[Gynecologic neoplasms in pregnancy].

Cancer in pregnancy represents a complicated scenario and a unique challenge to the pregnant patient, her family and the physicians. Extraordinary decisions are forced upon the woman and all participants involved with her care. They must address medical, religions, social, ethical and emotional concerns of the mother and her family. Because of the low incidence of malignant disease in pregnancy it is not possible to develop a large personal experience. The most common malignancies in pregnancy are cancers of the cervix and the breast, followed by melanomas and ovarian cancer. After stratification for stage all gynaecological malignancies have a similar prognosis as cancers in nonpregnant patients, provided they are treated correctly. The general principle is to treat the cancer and to allow the pregnancy to proceed until adequate foetal maturity has been achieved. In cervical cancer a delay in therapy of several weeks revealed no adverse effects on treatment outcome. Generally caesarean section should be the delivery method of choice. In breast cancer diagnoses is typically delayed for 5 to 7 months for various reasons. Therefore work-up of a mass discovered during pregnancy has to be as strict and complete as outside pregnancy. Breast-conservation therapy remains an option even in pregnancy but adjuvant radiotherapy should be started after the child has been born. Even chemotherapy is possible although the first trimester is the most critical time resulting in a 10-20% malformation rate as compared with a rate of 3% in the general population. Chemotherapy in the second and third trimester may result in intrauterine growth restriction. Breast feeding is contraindicated in women receiving chemotherapy. Therapeutic abortion does not improve survival. Most ovarian cancers diagnosed in pregnancy are of low grade and early stage (Stage I). Work-up and treatment involving surgery and chemotherapy follows the same guidelines as in the nonpregnant woman. In order to arrive at the optimal decision, the patient and her family have to be optimally informed.