Ovarian cancer

The incidence of ovarian malignancies during pregnancy is estimated to be between 1/10 000 to 1/100 000 deliveries. The increased use of ultrasound in early fetal evaluation has led to more frequent findings of adnexal mass in pregnancy. The vast majority of tumors detected during pregnancy are benign. Functional cysts (follicular or corpus luteum cysts) are the most common detected masses during pregnancy. Benign neoplasms such as cystadenomas and dermoid cysts, are also frequently diagnosed in pregnancy. Fortunately, only 3 to 6 % of the adnexal masses detected during pregnancy are true malignant neoplasms. Most of the patients with ovarian cancer diagnosed during pregnancy have disease confined to the pelvis or abdomen, mostly stage I disease. 

Adnexal masses during pregnancy are managed according to characteristics of the mass and sonographic appearance, gestational age and patient symptomatology. In case of doubt, surgical exploration is preferred in order to prevent a missed diagnosis. Staging surgery (adnexectomy, omentectomy and pelvic/para-aortic lymphadenectomy) and chemotherapy used for ovarian cancer (paclitaxel and carboplatin) are possible during pregnancy. For uncommon advanced stage disease, neoadjuvant chemotherapy followed by a cytoreductive surgery after delivery is advocated. A complete debulking procedure during pregnancy is virtually impossible since the pouch of Douglas is inaccessible due to a pregnant uterus.