Mucinous ovarian carcinoma: Impact of ovarian stimulation, hormonal contraception, and hormone replacement therapy

Unlike high-grade serous carcinoma (HGSC), which mainly affects postmenopausal women, mucinous ovarian carcinoma (MOC) affects younger patients, with a median age at diagnosis of 53 years, and is rare among premenopausal women. After they receive anticancer treatment, these women encounter specific issues involving fertility preservation (FP) and/or pregnancy, which potentially require assisted reproductive technology (ART) as well as the prescription of hormonal contraception (HC) or hormone replacement therapy (HRT). We reviewed the available literature in PubMed/Medline concerning the risks of the development of ovarian cancer (OC), including MOC, associated with ART, HC and HRT, and literature on the impact of ovarian stimulation in the context of FP and/or ART, HC and HRT in women previously treated for OC, including MOC. MOC is usually a nonhormone-sensitive tumour. In the context of ART, ovarian stimulation is not associated with an increased OC risk. However, data that evaluate the impact of ovarian stimulation in the context of FP or ART after OC, including after MOC, are still scarce. Oral contraception, contraceptive implant or levonorgestrel intrauterine device use are associated with decreased OC risk. This protective effect does not seem to occur in MOC, and no data have been published concerning contraceptive use after OC. HRT is associated with an increased risk of OC, but the risk of MOC is not modified in HRT users when considering histological subtypes. HRT after OC is associated with better overall survival but does not seem to affect disease-free survival. However, since the data are insufficient, it is not feasible to draw robust conclusions in the specific context of MOC. Overall, data on the impact of oral contraceptive and HRT use on the risk of MOC are reassuring. Despite little specific data on the impact of HRT after MOC, data on OC (all histological types) survivors are encouraging. Data concerning the effects of contraceptive use and ovarian stimulation in the context of FP or ART in OC survivors are still lacking. Therefore, the findings from prospective or larger studies in these two groups would help to counsel MOC survivors on contraceptive and fertility options.