Gynaecological malignancies in pregnancy

Malignancies of the genital tract in pregnancy are uncommon. When they are encountered in pregnancy there is always a conflict between optimal maternal therapy and fetal well-being. In most instances the cancer should be managed as though the patient were not pregnant. Surgery is preferred for the various site-specific cancers; the timing and mode of delivery should be individualised. The commonest gynaecological cancer encountered is cervical cancer. Delivery by classical Caesarean section followed by radical hysterectomy appears to be the method of choice for cervical cancer; significantly poorer survivals were observed if this was delayed until the puerperium.

Ovarian cancer, the second most common gynaecological cancer in pregnancy has a good prognosis due to early presentation in the majority. Malignant germ-cell tumours are just as common as epithelial ovarian cancers.

The association of pregnancy with other gynaecological malignancies—carcinoma of endometrium, vagina, fallopian tube, vulva, and choriocarcinoma are discussed.

Cytotoxic drugs are highly teratogenic in the first trimester; other fetal problems can arise when these are used after 12 weeks’ gestation. Therefore, cytotoxic chemotherapy is best avoided in pregnancy.