Diagnosis and treatment of gestational non-epithelial ovarian cancer: A systematic review

Background/Aim: Ovarian cancer is categorized into epithelial ovarian cancer and non-epithelial ovarian cancer (NEOC), with NEOC accounting for approximately 10% of cases, predominantly affecting young women and adolescents. The incidence of gestational ovarian cancer is expected to rise in developed nations due to delayed childbearing. NEOC in pregnancy presents various risks, including spontaneous abortion, ventriculomegaly, respiratory distress, and maternal-fetal mortality. This review aims to evaluate the diagnostic tools and management strategies for early NEOC detection during pregnancy to improve maternal and fetal outcomes.

Materials and Methods: A systematic literature search was conducted in PubMed and Embase, covering studies from January 2019 to January 2024. The search terms included “pregnan*” AND “non-epithelial ovarian cancer” AND “diagnos*” AND “manage*” to identify relevant studies. Only articles addressing the diagnosis and management of NEOC during pregnancy were included.

Results: Four relevant articles published between 2019 and 2021 were identified, reporting a total of 44 NEOC cases during pregnancy. In 34 of these cases, NEOC was diagnosed at International Federation of Gynecology and Obstetrics (FIGO) stage I, primarily through routine ultrasonography. Fertility-sparing unilateral salpingo-oophorectomy (USO), often combined with adjuvant platinum-based chemotherapy, was the standard treatment for stage I cases.

Conclusion: Currently, no standardized management guidelines exist for NEOC during pregnancy, due to factors such as FIGO staging, gestational age, and maternal preferences. Routine ultrasonography is effective for the early identification of NEOC, particularly in asymptomatic patients. For pregnant women with stage I NEOC who wish to continue their pregnancy and preserve fertility, fertility-sparing surgery with chemotherapy represents a promising treatment approach.