n Obstetrics and Gynaecology Forum - Gynaecologic malignancies in pregnancy




Malignancy in pregnancy is rare. Cervical and, to a lesser extent, ovarian cancer are the commonest gynaecological malignancies diagnosed in pregnancy. Cancer care may involve surgery, radiation or chemotherapy. The timing of treatment in pregnancy is paramount as it may impact on the fetus. A balance needs to be found in treating the patient optimally thus maintaining oncological safety and fetal preservation (when possible). The management of cervical cancer depends on the clinical stage, histology and gestational age. In early stage cervical cancer, treatment can be delayed or neoadjuvant chemotherapy offered depending on the gestation. Locally advanced cervical cancer diagnosed early in 1st trimester pregnancy should be offered chemo radiation which induces a termination of pregnancy and women should be adequately counselled. At a later gestation, the current trend is to delay treatment with careful follow-up or neoadjuvant chemotherapy. Only 1-3% of adnexal masses in pregnancy are malignant. In most cases, surgery can be delayed unless the patient is symptomatic or if there is concern regarding extra-ovarian disease with ascites. It is recommended that women with a gynaecological cancer in pregnancy, be cared for by a multidisciplinary team.


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