Chemotherapy of ovarian cancer in pregnancy
- Carolyn D Runowicz, MD
Carolyn D Runowicz, MD
- Executive Associate Dean for Academic Affairs
- Professor of Obstetrics and Gynecology
- Florida International University
- Herbert Wertheim College of Medicine
- Molly Brewer, DVM, MD, MS
Molly Brewer, DVM, MD, MS
- Division of Gynecologic Oncology
- Department of Obstetrics and Gynecology
- Carole and Ray Neag Comprehensive Cancer Center
- University of Connecticut Health Center
- Section Editors
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Don S Dizon, MD, FACP
Don S Dizon, MD, FACP
- Section Editor – Gynecologic Oncology
- Clinical Co-Director, Gynecologic Oncology
- Founder and Director, The Oncology Sexual Health Clinic
- Massachusetts General Hospital Cancer Center
- Associate Professor of Medicine
- Harvard Medical School
- Deputy Editors
- Sadhna R Vora, MD
Sadhna R Vora, MD
- Deputy Editor — Oncology
- Instructor in Medicine
- Harvard Medical School
- Vanessa A Barss, MD, FACOG
Vanessa A Barss, MD, FACOG
- Senior Deputy Editor — UpToDate
- Deputy Editor — Obstetrics, Gynecology and Women's Health
- Associate Clinical Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
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".)
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 . 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 .
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- GENERAL PRINCIPLES
- OVARIAN CANCER DURING PREGNANCY
- EPITHELIAL OVARIAN CANCER
- - Platinum
- - Taxanes
- - Intraperitoneal (IP) therapy
- Timing of chemotherapy
- - Early-stage disease
- - Advanced-stage disease
- GERM CELL TUMORS
- Timing of chemotherapy
- TUMORS OF LOW MALIGNANT POTENTIAL
- SEX CORD-STROMAL TUMORS
- SUMMARY AND RECOMMENDATIONS