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Ovarian Cancer During Pregnancy

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Ovarian Cancer During Pregnancy

Ovarian Cancer During Pregnancy

The nine months of pregnancy can be an exciting part of a mother’s life but can become very challenging when faced with a cancer diagnosis. If you are having symptoms that concern you and are wondering if it is possible that you have ovarian cancer during your pregnancy, talk to your doctor right away about diagnostic tests.

The important thing to note is that most ovarian masses found during pregnancy are not malignant, and the ones which are cancerous are often in earlier stages. For most women, this means that the baby’s life does not have to be jeopardized. Also, many women are able to preserve their fertility (if desired) through conservative surgery by removing only the one affected ovary and fallopian tube. Though there are suggested and researched standardized methods of care for ovarian cancer (detailed below), there is still not enough research due to its rarity. Thus, treatment of and care for ovarian cancer during pregnancy is often very individualized.

For more information on ovarian cancer itself and resources available to you, please visit our two related articles Ovarian Cancer and Ovarian Cancer Resources. If you have questions about the terms your doctor or treatment team are using, check out our Terms to Know page.

It is rare to find an ovarian tumor or mass during pregnancy. One study estimates that only 2.4 – 5.7% of pregnancies will present with an ovarian mass.

If an ovarian tumor is found, it is again rare that the mass is malignant (cancerous). The study above mentions that of these masses, only about 5% are expected to be malignant.

If a mass subsides before the second trimester, surgery may not be suggested. Masses or cysts may come and go, and if the mass subsides by the second trimester, it may have just been due to early pregnancy.

Surgery is often performed to remove a sample of the mass for biopsy (for diagnosis and staging). Before a more serious surgery or treatment is prescribed, your doctor will want to confirm if the mass is cancerous. So, laparoscopy & laparotomy will be used to remove a section of the mass for biopsy, including histology, and if there is fluid (ascites or the mass contains fluid), this may be removed and sent off for a cytology report. These tests can determine if the mass is cancerous or not, as well as the grade and stage of cancer if malignant.

If additional imaging tests are needed, there are some safe options. X-rays and MRIs (Magnetic Resonance Imaging) are both generally considered safe during pregnancy. CT scans of the abdomen are not suggested during pregnancy.

Facts about Ovarian Cancer Treatment during Pregnancy:

Fertility can often be spared if the cancer is diagnosed during an early stage (IA to IIC). If the ovarian cancer is found and diagnosed early (before major metastasis), it is possible to perform a unilateral salpingo-oophorectomy, leaving the ovary and fallopian tube on the other side to preserve fertility.

Chemotherapy is only given in the second or third trimesters, and if possible, postponed until after birth. There are many studies showing that chemotherapy can cause serious deformities (83.3%) and/or miscarriage when given in the first trimester. There are few concerns about chemo in the second and third trimesters, although there still is the potential for long-term effects and/or teratogenic effects. This is why it is postponed until after the birth if it is deemed safe enough for the mother’s health.

Conservative surgery is performed, but usually not until the 16th – 20th gestational week. Doctors prefer to wait until a few weeks into the second trimester before going in for surgery. This is because surgery in the first trimester is more likely to bring on a miscarriage (spontaneous abortion). This outcome is rarely seen with conservative surgeries after the first trimester.

Full debulking surgery is typically scheduled for after the pregnancy. Unless the cancer is very advanced and is putting the mother’s (or fetus’s) life in jeopardy, then a full debulking surgery (removing all visible tumors and problem areas) is usually postponed until after birth. This is mainly to protect the fetus and the mother’s less stable condition during pregnancy. Conservative surgery plus chemotherapy as needed is typically the course during pregnancy.

If the cancer is in an advanced stage, often the treatment should go on as if there were not a pregnancy involved. If the cancer is to a point of threatening the mothers (and fetus’s) life, then the risks of full treatment for the cancer may outweigh the risks to the fetus. Full debulking surgery may still be possible without disrupting the fetus, but there are risks involved with more invasive surgery.

Radiation therapy is considered to be dangerous at any time during pregnancy. Studies show that the high-energy x-rays used have the potential to harm the fetus in any trimester, and so this treatment method is not performed during pregnancy. Doctors prefer to wait until after birth to begin radiation treatment. The risk to the developing baby does depend on dosage and the location being treated.

Does pregnancy make me more susceptible to getting ovarian cancer?

Ovarian cancer is rare, first of all, and research studies have not shown that pregnancy itself increases your chances of getting ovarian cancer. Actually, women who have carried to term before the age of 30 may have a decreased lifetime risk of experiencing ovarian cancer.

This question is often asked because ovarian tumors or cancerous growths are more easily detectable during pregnancy, thanks to routine ultrasound procedures. Often, a suspicious growth can be detected early in pregnancy through these sonograms. If an ovarian mass is detected early, you and your doctor can form a plan for the diagnosis first, and then treatment.

Can I still have debulking surgery and undergo chemotherapy during pregnancy?

The short answer is yes. However, most treatment plans involve only a conservative surgery (typically a unilateral salpingo-oophorectomy) during pregnancy after 16 – 20 weeks with the debulking surgery after birth if necessary. Since chemotherapy is contraindicated (not suggested) in the first trimester, it will only be given after that point. Usually, though, doctors will attempt to postpone chemotherapy until after birth.

The postponing of debulking surgery and chemotherapy can be problematic in the sense that the ovarian cancer may be allowed more time to grow, spread, and undifferentiate (go through cancer-promoting cellular/DNA changes). However, the detriment of postponing will depend upon the stage and grade of the cancer. The more aggressive the cancer, the more it can spread in a short amount of time.

Most of the time, ovarian cancer will not affect your growing baby. The concerns come if the cancer is threatening the life of the mother, is too large and is blocking the normal growth of or blood flow to the fetus, or if the cancer is causing abnormal hormone levels in the body. There is little to no documentation of ovarian cancer spreading to the fetus, amniotic sac, or placenta during pregnancy, so this is likely not something to worry about. Your doctor can help you understand your specific situation and how your baby may or may not be affected.

Treatments for ovarian cancer and their side effects are what typically pose risks for the fetus. This is why only conservative surgery is suggested during the pregnancy, and why gynecologic oncologists prefer to wait until after the 16-20th gestational week of pregnancy to do surgery. This is because of the higher rates of miscarriage (spontaneous abortion) when surgery is performed in the first trimester and early into the second. This is also why chemotherapy is not given in the first trimester and why doctors try to postpone chemo treatment until after birth. In the first trimester, there is an extremely high rate of teratogenic effects/deformations (83.3%) and miscarriages. Chemo treatment in the latter half of pregnancy can cause a lack of appetite, nausea/vomiting, and/or a low blood count, meaning poor nutrition or a greater chance of infection (especially during birth).

Will this mean changes in how I can deliver my baby?

Much of your pregnancy care will depend upon the stage and grade of your specific cancer. Many women are able to go on to have a normal, vaginal delivery. Some others might have a scheduled c-section, but this could be due to other factors that are not cancer-related. If the cancer is a more advanced stage, your team of healthcare providers may suggest a c-section in order that they perform the debulking surgery at that time.

Don’t be afraid to go ahead and create your own birth plan! From there you will be able to work with your OB/GYN and gynecologic oncologist to find a solution that works for you and also takes the cancer into consideration. You may not have to change much if at all.

How can I tell the difference between a symptom of pregnancy and a symptom of ovarian cancer?

Hopefully, by the time you would begin feeling symptoms your doctors will already have seen an abnormal mass on the ovaries during regularly scheduled ultrasounds and have begun a treatment plan. However, it is always important to talk to your doctor about changing symptoms, especially if you have a family history of ovarian, breast, or colorectal cancers or you are aware of a cancer susceptibility gene mutation in your family or personal genetics.

The typical symptoms of ovarian cancer are bloating, frequent urination or the urgent need to urinate, lower abdominal pain, feeling full quickly/difficulty eating, fatigue, constipation, backaches, and pain during intercourse. Since most if not all of these can be due to pregnancy as well, it can be difficult to decipher on your own what the symptoms may be due to. One of the reasons that it is so important to update your doctor about your symptoms is that they may be a sign of a complication, such as reproductive cancer. Most cases of ovarian cancer that are discovered during pregnancy are asymptomatic.

Can I breastfeed if I’m receiving chemotherapy or radiation therapy?

The general answer is no. Chemo drugs and radioactive drugs can both transfer to the child through breast milk and cause serious complications.

 

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