title: Gynecologic Malignancies in Pregnancy: Balancing Fetal Risks With Oncologic Safety.
abstract: OBJECTIVE
  Cancer occurs in 0.05% to 0.1% of all pregnancies. Despite literature reporting good oncologic and fetal outcomes in women treated for cancer during pregnancy, as many as 44% of gynecologists would offer termination, and 37% would not administer chemotherapy or radiotherapy in pregnancy.
  
  
  OBJECTIVE
  The aims of this study were to summarize current recommendations for the treatment of cervical and ovarian cancers in pregnancy and to review updates on existing knowledge regarding the safety of surgical and chemotherapeutic treatments in pregnancy, including both oncologic and fetal outcomes.
  
  
  METHODS
  A detailed literature review was performed on PubMed.
  
  
  RESULTS
  The treatment of gynecologic malignancies during pregnancy mirrors that outside pregnancy, with a balance between maternal versus fetal health. Fertility-sparing surgery can be offered to stage IA2 and low-risk IB1 cervical, stage I epithelial ovarian, germ cell ovarian, or sex-cord stromal ovarian tumors. Delayed treatment can be offered for stage IB1 cervical cancer. Neoadjuvant and/or adjuvant chemotherapy can be given for advanced gynecologic cancers with good disease-free survival without significant adverse neonatal outcomes.
  
  
  CONCLUSIONS
  A multidisciplinary approach and improved education of providers regarding the surgical and chemotherapeutic treatments in pregnancy are needed in order to fully inform patients regarding treatment options. Further research in women who are pregnant is needed to determine the safety of diagnostic and therapeutic procedures used in the nonpregnant woman.
  
  
  CONCLUSIONS
  This article reviews and supports treatment of gynecologic cancer during pregnancy, calls for additional study and long-term follow-up, and justifies improved education of patients and providers regarding treatment options.
  
  
  BACKGROUND
  Obstetricians and gynecologists, family physicians.
  
  
  OBJECTIVE
  After completing this activity, the learner should be better able to (1) review general principles in the management and treatment of gynecologic cancers in pregnancy, (2) review the diagnosis and treatment of cervical cancer in pregnancy, and (3) review the diagnosis and treatment of ovarian cancer in pregnancy.
authors.affiliation: Resident Physician, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Christina N
authors.initials: CN
authors.lastname: Cordeiro
authors.affiliation: Attending Surgeon, Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Gemignani
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D005260:Female; D005333:Fetus / Q000187:drug effects; D006801:Humans; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D011256:Pregnancy Outcome; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents