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Ovarian Cancer and Pregnancy — Diagnosis and Next Steps

Posted on May 11, 2022
Medically reviewed by
Howard Goodman, M.D.
Article written by
Maureen McNulty

Cancer of the ovaries, fallopian tubes, and peritoneum (lining of the abdomen) is collectively called ovarian cancer. While this cancer usually occurs in older adults (ages 55 to 64, in particular), it can also develop in younger people in rare cases. Also uncommonly, some people may discover that they have ovarian cancer while pregnant.

Receiving a cancer diagnosis during a pregnancy can be devastating. However, learning more about how ovarian cancer and its treatments affect you and your developing fetus can help you make important decisions.

People who are diagnosed with ovarian cancer during pregnancy often have a good outlook. Typically, it is hard to identify ovarian cancer in the early stages, and this condition is usually not diagnosed until after it has begun to spread.

However, because people who are pregnant usually go through many imaging tests such as ultrasounds, there is a higher chance that ovarian cancer will be detected and treated early.

How Does Ovarian Cancer Affect a Developing Fetus?

In general, ovarian cancer doesn’t directly affect how your unborn baby grows and develops. For example, experts haven’t found evidence that ovarian cancer itself can spread to the fetus. However, ovarian cancer can cause situations that indirectly might harm your pregnancy.

For example:

  • A large ovarian tumor could prevent the unborn baby from growing normally or it could block blood flow to the fetus.
  • Ovarian cancer can lead to abnormal hormone levels that affect your pregnancy, because the ovaries make hormones,
  • Ovarian cancer can put your health or life at risk, which then puts the life of your developing fetus at risk.

Certain diagnostic tests and ovarian cancer treatments also have the potential to harm the fetus. Make sure to talk to your doctor about how any procedures or therapies may affect both you and your unborn baby.

Undergoing Tests While Pregnant

Surgery is the only way to tell for sure whether an ovarian mass is cancerous. During surgery, a doctor will perform a biopsy — they will remove a piece of your tissue and study it under a microscope.

If cancer cells are detected, you may need to undergo additional tests to determine how far the cancer has spread, decide which treatments may work best, and detect other potential health problems.

Imaging Tests

During pregnancy, some tests may be better choices than others. Ultrasounds and MRIs don’t harm the fetus and can be used while you’re pregnant without risking the fetus’s health.

X-rays use radiation to capture images of your internal organs and tissues. While high doses of radiation can lead to birth defects or disease, X-rays generally expose your unborn baby to low levels of radiation. The chances that a single X-ray will lead to harm are very small and the benefits of learning more about your cancer may outweigh any risk. However, make sure to tell your doctor that you are pregnant before undergoing an X-ray. Ask them about the risks for you and your developing fetus, and if there are any other safer options that may provide the same information.

That said, avoid getting a CT scan of the abdomen while you’re pregnant. These tests involve taking many different X-rays, which can lead to an increased risk of gene mutations in the fetus. Such mutations could later lead to fetal death, childhood cancers, and more.

Blood Tests

Blood tests are safe (and routine) during pregnancy, but the results for someone with ovarian cancer may be harder to interpret. For example, managing ovarian cancer often involves measuring levels of CA-125, a protein made by ovarian cancer cells.

Tracking CA-125 levels over time can help doctors measure an ovarian tumor’s response to treatment. However, pregnancy can also lead to higher levels of CA-125, so this blood test may not be a useful way to monitor your ovarian cancer if you are pregnant.

Treating Ovarian Cancer While Pregnant

Ovarian cancer during pregnancy is not very common, and there has not been a lot of research to determine which treatments are the best, considering. Your treatment plan will likely be very personalized, based on:

  • The type of ovarian cancer you have
  • Your ovarian cancer stage (how far it has spread)
  • Your ovarian cancer grade (how abnormal the cancer cells are)
  • Whether your cancer is newly diagnosed or recurrent (came back after being treated)
  • How far along you are in your pregnancy
  • Your own personal preferences and priorities

Typically, treatment of ovarian cancer during pregnancy involves minimal surgery and chemotherapy.

Undergoing Surgery

Most people with ovarian cancer need to have surgery in order to remove the cancer. There are several different surgical options:

  • For certain types of ovarian cancer that are diagnosed at an early stage, treatment may involve removing just one ovary and fallopian tube, which allows a person to get pregnant again in the future.
  • For more aggressive types of cancer, or for ovarian cancer that has spread to other tissues, surgery typically includes removing both ovaries and fallopian tubes.
  • For people who aren't pregnant, surgery options may also include debulking, the type of surgery that involves removing visible cancerous growths and the tissues and organs affected by them. In ovarian cancer, debulking can include removing the uterus, fallopian tubes, and ovaries, as well as any other organs or tissues that contain cancer.

For people who are pregnant, doctors may recommend delaying surgery for ovarian cancer until after the first trimester. If surgery occurs early on in the pregnancy, the risk for miscarriage is higher.

The chances of experiencing problems during surgery drop in the second trimester. On the other hand, doctors may not want to wait too long to perform surgery — delaying treatment gives the cancer more time to spread.

Surgery is often performed in the 16- to 20-week range of the pregnancy. The fetus’s organs are fully developed by then, reducing the chances that there will be defects. Additionally, there is a much lower risk of miscarriage at this time.

During pregnancy, doctors will generally perform conservative surgery, only removing tissue where absolutely necessary, in order to decrease the risk of problems. Full debulking surgery is often not recommended until after the baby has been born. At that point, doctors can more safely remove cancer-containing tissues. However, doctors may need to do more extensive debulking if the lives of the pregnant person and/or fetus are at risk.

If both of your ovaries are surgically removed early in pregnancy, you will likely have to take progesterone, a hormone normally made by the ovaries. Later in pregnancy, the placenta takes over this role and produces progesterone. This hormone is important for supporting a healthy pregnancy.

Using Chemotherapy

Many people with ovarian cancer receive chemotherapy, which uses prescribed cancer-killing drugs. Chemotherapy can be harmful to a developing fetus, especially when given in the first trimester. These medications can lead to birth defects and miscarriage. When chemotherapy is used in the second or third trimesters, there is less risk to the fetus, but there is still a chance that the unborn baby could have long-term health effects.

In some cases, a person may choose to go through chemotherapy later in the pregnancy if their health is at risk. In other cases, they may wait until after giving birth to start chemotherapy treatments.

Chemotherapy also leads to several side effects that could affect a pregnancy. For example, these medications can make it hard to eat normally by causing nausea, vomiting, loss of appetite, or mouth sores. These side effects could make it hard for you to get the nutrition that your fetus needs in order to grow properly.

Additionally, chemotherapy often leads to low levels of white blood cells, which can increase your risk of infections that could harm the fetus.

Targeted Therapies

Targeted therapies are medications that attack specific molecules found on cancer cells. This is a newer group of drugs, so health care experts don’t yet know their effects during pregnancy.

Research has found that many targeted therapy drugs can cross into the placenta and reach the fetus, but it isn’t yet known what health effects the drugs will cause in a fetus. Some types of targeted therapy, such as angiogenesis inhibitors, should not be used. These drugs block the growth of new blood vessels with the intention of cutting off blood, which is vital for a tumor to spread. However, new blood vessels are essential for the fetus’s development. Most doctors recommend waiting to use targeted therapy until after delivery.

Radiation Therapy

Radiation treatment is rarely used for ovarian cancer — and it’s always risky during a pregnancy. Regardless of the age of the fetus, radiation can cause harm. Doctors will often recommend waiting until after the baby has been born to undergo radiation therapy.

Choosing More Aggressive Treatment Options

Ovarian cancers diagnosed during pregnancy tend to be smaller and easier to treat, but not always. A pregnant person may be diagnosed with a more advanced-stage tumor or with a type of ovarian cancer that tends to grow more aggressively.

In this case, the cancer puts the life of the pregnant person at risk — and that of the developing fetus. The benefits of aggressive treatment may outweigh the risks to the unborn baby in some situations. Doctors may recommend treating the ovarian cancer using typical treatments, as if the person were not pregnant.

The advantage of aggressive treatment is that the pregnant person will likely have a better chance of having a good outcome. However, the fetus’s health will be at risk.

On the other hand, waiting to use more aggressive treatments until after birth will increase the chances of a healthy birth, but the delay gives the cancer more time to grow and spread throughout the body.

How quickly ovarian cancer spreads depends on the type of ovarian cancer, the cancer stage, and the cancer grade. Your cancer care team can help you understand how quickly your ovarian cancer is expected to grow and what your outlook may be with different treatment options.

Giving Birth After an Ovarian Cancer Diagnosis

If you have ovarian cancer while pregnant, your pregnancy will be considered high-risk. There is a chance that you will go into labor early or experience other complications.

Ask your health care team what, if anything, you can do to minimize risks. For example, your doctor may recommend taking steroids to help your fetus’s lungs develop faster. This decreases the chances that your child will have health problems if you go into premature labor.

Ovarian cancer may not affect your birth plan. It’s possible to have a typical vaginal delivery, although this depends on other factors, such as your cancer stage and characteristics related to your pregnancy.

In some cases, your doctors may recommend a C-section so they can perform debulking surgery immediately following the baby’s birth. Talk to your oncologist and your OB-GYN to come up with a birth plan that will work best for your baby and for you.

Breastfeeding With Ovarian Cancer

You will most likely not be able to breastfeed while undergoing ovarian cancer treatments. Chemotherapy drugs generally travel throughout your body and are present in your breast milk. If they are passed on to your baby, they can cause serious health problems.

If you’re interested in breastfeeding, ask your doctor about whether it’s compatible with your ovarian cancer treatment plan.

Talk With Others Who Understand

On MyOvarianCancerTeam, the social network for people with ovarian cancer and their loved ones, more than 4,000 members come together to ask questions, give advice, and share their stories with others who understand life with the condition.

Have you received a diagnosis of ovarian cancer while going through a pregnancy? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Howard Goodman, M.D. is certified by the American Board of Obstetrics and Gynecology and specializes in the surgical management of women with gynecologic cancer. Review provided by VeriMed Healthcare Network.. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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