Table 1.
Stage-adapted treatment of breast cancer and gynecological cancer diagnosed during pregnancy.
| Entity | Diagnostic Procedures | Tumor Stage | Possible Therapeutic Procedures During Pregnancy | Pregnancy and Delivery | Post Pregnancy | |
|---|---|---|---|---|---|---|
| Breast Cancer | Breast US Axilla US Mammography Chest x-ray Liver US Bone MRI |
Not locally advanced | 1st trimester: consider TOP 1 prefer mastectomy over lumpectomy 2 Prefer SNLB of the axilla over axillary dissection 2 CT 3 RT 4 gw > 36: DTAD 5 |
OM 5 | COT | |
| Locally advanced | 1st trimester: consider TOP 1 prefer mastectomy over lumpectomy 2 Prefer SNLB of the axilla over axillary dissection 2 CT 3 RT 4 gw > 36: DTAD 5 |
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| Metastatic | 1st trimester: consider TOP 1 CT 3 RT 4 gw > 36: DTAD 5 |
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| Ovarian Cancer | Epithelial | gw < 22: LSC gw > 22: LAP biopsy or adenectomy |
stage IA, IB | gw < 22, IAG1, no indication for CT, staging surgery without hysterectomy gw > 22, IAG1, no indication for CT, staging surgery after delivery gw > 22, indication for CT 3, staging surgery after delivery |
OM 5 | COT |
| >stage IB | Consider TOP 7 NACT 3, staging surgery after delivery |
OM 6 | COT | |||
| BOT | gw < 22: LSC gw > 22: LAP biopsy or adenectomy |
conservative surgery 2 | OM 5 | COT | ||
| Germ Cell | gw < 22: LSC gw > 22: LAP biopsy or adenectomy |
if no indication for CT 3: follow up CT 3, if indicated |
OM 5 | COT | ||
| Sex Cord | gw < 22: LSC gw > 22: LAP biopsy or adenectomy |
gw < 22, no indication for CT, staging surgery without hysterectomy 2 gw > 22, no indication for CT, staging surgery after delivery CT 3, if indicated |
OM 5 | COT | ||
| Cervical Cancer | Colposcopy Biopsy MRI gw < 22: LSC, PLND 2 |
IA1, LVSI- IA1, LNM- IA2, LNM- IB1, LNM- |
Conization 2 Simple trachelectomy 2 Radical trachelectomy 2 vs Consider NACT 3 vs gw > 22, DTAD can be considered |
CS 5 | COT | |
| Colposcopy Biopsy MRI gw < 22: LSC, PLND 2 |
IB2, LNM- | NACT 3 vs If gw > 22, DTAD can be considered |
CS 5 | COT | ||
| Colposcopy Biopsy MRI |
IB2, gw > 22, LVSI unkown, LNM unkown | NACT 3 vs DTAD |
CS 5 | COT | ||
| Colposcopy Biopsy MRI |
IB3 | Consider TOP 7 | CS 6 | COT | ||
| If TOP is not desired, discuss NACT 3 | CS 5 | |||||
| Colposcopy Biopsy MRI |
>IB3 | TOP 7 | CS 6 | COT | ||
| If TOP is not desired, discuss NACT 3 | CS 5 | |||||
| Colposcopy Biopsy MRI gw < 22: LSC, PLND 2 |
All stages, LNM+ | Consider TOP 7 | CS 6 | COT | ||
| If TOP is not desired, discuss NACT 3 | CS 5 | |||||
| Vulvar cancer | Vulvoscopy Biopsy MRI |
Early stages, no need for RT | Local excision 2 SNLB of the groin 2 |
CS 5 | COT | |
| Advanced disease, need for RT | Consider delay of RT for 6 to 8 weeks | CS 6 | COT | |||
| RT cannot be delayed: TOP 7 | CS 6 | |||||
| Vaginal cancer | Vaginoscopy Biopsy MRI |
Early stages, no need for RT | Local excision 2 | CS 5 | COT | |
| Advanced disease, need for RT | TOP 7 | CS 6 | COT | |||
BOT = borderline tumor of the ovary; COT = competition of treatment, if necessary; CT = Chemotherapy; CS = cesarian section; DTAD = delay treatment after delivery; gw = gestational weeks; LSC = laparoscopy; LAP = laparotomy; LVSI = lymphovascular space invasion; LNM = lymph node metastases; MRI = magnetic resonance imaging; NACT = neoadjuvant chemotherapy, until disease progression is detected; OM = obstetrical management and delivery, according to respective guidelines for high-risk pregnancies; PLND = pelvic lymphadenectomy; RT = radiotherapy; SNLB = sentinel lymph node biopsy; TOP = termination of pregnancy; US = ultrasound; vs = versus; − = negative; + = positive; 1 = in cases requiring urgent systemic treatment, 2 = 2nd trimester recommended for surgical procedures; 3 = allowed in 2nd and 3rd trimester before 35 weeks of gestation; 4 = possible in selected cases during 1st and 2nd trimester; 5 = avoid iatrogenic preterm delivery; 6 = if fetus viable; 7 = consider feticide, if fetus not viable, with either vaginal or laparotomic evacuation of the uterus.