Clinical management of epithelial ovarian cancer during pregnancy.
Epithelial ovarian cancer (EOC) in pregnancy is a rare situation. Due to its low incidence with a consecutive lack of clinical trials many questions regarding indication of different treatment approaches are unanswered. This article discusses the current literature to elaborate recommendations for the management of EOC during pregnancy. A literature search of diagnostic approaches and treatment strategies for EOC complicated by pregnancy was performed. We reviewed the available information with emphasis on surgery as well as chemotherapeutical treatment options. EOC in pregnancy is often diagnosed at early stage and no data support that concurrent pregnancy influences the growth rate or propensity for spread of EOC. Radical cytoreduction of all visible tumour followed by subsequent systemic chemotherapy is the standard treatment of EOC in most non-pregnant women. In pregnant women, however, chemotherapy as well as radical surgery should be avoided in the first trimester because of teratogenesis and high abortion rates. Besides induced abortion followed by classic management of EOC, pregnancy preserving surgery, followed by chemotherapy in the second or third trimester, timely delivery as well as neo-adjuvant chemotherapy with subsequent completing surgery appear to be viable treatment options.


CONCLUSIONS
Since there is only very limited information regarding the optimal therapeutic approach to EOC during pregnancy, each case needs to be addressed individually. Treatment in specialised centres should be intended especially in this rare and challenging situation.
Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Donata
D
Grimm
Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Linn
L
Woelber
Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Fabian
F
Trillsch
Department of Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Gunhild
G
Keller-v Amsberg
Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address: s.mahner@uke.de.
Sven
S
Mahner
D000970:Antineoplastic Agents / Q000627:therapeutic use; D000077216:Carcinoma, Ovarian Epithelial; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D009375:Neoplasms, Glandular and Epithelial / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000628:therapy*; D010052:Ovariectomy / Q000379:methods; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000628:therapy*; D011256:Pregnancy Outcome; D016896:Treatment Outcome
D000970:Antineoplastic Agents
Chemotherapy; Epithelial ovarian cancer; Pregnancy; Pregnancy preserving surgery