Gynaecological cancer in pregnancy

She is 23 weeks pregnant and your colposcopy just confirmed an invasive squamous carcinoma of the cervix. In the next hour you will not make a single decision alone — you will activate a multidisciplinary team, you will weigh her prognosis against her baby's survival, and you will resist the two impulses that wreck these cases: deferring treatment as if the cancer will wait, and delivering early as if prematurity is harmless. Neither is true. Cancer in pregnancy is the discipline where obstetrics and oncology must think as one.^[1][14]

Scope and why it is its own topic

Cancer is diagnosed in approximately one in every thousand pregnant women, and its incidence is rising as childbearing is delayed into the years when cancer becomes more common.^[6][7] Of the gynaecological cancers, cervical cancer is the commonest malignancy diagnosed in pregnancy; ovarian malignancy in pregnancy is uncommon and, in young women, is more often borderline or germ-cell than high-grade epithelial. The framework is unified by a single principle, stated in the ESGO/INCIP guideline: treatment during pregnancy should adhere to standard oncological management as much as possible to optimise maternal prognosis, always taking fetal wellbeing into account, and always within a multidisciplinary team.^[1][7]

The decision space is defined by three variables — tumour type and stage, gestational age, and the patient's values — and the answer is almost never "treat now at any cost" or "wait and see." It is "what standard treatment can I safely deliver now, and what must wait until fetal maturation?"^[1][2]

^{[2] [4] [6]}

References18ShowHide

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