PubMed  Google Scholar 

  33. Pye SM et al (2008) The effects of imatinib on pregnancy outcome. Blood 111(12):5505–5508

    Article  PubMed  CAS  Google Scholar 

  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–S17

    Article  PubMed  CAS  Google Scholar 

  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):257–258

    Article  CAS  Google Scholar 

  36. Culbert EC, Schfirin BS (2006) Malignant hypercalcemia in pregnancy: effect of pamidronate on uterine contractions. Obstet Gynecol 108(3 Pt 2):789–791

    Article  PubMed  Google Scholar 

  37. Yaghoobi M, Koren G, Nulman I (2009) Challenges to diagnosing colorectal cancer during pregnancy. Can Fam Physician 55(9):881–885

    PubMed  Google Scholar 

  38. Stensheim H (2009) Malignant melanoma and pregnancy. Onkologie 32(12):715–716

    Article  PubMed  Google Scholar 

  39. Vannucchi G et al (2010) Clinical and molecular features of differentiated thyroid cancer diagnosed during pregnancy. Eur J Endocrinol 162(1):145–151

    Article  PubMed  CAS  Google Scholar 

  40. Khochikar MV (2010) Management of urological cancers during pregnancy. Nat Rev Urol 7(4):195–205

    Article  PubMed  Google Scholar 

  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):345–350

    Article  PubMed  CAS  Google Scholar 

  42. Goncalves CV et al (2009) Diagnosis and treatment of cervical cancer during pregnancy. Sao Paulo Med J 127(6):359–365

    Article  PubMed  Google Scholar 

  43. Morice P et al (2009) French recommendations on the management of invasive cervical cancer during pregnancy. Int J Gynecol Cancer 19(9):1638–1641

    Article  PubMed  Google Scholar 

  44. Marret H et al (2010) Guidelines for the management of ovarian cancer during pregnancy. Eur J Obstet Gynecol Reprod Biol 149(1):18–21

    Article  PubMed  Google Scholar 

  45. Pentheroudakis G, Pavlidis N (2006) Cancer and pregnancy: poena magna, not anymore. Eur J Cancer 42(2):126–140

    Article  PubMed  Google Scholar 

  46. Sayedur Rahman M et al (2002) Ovarian carcinoma associated with pregnancy. A review of 9 cases. Acta Obstet Gynecol Scand 81(3):260–264

    PubMed  Google Scholar 

  47. Zanotti KM, Belinson JL, Kennedy AW (2000) Treatment of gynecologic cancers in pregnancy. Semin Oncol 27(6):686–698

    PubMed  CAS  Google Scholar 

  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):326–331

    Article  PubMed  CAS  Google Scholar 

  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):8–15

    Article  PubMed  CAS  Google Scholar 

  50. Boulay R, Podczaski E (1998) Ovarian cancer complicating pregnancy. Obstet Gynecol Clin North Am 25(2):385–399

    Article  PubMed  CAS  Google Scholar 

  51. Hermans RH et al (2003) Adnexal masses in pregnancy. Onkologie 26(2):167–172

    Article  PubMed  CAS  Google Scholar 

  52. Cardonick E, Iacobucci A (2004) Use of chemotherapy during human pregnancy. Lancet Oncol 5(5):283–291

    Article  PubMed  CAS  Google Scholar 

  53. Sood AK, Shahin MS, Sorosky JI (2001) Paclitaxel and platinum chemotherapy for ovarian carcinoma during pregnancy. Gynecol Oncol 83(3):599–600

    Article  PubMed  CAS  Google Scholar 

  54. http:\\www.cancerinpregnancy.org

  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):118–122

    Article  PubMed  CAS  Google Scholar 

  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):327–335

    Article  PubMed  CAS  Google Scholar 

  57. Ayhan A et al (1999) Endometrial adenocarcinoma in pregnancy. Gynecol Oncol 75(2):298–299

    Article  PubMed  CAS  Google Scholar 

  58. Schneller JA, Nicastri AD (1994) Intrauterine pregnancy coincident with endometrial carcinoma: a case study and review of the literature. Gynecol Oncol 54(1):87–90

    Article  PubMed  CAS  Google Scholar 

  59. Zirkin HJ, Krugliak L, Katz M (1983) Endometrial adenocarcinoma coincident with intrauterine pregnancy. A case report. J Reprod Med 28(9):624–626

    PubMed  CAS  Google Scholar 

  60. Regan MA, Rosenzweig BA (1993) Vulvar carcinoma in pregnancy: a case report and literature review. Am J Perinatol 10(4):334–335

    Article  PubMed  CAS  Google Scholar 

  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):659–661

    PubMed  CAS  Google Scholar 

  62. Ogunleye D et al (2004) Recurrent vulvar carcinoma in pregnancy. Gynecol Oncol 95(2):400–401

    Article  PubMed  Google Scholar 

  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):46–50

    CAS  Google Scholar 

  64. Gitsch G, van Eijkeren M, Hacker NF (1995) Surgical therapy of vulvar cancer in pregnancy. Gynecol Oncol 56(2):312–315

    Article  PubMed  CAS  Google Scholar 

  65. Creasman WT (2005) Vaginal cancers. Curr Opin Obstet Gynecol 17(1):71–76

    PubMed  Google Scholar 

  66. Baruah N, Sangupta S (1973) Primary carcinoma of vagina complicating pregnancy. J Indian Med Assoc 60(12):469–470

    PubMed  CAS  Google Scholar 

  67. Church E et al (2010) An unusual case of vaginal leiomyosarcoma in pregnancy. J Obstet Gynaecol 30(7):736–737

    Article  PubMed  CAS  Google Scholar 

  68. Collins CG, Barclay DL (1963) Cancer of the vulva, and cancer of the vagina in pregnancy. Clin Obstet Gynecol 30:927–942

    Article  PubMed  CAS  Google Scholar 

  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):211–213

    PubMed  CAS  Google Scholar 

  70. Lutz MH et al (1977) Genital malignancy in pregnancy. Am J Obstet Gynecol 129(5):536–542

    PubMed  CAS  Google Scholar 

  71. Palumbo L Jr et al (1969) Primary carcinoma of the vagina. South Med J 62(9):1048–1053

    Article  PubMed  Google Scholar 

  72. Steed HL et al (2002) Invasive squamous cell carcinoma of the vagina during pregnancy. Obstet Gynecol 100(5 Pt 2):1105–1108

    Article  PubMed  CAS  Google Scholar 

  73. Roth GLU (2004) Vaginal cancer during pregnancy. Gynäkologe 37:514–518

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Hospital of Schleswig–Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany

    Friederike Hoellen, Marc Thill, Doerte W. Luedders, Katharina Kelling & Michael K. Bohlmann

  2. Department of Internal Medicine III; Klinikum Grosshadern, Ludwigs-Maximilians-University of Munich, Munich, Germany

    Roland Reibke

  3. Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany

    Katrin Hornemann

  4. Department of Obstetrics and Gynecology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

    Amadeus Hornemann

Authors
  1. Friederike Hoellen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roland Reibke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katrin Hornemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc Thill
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Doerte W. Luedders
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Katharina Kelling
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Amadeus Hornemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael K. Bohlmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Friederike Hoellen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoellen, F., Reibke, R., Hornemann, K. et al. Cancer in pregnancy. Part I: basic diagnostic and therapeutic principles and treatment of gynecological malignancies. Arch Gynecol Obstet 285, 195–205 (2012). https://doi.org/10.1007/s00404-011-2058-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-011-2058-8

Keywords

Search

Navigation