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Chemotherapy of ovarian cancer in pregnancy

Authors
Carolyn D Runowicz, MD
Molly Brewer, DVM, MD, MS
Section Editors
Barbara Goff, MD
Don S Dizon, MD, FACP
Deputy Editors
Sadhna R Vora, MD
Vanessa A Barss, MD, FACOG

INTRODUCTION

A gynecologic malignancy is estimated to complicate four to eight of every 100,000 pregnancies [1-4]. Unfortunately, the data on the effects of antineoplastic drugs administered during pregnancy have largely been derived from case reports, small case series, and collected reviews of pregnant women treated for a variety of cancers. There are even less data on long-term outcomes in offspring.

This topic will address the administration of chemotherapy for women diagnosed with ovarian cancer in pregnancy. In order to optimize treatment outcomes, a pregnant woman with a diagnosis of ovarian cancer should be managed by a multidisciplinary team that includes experts in the fields of maternal-fetal medicine, gynecologic oncology, pediatrics, and pathology.

The clinical manifestations and diagnosis of ovarian cancer in pregnancy and surgical management of this disease are reviewed separately. (See "Adnexal mass in pregnancy".)

GENERAL PRINCIPLES

Concerns about the administration of cytotoxic chemotherapy during pregnancy arise because chemotherapy preferentially kills rapidly proliferating cells, and the fetus represents a rapidly proliferating cell mass. All chemotherapy agents used in the treatment of epithelial and nonepithelial ovarian cancers are pregnancy category D, meaning that fetal exposure to individual chemotherapeutic agents have resulted in adverse effects including intrauterine growth restriction, prematurity, and low birth weight in the infants [5]. Chemotherapy may also cause fetal toxicities similar to those observed in the mother (eg, bone marrow suppression).

The risks of spontaneous abortion, fetal death, and major malformations vary depending on the agent used and the trimester of pregnancy. These risks must be weighed against the benefits of immediate versus delayed (ie, postdelivery) chemotherapy for the mother. Ethical considerations of treatment during pregnancy have emphasized the role of patient autonomy and the concept of beneficence and nonmaleficence for both the mother and fetus [6].

                 

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Literature review current through: Nov 2016. | This topic last updated: Thu Jul 31 00:00:00 GMT+00:00 2014.
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