Title: Incidence and Clinical outcome of ovarian neoplastic tumors in pregnancy: A prospective case series and review of literature
Authors: Dr Priyanka Bhadana, M.B.B.S., M.S.(O&G), Sumitra Bachani
DOI: http://dx.doi.org/10.18535/jmscr/v4i7.27
Abstract
Objective: The purpose of this study was to review patients diagnosed with ovarian cancer in pregnancy and to assess their incidence, the effectiveness of the available methods of treatment and prognosis of these tumors.
Methods: A review of 11 women diagnosed to have cancer of the ovary associated with pregnancy who delivered at a tertiary care institute between Jan 2013 to Dec 2016. The clinical presentation, time and mode of diagnosis, treatment, pregnancy outcome and maternal survival were noted. The role and effect of surgery and chemotherapy on maternal and fetal outcome was noted.
Results: The incidence of ovarian carcinoma associated with pregnancy in this study was 0.265 per 1000 deliveries. Out of these women 63.6% (7/11) were primigravidas. 45.45% (5/11) women were asymptomatic at the time of presentation and diagnosed on routine ultrasonography. 7 patients had ovarian epithelial malignant neoplasia. Fetal survival rate was 81.81%.
Conclusions: Ovarian tumors in pregnancy are usually diagnosed early due to frequent routine examinations. Epithelial tumors constitute a majority of ovarian carcinomas. The surgical staging and management should follow the standard protocol, since outcome depends on the stage of lesion. Early diagnosis and prompt treatment offers the best prognosis for the patient
Keywords: Ovarian neoplasm; pregnancy; surgical staging; chemotherapy; tumour markers
References
1. Sankaranarayanan R, Ferlay J. Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Obstet Gynaecol. 2006;20:207-225.
2. Oehler MK, Wain GV, Brand A. Gynaecological malignancies in pregnancy: a review. Aust N Z J Obstet Gynecol 2003;43(6):414-20.
3. Gezginc K, Karatayli R, Yazici F, Acar A, Celik C, Capar M. Ovarian cancer during pregnancy. International Journal of Gynae-cology and Obstetrics 2011;115:140-143.
4. Amant F, Calsteren KV, Halaska MJ, Beijnen J, Lagae L, Hanssens M, et al. Gynecological cancers in pregnancy: Guidelines of a international consensus meeting. International Journal of Gyneco-logical Cancers 2009;19(S1):S1-S9.
5. Zhao XY, Huang HF, Lian LJ, Lang JH. Ovarian cancer in pregnancy: a clincopathological analysis of 22 cases and review of literature. Int J Gynecol Cancer 2006;16(1):8-16.
6. Beral V, Fraser P, Chilvers C. Does pregnancy protect against ovarian cancer? Lancet 1978;1:1083-6.
7. Gwinn ML, Lee NC, Rhodes PH, Layde PM, Rubin GL.Pregnancy, breast feeding, and oral contraceptives and the risk of epithelial ovarian cancer. Journal of Clinical Epidemiology 1990;43(6):559-68.
8. Whittmore AS, Harris R, Itnyre J. Characteristics Relating to Ovarian Cancer Risk: Collaborative Analysis of 12 US Case -Control Studies Am J Epidemiol 1992; 136: 1184–1203.
9. Machado F, Vegas C, Leon J, et al. Ovari-an cancer during pregnancy: analysis of 15 cases. Gynecol Oncol 2007;105:446-50.
10. Takeuchi T, Suzuki S, Hayashi Z, et al. Primary ovarian tumor undergoing surgical management during pregnancy. J Nippon Med Sch 2002;69:39-42.
11. Nelson L, Ekbom A, Gerdin E. Ovarian cancer in young women in Sweden, 1989-1991. Gynecol Oncol 1999;74(3):472-6.
12. Zemlickis D, Lishner M, Degendorfer P, Panzarella T, Sutcliffe SB, Koren G. Fetal outcome after in utero exposure to cancer chemotherapy. Arch Intern Med 1992;152(3):573-6.
13. Grendys Jr EC, Barnes WA. Ovarian cancer in pregnancy. Surg Clin North Am 1995;75(1):1-14.
14. Jubb ED. Primary ovarian cancer in pregnancy. Am J Obstet Gynecol 1963;85:345–54.
15. Copeland LJ, London MB. Malignant disease in pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL, editors. Obstetrics, Normal and Problem Pregnancies, 3rd edition. New York, NY: Churchill Livingstone; 1996. pp. 1155–81.
16. Partridge EE, Phillips JL, Menck HR. The National Cancer Database report on ovarian cancer treatment in United States hospitals. Cancer 1996;78:2236–46.
17. Kwon YS, Mok JE, Lim KT, Lee IH, Kim KH, Lee KH, et al. Ovarian cancer during pregnancy: clinical and pregnancy outcome. J Korean Med Sci 2010;25 (2);230-4.
18. Halila H, Stenman U, Seppala M. Ovarian cancer antigen Ca125 levels in pelvic inflammatory disease and pregnancy. Cancer 1986;57:1327-9.
19. Kobayashi F, Sagawa N, Nakamura K, Nonogaki M, Ban C, Fujii S, et al. Mechanism and clinical significance of elevated Ca125 levels in the sera of pregnant women. Am J Obstet Gynecol 1989;160:563–6.
20. Creasman WT, Rutledge F, Smith JP. Carcinoma of the ovary associated with pregnancy. Obstet Gynecol 1971;38:111–16.
21. Husseinzadeh N, Sibai B, Siddiqi TA. Ovarian tumors in pregnancy: Diagnosis and management. Am J Perinatol 2012;29:327-34.
22. Palmer J, Vatish M, Tidy J. Epithelial ovarian cancer in pregnancy: a review of the literature. BJOG 2009;116(4): 480–491.
23. Novak ER, Lambrou CD, Woodruff JD. Ovarian tumors in pregnancy. An ovarian tumour registry review. Obstet Gynecol 1975;46:401–6.
24. Behtash N, Karimi ZM, Modares GM, Ghaemmaghami F, Mousavi A, Ghotbizadeh F. Ovarian carcinoma associated with pregnancy: a clincopathologic analysis of 23 cases and review of literature. BMC Pregnancy Childbirth.2008;8:3.