Managing ovarian tumors during pregnancy

An ovarian mass may be diagnosed in 2–4 % of pregnancies: most of them undergo spontaneous resolution, and only 1–2 % of persistent lesions are malignant. Ovarian cancer is the second most frequent gynecologic cancer complicating pregnancy (the first is cervical cancer): the relative frequency of the different histological subtypes reproduces what is observed in young nonpregnant women. Lesions are generally identified by routine ultrasound scans that will in most cases provide sufficient details in the first weeks of pregnancy. MRI may be used when uterine size does not allow proper evaluation by US or to resolve any doubtful result. This is also necessary to obtain an adequate clinical staging of cancer. Serum tumor markers are not reliable during pregnancy. Surgery may be performed even during the first weeks of pregnancy, but fetal risks are elevated, and the patient and her family should be properly informed about the risks and benefits of any procedure. It is recommended that patients are referred to specialized centers that may guarantee the best outcome. Systemic chemotherapy may be safely administered after the second trimester: its use should be carefully evaluated considering tumor stage, gestational age, and the overall prognosis. The standard chemotherapy regimen (carboplatin and paclitaxel) may be safely used in pregnant patients. The aim of treatment is to maximize fetal development before delivery: both vaginal delivery and cesarean section are possible.