Friday 7th September 2012
Erica Lucero, Macmillan Gynae Oncology CNS, writes about the discovery of a germ cell tumour during a pregnancy scan.
Mary (not her real name) was 22 weeks pregnant with her first child when an ultrasound scan detected an ovarian mass. Her scan and tumour markers raised a high suspicion of malignancy or ovarian cancer.
Ovarian cancer occurs in around 1 in 18,000 pregnancies and the combination of a germ cell tumour during pregnancy is even rarer. As with many early stage ovarian cancers, Mary did not have any symptoms.
Mary’s case was discussed at a multidisciplinary team meeting and Mary subsequently chose to have her ovary surgically removed at 26 weeks, rather than wait until after her pregnancy. The team ensured that the unborn baby was considered in all discussions of care.
Before Mary had the procedure, she was counselled by the gynaecology consultant about possible complications during and after surgery, and the possibility of miscarriage during surgery. I was also on hand to provide psychological support and to answer Mary’s questions.
She was worried about her baby and did not say or ask much, which is not unusual after receiving bad news. I gave her a pack with information about ovarian cancer, contact details and some information and support websites.
Before Mary left, I emphasised that she could call me if she had any queries or needed any psychological support. Mary’s partner was included in the discussions about her diagnosis and treatment. After a few days, she rang with a list of questions related to the cancer and her pregnancy. At the end of our conversation, she said she felt better and reassured. I also referred her to the Macmillan cancer support centre.
Following the operation, she was told that the ovary that was taken out had an early stage of ovarian cancer. She was speechless and teary. At her follow-up appointment, she was well and fully recovered from the operation. She has had monthly MRI scans and blood tests following her treatment.
The rest of her pregnancy went well and she is expecting a baby girl in few weeks. Mary was grateful that a routine scan detected the cancer and that it was investigated promptly.
Germ cell tumours of the ovary are a rare type of ovarian cancer. Fewer than 1,500 women are diagnosed with this type of cancer in the UK each year.
Many woman with early stage ovarian cancer do not have any symptoms. If symptoms are present, they can include abdominal pain, a feeling of fullness or abdominal swelling, and sometimes an increased need to pass urine. Some women may have irregular vaginal bleeding.
Several tests may be used including blood tests, ultrasound and CT scans, and laparoscopy.
Treatment will usually involve a combination of surgery and chemotherapy.
Macmillan has information about germ cell tumours of the ovary