Gynecologic cancers in pregnancy: Guidelines of an international consensus meeting

Abstract

Cancer in pregnancy presents a rare coincidence which demands intensive interdisciplinary care. Among this, gynecologic cancer is a special challenge because cancer or treatment may not only affect the pregnant women in general but involve the reproductive tract and fetus directly. Currently, there are no guidelines on how to deal with this special coincidence. An international consensus meeting on staging and treatment of gynecologic malignancies during pregnancy including systematic literature search, interpretation, and preparation followed by a physical meeting of all participants with intensive discussion. In the absence of large trials and randomized studies, recommendations were based on available literature data and personal experience, thus representing a low but best achievable level of evidence. Randomized trials and prospective studies on cancer treatment during pregnancy are lacking. Gynecologic cancer during pregnancy is a demanding problem and multidisciplinary expertise should be available. Counseling both parents on the maternal prognosis and fetal risk is needed. When there is a firm desire to continue the pregnancy, gynecologic cancer can be treated in selected cases. The staging and treatment should follow the standard approach as much as possible. Guidelines for safe pelvic surgery during pregnancy are presented. Mainly in cervical and ovarian cancer, chemotherapy and an alternative surgical approach need to be considered. Administration of chemotherapy during the second or third trimester may probably not increase the incidence of congenital malformations. Until now, the long-term outcome of children in utero exposed to oncological treatment modalities is poorly documented, but preterm birth on its own is associated with cognitive impairment. Delivery should be postponed preferably until after a gestational age of 35 weeks. © 2011 Springer-Verlag Berlin Heidelberg.