Nearly 10% of the 1.3 million women living with a gynecologic cancer are less than 50 years of age. For these women, while their cancer treatment can be lifesaving, it’s also life-altering, as traditional surgical procedures can cause infertility and, in many cases, induce surgical menopause. For appropriately selected patients, fertility-sparing options can reduce the reproductive impact of life-saving cancer treatments. This review will highlight existing recommendations as well as innovative research for fertility-sparing treatment in the three major gynecologic cancers.
N/A, Methods of Study Selection: N/A TABULATION, INTEGRATION AND RESULTS: For early-stage cervical cancers, fertility-sparing surgeries include cold knife conization, simple hysterectomy with ovarian preservation, or radical trachelectomy with placement of a permanent cerclage. In locally-advanced cervical cancer, ovarian transposition prior to radiation therapy can help preserve ovarian function. For endometrial cancers, fertility-sparing treatment includes progestin therapy with endometrial sampling every 3-6 months. After cancer regression, progestin therapy can be halted to allow attempts to conceive. Hysterectomy with ovarian preservation can also be considered, allowing for fertility using assisted reproductive technology and a gestational carrier. For ovarian cancers, fertility-sparing surgery includes unilateral or bilateral salpingo-oophorectomy (with lymphadenectomy and staging depending on tumor histology). With higher risk histology or higher early-stage disease, adjuvant chemotherapy is recommended – however, this carries a 3-10% risk of ovarian failure. Use of oocyte or embryo cryopreservation in patients with early stage ovarian malignancy remains an area of ongoing research.
Overall, fertility-sparing management of gynecologic cancers is associated with acceptable rates of progression-free survival and overall survival and is less life-altering than more radical surgical approaches.
Copyright © 2020. Published by Elsevier Inc.