Ovarian cancer and pregnancy: What to know

Tumors and masses on the ovaries are relatively common during pregnancy. However, if a doctor locates an ovarian tumor during pregnancy, it is rarely cancerous. Ovarian cancer during pregnancy is uncommon.

Doctors may have difficulty diagnosing ovarian cancer during pregnancy, as certain ovarian cancer symptoms, such as bloating or pressure in the pelvis, are also common during this time.

If a person has ovarian cancer during pregnancy, doctors will usually aim to treat it and help the person achieve full-term delivery.

This article examines how ovarian cancer can affect the birthing parent and fetus during pregnancy and the treatment options available. It also looks at possible options for those trying to conceive after surviving ovarian cancer.

According to a 2020 review, masses on the ovaries can occur in 0.15–5.7% of pregnancies, and most of these are benign.

The authors note that it is very rare for benign ovarian tumors to develop into ovarian cancer. Ovarian cancer accounts for approximately 3–6% of abnormal growths on the ovaries during pregnancy.

If a person receives an ovarian cancer diagnosis during pregnancy, a doctor will consider their pregnancy as high risk.

The overall survival rates for pregnant people with ovarian cancer are similar to those who are not pregnant.

Learn more about the survival rates for ovarian cancer here.

It is unlikely that cancer will affect the health or development of the fetus. For cancer to affect the fetus, cancer cells would have to pass through the barrier of the placenta.

Although nutrients and oxygen from a person’s blood supply pass through the placenta to the fetus, it is rare for cancer cells to spread to the placenta and even rarer for them to spread to the fetus.

Treatment for ovarian cancer, involving surgery and chemotherapy, may pose a higher risk to the fetus than cancer itself.

Surgeons can perform surgery on ovarian cancer during pregnancy with relative safety. However, if a person receives surgery during their first trimester, there is a slightly higher risk of miscarriage. Although there may be a slight increase in risk to the fetus, a person should not delay surgery if it is required.

It is safest for the fetus if a person receives chemotherapy during the second or third trimesters of pregnancy. The first trimester is when the fetus is developing organs. There is a 10–20% chance of fetal malformation with chemotherapy in the first trimester and a 1.3% risk of malformation during the second or third trimester.

According to research, there are no significant long-term complications in fetuses with chemotherapy exposure during the second and third trimesters of pregnancy.

According to LabTestsOnline, human chorionic gonadotropin (hCG) is a hormone that is usually only measurable during pregnancy. A pregnancy test can detect hCG in the urine.

Some abnormal tumors and cancers release hCG, which means it can be a tumor marker. However, pregnancy tests are unable to diagnose ovarian cancer.

Blood is the preferred way to measure hCG levels as a diagnostic tool for cancer. Although elevated levels of hCG in the blood mean that hCG levels will be elevated in the urine, the results are not interchangeable.

To diagnose ovarian cancer, a healthcare professional will perform the following tests:

  • a physical examination and pelvic exam
  • ultrasounds and other imaging tests
  • blood tests, such as a CA-125
  • excision of the mass, if a tumor is suspected

A person may also undergo a transvaginal ultrasound, which involves inserting an ultrasound probe into the vagina.

The healthcare team involved in managing and treating ovarian cancer during pregnancy may comprise:

  • an obstetrician
  • an oncologist
  • an anesthesiologist
  • a neonatologist
  • a psychologist

This is because the decision is complex, and there may be concern about the well-being of the birthing parent and the fetus.

The type of treatment and treatment schedule could depend on various factors, including the stage or spread of the cancer, the type of cancer, and the subtype.

A doctor will administer and tailor treatment to an individual, which will usually involve surgery and chemotherapy.

A 2020 review notes that doctors can typically perform surgery between 16–20 weeks of gestation and administer chemotherapy during the second and third trimesters of pregnancy.

If a doctor diagnoses cancer later in pregnancy, it may be possible for a person to wait until after the birth to begin treatment. A doctor may also consider bringing labor on early to start treatment and minimize risk to a person with ovarian cancer.

In certain situations, a person may need to decide with their doctor about continuing the pregnancy. If cancer is advanced or aggressive, a person may require immediate treatment.

How will treatment affect any future pregnancies?

Cancer treatment may affect future pregnancies in the following ways:

  • Surgery to the cervix: If a person has surgery to remove part of their cervix, they may be at higher risk of miscarriage or early birth. This is because the cervix may not be able to support a developing pregnancy after surgery.
  • Chemotherapy: Some chemotherapy treatments may damage heart cells and weaken the heart, making pregnancy more high risk.
  • Radiation therapy: If a person has radiation therapy, it may affect the cells and blood supply of the uterus. It could also increase the chances of early birth, miscarriage, and low birth weight.

Doctors may advise a person to wait some time before they try to become pregnant after cancer treatment. How long depends on various factors, including:

  • the type and stage of cancer
  • the person’s age
  • the treatment they receive

A healthcare professional will be able to advise how long a person should wait before conceiving.

If a person has ovarian cancer, part of their treatment may be removing both ovaries, fallopian tubes, and the uterus. This means the person will not become pregnant naturally, but they may have other options.

If doctors diagnose cancer early and it only involves one ovary, it may be possible to preserve the uterus, and the other ovary may remain fertile. However, chemotherapy may increase a person’s risk of earlier menopause and could damage their remaining ovary.

Options for pregnancy after ovarian cancer may include:

In vitro fertilization (IVF)

If a person did not have a total hysterectomy as part of their ovarian cancer treatment, it could be possible for them to conceive using IVF.

IVF is a process where sperm from a person’s partner or a donor fertilizes a person’s eggs or a donor’s eggs, which a healthcare professional places into the womb.

Surrogacy

If a person had a total hysterectomy with removal of their ovaries and uterus, or IVF is not a suitable option, they may consider surrogacy. Surrogacy means that another individual carries the growing fetus through pregnancy for a person.

Healthcare professionals place a partner’s or donor’s sperm into the surrogate via artificial insemination or place an embryo from a person’s, or a donor’s, egg and a partner or donor’s sperm into the surrogate’s uterus.

The American Cancer Society has a cancer helpline that people can call for cancer support on 800-227-2345, or individuals can chat with them online.

Organizations that provide ovarian cancer support include:

Several cancer organizations provide support specifically for People of Color, such as:

Healthcare professionals consider any pregnancy that exists alongside cancer to be high risk. The ovarian cancer treatment someone receives during pregnancy is often similar to those who are not pregnant, involving surgery and chemotherapy. However, when and how they receive treatment may differ.

Doctors may schedule surgery for after the first trimester, but this depends on several variables. They may administer chemotherapy during the second and third trimesters. This is to minimize risk to the fetus. However, if the cancer is advanced or aggressive, a doctor may discuss terminating the pregnancy, as delaying treatment could be life threatening.

It can be more difficult to conceive after ovarian cancer treatment involving surgery to remove one or both ovaries, fallopian tubes, and the uterus.

If a person retains one ovary and their fallopian tubes and uterus, they may become pregnant naturally or may want to consider IVF. They may also consider surrogacy. A person may discuss with their healthcare professional how long they should wait before getting pregnant.