At a Glance:
What are the chances of a woman getting pregnant if she has ovarian cancer?
What are the chances of getting pregnant with single ovary?
Is a pregnant woman more susceptible to ovarian cancer?
What are the symptoms of ovarian cancer, how is it differentiated from pregnancy?
Does ovarian cancer change the way a woman will deliver a baby?
How do doctors diagnose ovarian cancer?
What are the fertility-sparing treatments for ovarian cancer?
Treating ovarian cancer – does pregnancy affect the way ovarian cancer is treated?
Is there any risk for the developing baby due to ovarian cancer during pregnancy?
Is it possible to breastfeed while on chemotherapy or radiation therapy?
Any form of cancer that begins or develops in the ovary or ovaries is called as ovarian cancer. Ovaries are reproductive organs found in females that are responsible for the production of ova (eggs) for reproduction.
Ovarian cancer is different from benign forms of ovarian tumours that generally do not spread beyond the ovaries. Ovarian cancer is one of the most common types of gynaecological cancers and is associated with the highest rate of deaths amongst gynaecological cancers.
Ovarian cancer, as well as the treatment for ovarian cancer (surgical or medical), can affect the chances of getting pregnant. This may be because of surgical removal of ovaries and/or uterus (womb) or the side effects of chemotherapy & radiation (early menopause). Fertility after ovarian cancer depends on a few factors such as the stage of cancer and the age of the woman at the time of treatment.
Those women who are diagnosed with early-stage ovarian cancer where only one ovary is affected the other ovary continues to produce eggs. However, this ovary can be damaged by chemotherapy medications leading to early menopause. Such individuals can get their eggs frozen and opt for getting pregnant on treatment completion. Hence, it is important that the individual discusses fertility options with the treating doctor once she’s diagnosed with ovarian cancer.
Removal of ovaries, also known as oophorectomy in women may be done for a variety of reasons. Some of the common reasons being, the presence of a tumour, infections not amenable to conservative options, cysts, endometriosis or sometimes cancer. Sometimes only one ovary is removed (unilateral oophorectomy) leaving behind the other one. A woman may become pregnant even with a single ovary in place, though conception in such a case may happen with some challenges. Further, in such cases, underlying factors like maternal age, blockage of a fallopian tube, hormonal disturbances, ovarian reserve etc may add to the existing challenges. The chances of conception after unilateral oophorectomy may range from 42-88% in case of women who may have undergone a constructive surgery for ovarian cancer or tumour removal. In case you have undergone or would be undergoing an oophorectomy and have plans to conceive later, do consult your gynaecologist about your options for increasing future chances of pregnancy like prescription medicines, egg or embryo freezing techniques
Although the exact cause of ovarian cancer may not be known in many cases, there are a few factors that are identified with a higher risk for ovarian cancer
Of note, pregnancy lowers the risk of breast cancer, especially in women who have had full-term pregnancy at or below 30 years of age. Risk reduces with each full-term pregnancy. Breastfeeding lowers the risk of ovarian cancer even more. Similarly, birth control pills and some gynaecological surgeries (tubal ligation and hysterectomy) reduce the risk of ovarian cancer.
Ovarian cancer is reported to occur more frequently in post-menopausal women between the age group of 55 and 64 years. Although the chances are less, it can occur during the childbearing years and it’s rare to be diagnosed with ovarian cancer during pregnancy. Conversely, pregnancy before 35 years of age lowers the risk of breast cancer, especially in women who have had full term pregnancy. Risk lessens with each full-term pregnancy.
Ovarian cancerous growths are easily detectable by routine ultrasound during pregnancy in otherwise asymptomatic pregnant women. But this does not mean that pregnancy is a causative factor for ovarian cancer as many times the finding may be coincidental.
The typical signs and symptoms of ovarian cancer in relation to pregnancy are:
Since most of these symptoms occur during a normal pregnancy as well, it is difficult to differentiate those from those of ovarian cancer. Also, the symptoms of ovarian cancer can be more severe or persistent than the usual symptoms of pregnancy. The timing of these symptoms also could give a clue to the individual that there might be some other issue than pregnancy in causing these symptoms. For example, excessive weight gain during the first trimester of pregnancy might occur in a pregnant woman with ovarian cancer. Normally, weight gain is not much in normal pregnant women. This makes it very important to discuss these symptoms with your doctor or gynaecologist as soon as you notice them, especially when there is a family history of ovarian or breast cancer.
In many cases, the doctors detect abnormal growth on the ovaries during routine ultrasound examination in pregnancy. Many times, the pregnant woman might not have experienced any symptoms.
Most of the time, the woman can continue through the pregnancy and deliver the baby normally. The way by which the baby is delivered, either normally or through a C-section will depend on the stage and grade of ovarian cancer. Many women can have a full-term, normal vaginal delivery. However, other indications for a C-section cannot be overlooked. Sometimes, the surgeon may schedule a C-section for delivery as well as debulking of cancer or tumour at the same time
Before running any tests, the doctors will take a detailed medical history to learn about any possible symptoms that could be liked to ovarian cancer. This will also include a family history to understand if any of the close relatives of an individual have had breast or ovarian cancer.
The doctor will also perform a physical exam to check for any signs of ovarian tumours like enlarged ovaries or free fluid in the abdomen (ascites).
If the doctor finds anything suspicious in your medical history and/or physical exam, the doctor will recommend some tests to ascertain the cause. Diagnostic tests that doctors use to detect ovarian cancer are:
Other tests: Some additional tests can be done to understand whether cancer has spread to other parts of the body. This helps in the staging of the disease as well as deciding the treatment approach.
Fertility sparing treatments are of interest for women of child-bearing age (upto 45 years) with any gynecologic cancers including ovarian cancer, cervical cancer & endometrial cancer. These patients are reffered to oncofertility specialist for a consultation. Considering the medical and fertility history, age and suppression medicines, the oncologist and oncofertility specialists plan treatments which are either conservative or traditional. It is possible to spare fertility by conservative surgery in case the cancer is found at an early stage. This surgery generally includes removal of the ovary and fallopian tube of the affected side.
Fertility-sparing surgery (FSS) is indicated for patients with stage 1 epithelial ovarian cancer. FSS has proven efficacy in preserving fertility without apparent adverse impact on cancer outcomes. Advances in Assisted Reproductive Technologies (ART) have provided patients with more fertility options. Fertility preservation options such as ovarian tissue or oocyte retrival & storage is recommended for young women as the survival rates continue to improve.
Treatment options for ovarian cancer depend on the stage and severity of the disease. Currently, due to routine use of ultrasound early in pregnancy, it is possible to diagnosis the ovarian cancer early thus leading to effective management of asymptomatic ovarian cancers. Certain factors that affect treatment for ovarian cancer during pregnancy include:
Ovarian cancer generally would not affect the developing baby. There is a substantial risk for the baby only when the cancer is advanced, blocking blood flow to the baby, or causing abnormal hormone production. In many cases, the cancer treatments may pose risk than the cancer itself.
Chemotherapy as well as radiotherapy medication can be transmitted to the baby/child via breast milk and can cause serious side effects. So as a rule, breastfeeding is best avoided if an individual is receiving chemotherapy or radiation therapy.
Extensive debulking surgery can cause harm to the developing baby. Thus, it is recommended that the pregnant woman undergo a conservative surgery at 16-20 weeks of pregnancy as there is a high rate of miscarriage if performed in the first trimester (first 3 months) of pregnancy. This surgery generally includes removal of the ovary and fallopian tube of the affected side.
Chemotherapy in the first trimester (first 3 months) may cause birth defects & miscarriages. So, chemotherapy is contraindicated in the first trimester of pregnancy and may be considered thereafter. However, the safest approach is to start chemotherapy after birth.
Thus, debulking surgery and chemotherapy can be performed after childbirth.
Radiation therapy is dangerous at any trimester of pregnancy as the X-rays can cause harm to the developing baby at any stage of pregnancy.
In the scenario where the ovarian cancer is so advanced that it poses a serious threat to the mother to the point of being life-threatening, the risks of not doing the treatment outweigh those risks to the pregnancy. In this case, debulking surgery as well as chemotherapy will go on as it would in a non-pregnant woman.
HIPEC is shown to be effective in treating advanced or metastatic cancer of the ovaries. When done in carefully selected individuals by an experienced surgeon in a facility employing a multidisciplinary approach, the outcome can be greatly improved. HIPEC is generally a part of a surgical procedure which is commonly referred to as Cytoreductive Surgery (CRS), the surgical removal of visible cancer or tumor/s in the abdominal cavity. HIPEC is delivered after completion of CRS to target the microscopic cancer cells that remain in the body. CRS and HIPEC combined provide an effective treatment approach for ovarian cancer by both, increasing the survival rate as well as the quality of life parameters. Thus, HIPEC can be an effective treatment option for individuals where other forms of treatment have not worked or not available or not suitable.
Ovarian cancer is a rare occurrence during pregnancy. Although the symptoms of ovarian cancer are difficult to differentiate from those of normal pregnancy, it is still possible to detect the disease in the early stage by way of routine ultrasound examination during pregnancy. The treatment of ovarian cancer during pregnancy depends on the stage and severity of the cancer. It is possible to preserve fertility in early stages through conservative surgery. The woman can continue the pregnancy with conservative treatment measures. However, this depends on the stage of the disease and the judgment of the treating doctor. Ultimately, if the risk to the pregnant woman is high due to the underlying cancer, the treatment protocol will follow that of a non-pregnant woman.
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