Ovarian Cancer During Pregnancy: Understanding Risks, Symptoms, and Treatment

Understanding Ovarian Cancer During Pregnancy While it is rare, it is possible for women to be diagnosed with ovarian cancer while they are pregnant. The lifetime risk of developing ovarian cancer is approximately 1.1%, but the chance of being diagnosed with it during pregnancy is significantly lower, estimated to be between 1 in 15,000 to 1 in 30,000 pregnancies. This accounts for about 3% to 6% of abnormal tissue masses found during pregnancy. Fortunately, many ovarian cancers discovered during pregnancy are found at an early stage, often during routine ultrasounds, with about 90% diagnosed at stage 1. What is Ovarian Cancer? Ovarian cancer originates in the ovaries, the organs responsible for producing eggs for reproduction. It is the second most common gynecological cancer after uterine cancer. While epithelial tumors are the most common type overall, germ cell and borderline tumors are more frequently seen in pregnant individuals diagnosed with ovarian cancer. Can Pregnancy Occur with Ovarian Cancer? Yes, it is possible to develop ovarian cancer while pregnant. However, this is a rare occurrence. The types of ovarian cancer that pregnant individuals may develop can differ, with germ cell and borderline tumors being more common in this demographic. Risks to the Developing Baby The risk of ovarian cancer spreading from the mother to the baby is very low. The primary risks to a developing baby are generally associated with the cancer treatment itself. While treating ovarian cancer during pregnancy can be safe, the specific treatment and its timing require careful consideration. Potential risks include: Premature birth: Certain treatments might increase the likelihood of delivering the baby early. Low birth weight: Babies born prematurely or affected by treatment may have a lower birth weight. Birth defects: Depending on the type and timing of treatment, there could be a risk of birth defects, though this is carefully managed. Increased risk of infections or bleeding during delivery: Chemotherapy, in particular, can affect the mother's immune system and clotting factors, necessitating adjustments in treatment schedules, especially in the weeks leading up to delivery. Chemotherapy is typically stopped about 3 weeks before the expected delivery date to mitigate these risks. It is crucial to have open discussions with your healthcare team about these potential risks and how they can be managed to ensure the best outcomes for both mother and baby. Symptoms of Ovarian Cancer During Pregnancy Many pregnant individuals with ovarian cancer do not experience any symptoms. When symptoms do occur, they can be subtle and easily mistaken for common pregnancy discomforts. These symptoms may include: Abdominal pain or bloating A feeling of fullness, even after eating a small amount Changes in bowel or bladder habits (e.g., constipation or frequent urination) Nausea or vomiting Unexplained weight loss or gain Fatigue Changes in menstrual cycle (though this is less relevant during pregnancy) Pelvic pain Because these symptoms are nonspecific and overlap significantly with typical pregnancy symptoms, they can often be overlooked. This is why many ovarian cancers in pregnant individuals are detected during routine prenatal ultrasounds. Diagnosis The diagnosis of ovarian cancer during pregnancy often begins with imaging tests, such as an ultrasound, which may reveal an abnormality in the ovaries. If a suspicious mass is found, further investigations might include: Transvaginal ultrasound: Provides a more detailed view of the ovaries and surrounding structures. Blood tests: To check for tumor markers, such as CA-125, although levels can be elevated during pregnancy for other reasons. Biopsy: A sample of the suspicious tissue is taken and examined under a microscope to confirm the presence and type of cancer. This is often done after delivery or during surgery. Imaging scans: Such as MRI or CT scans, may be used to determine the extent of the cancer, though their use during pregnancy is carefully considered due to radiation exposure. It's important to note that a standard pregnancy test detects the hormone human chorionic gonadotrophin (hCG). While some tumors can produce hCG, this is not a diagnostic tool for ovarian cancer, and pregnancy tests are not used to screen for it. Treatment Options The treatment plan for ovarian cancer during pregnancy is highly individualized and depends on several factors, including the stage and type of cancer, the mother's overall health, and the stage of the pregnancy. The primary goal is to treat the cancer while minimizing risks to the baby. Surgery Surgery is often the first line of treatment and may involve removing the affected ovary (oophorectomy) or, in more advanced cases, both ovaries, the uterus, and nearby lymph nodes. The extent of surgery is determined by the cancer's stage. In some cases, surgery can be performed during pregnancy, often after the first trimester when the risk to the fetus is lower. Chemotherapy Chemotherapy may be recommended, particularly for more aggressive or advanced cancers. Certain chemotherapy drugs are considered safer to use during pregnancy, especially during the second and third trimesters. However, chemotherapy is typically stopped in the weeks leading up to delivery to reduce the risk of complications for the mother and baby during birth. The decision to use chemotherapy involves a thorough discussion of potential benefits and risks. Termination of Pregnancy In situations where immediate and aggressive cancer treatment is necessary, and the risks to the mother are significant, the termination of the pregnancy may be discussed as an option. This is a deeply personal decision, often made in the first trimester when cancer is diagnosed and requires immediate

In summary, timely diagnosis, evidence-based treatment, and prevention-focused care improve long-term health outcomes.