Treatment of Ovarian Cancer During Pregnancy

Pregnant woman at doctor's office.
Ovarian Cancer While Pregnant. M_a_y_a / Getty Images


Ovarian cancer occurs in approximately 1 in 18,000 pregnancies. Symptoms and signs are similar to those in the absence of pregnancy. Typically an ovarian mass is found during an antepartum (a routine pre-birth checkup) visit. If it reverts to normal after several examinations and ultrasounds, the diagnosis is usually a functional cyst which occurs because of hormonal issues during pregnancy.

Germ cell ovarian tumors are the ones most commonly diagnosed up to age 30, and gonadal stromal tumors are found throughout child-bearing years. Both of these types are more often involving only one ovary compared to the more common epithelial ovarian cancers. Consequently, if the tumor is found on only one ovary, removal of that ovary alone may be a satisfactory treatment during the course of pregnancy.

Common symptoms may be the same for benign or malignant ovarian masses. These include twisting of the ovary on its blood supply (torsion), leak, rupture, bleeding or infection. Depending upon when in pregnancy an ovarian mass is found, it may or may not be felt on pelvic or abdominal examination by the doctor. If it can be felt, the findings may help in the decision about whether to operate or carefully observe with periodic examinations and ultrasound. A one-sided ovarian mass which freely moves and is smaller than 10 centimeters (about 4 inches), can be observed with periodic evaluation until the second trimester of pregnancy.

During this time, if the mass diminishes in size, presumptively it may be a functional cyst. On the other hand, if it grows, you'll need surgery as soon as possible. Also, if on the first examination the mass feels irregular, does not move (is attached to other pelvic organs), seems to involve both ovaries or fluid in seen in the abdomen and pelvis on ultrasound, it may be time for surgery regardless of the trimester of pregnancy.

Luckily, cancer during pregnancy is usually diagnosed at an early stage (stage I), largely because the patient often seeks medical attention early due to pregnancy, before the onset of symptoms of advancing ovarian cancer. The prognosis is the same as that without pregnancy, basically depending on the type of tumor and the stage and grade.

Evaluation and Testing

Ultrasound is safe during pregnancy, but CT or CAT scans produce radiation and are not safe, especially during early pregnancy. MRI or Magnetic Resonance Imaging is generally considered safe during pregnancy and may be used if the ultrasound does not provide enough information.

CA-125 blood testing may be performed but is not entirely accurate during pregnancy. The pregnancy itself can cause an elevation in this tumor marker, at least into the range of several hundred. So, a level over 35IU/ml is usually considered abnormal, but in pregnancy, this level may be 200 or 300 or even more simply due to the pregnancy itself. However, a level in the thousands is probably due to cancer.


Treatment is basically the same as in the non-pregnant state. The first step is surgery, with the only question being when. The second trimester is generally preferred since it is associated with less chance of pregnancy loss.

If the tests suggest a low suspicion of cancer, then this is the target time. If the suspicion is high, then the surgery should be done as soon as possible.


During surgery, if the pathologist confirms cancer, then staging surgery is completed. This means at least removal of the affected ovary, biopsies of lymph nodes and peritoneum in various areas. If it looks like the cancer has spread beyond the ovary, then cytoreduction or debulking is performed just like it is in the absence of pregnancy.

It is crucial to discuss the possibilities and options BEFORE the surgery. The critical decision, depending upon the trimester, is what to do about the pregnancy.

In an early cancer, the pregnancy can often be continued and only the ovary removed along with staging. If the cancer has spread beyond the ovary, it may be best to remove the uterus to get rid of as much cancer as possible. If the pregnancy is less than 24 weeks, removing the uterus would obviously terminate the pregnancy and the fetus would not survive. If the pregnancy is beyond 24 weeks but not yet at a mature state (generally beyond 36 weeks) a Cesarean section could be performed before removing the uterus and the baby delivered. However, there is a big difference in the ability of the newborn to survive the closer it is to 24 weeks as opposed to beyond 36 weeks. All of these issues are important to cover before surgery.


Treatment of ovarian cancer beyond surgery is exactly the same, stage for stage, as if there was no pregnancy beyond the first trimester. All of the fetal organs have completed development by the end of the first trimester. Beyond this point is mainly growth, which can be retarded somewhat by chemotherapy, but there is no danger of congenital malformation.

The chemotherapy drugs and decisions as to whether or not chemotherapy is required are the same as in the non-pregnant state. Fortunately, since most ovarian cancers found during pregnancy are stage I, chemotherapy can often be avoided. When required, it should be started as soon as possible. If chemotherapy is required during the first trimester, it is possible that a choice will be required about terminating the pregnancy. Waiting for months can endanger the mother's life and limit the chances of cure.