Fertility preservation in gynaecologic cancers (original) (raw)
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Innovations in fertility preservation for patients with gynecologic cancers
Fertility and Sterility, 2005
Objective: To review options for fertility preservation in women with gynecologic cancers. Design: Literature review. Result(s): We discuss the data regarding cancer treatment and fertility outcomes and current controversies for women with gynecologic cancers. Conclusion(s): Gynecologic cancers represent 12%-15% of cancers affecting women, and 21% of these are diagnosed in women of reproductive age. Current advances in our understanding of these diseases, along with improved multimodality treatment, allow for consideration of fertility options. For some women with gynecologic cancers, fertility-sparing treatment might be appropriate.
Fertility preservation in patients with gynecological cancer - is it possible?
Libri oncologici, 2022
The aim of this review article is to present current options for fertility preservation in young women with gynecological tumors (ovarian, endometrial or cervical cancer). An early pretreatment referral to multidisciplinary team which consists of general gynecologists, gynecologic oncologists, embryologists, radiologists, pathologists, and reproductive endocrinologists should be suggested to young women with gynecologic cancer, concerning the risks and benefits of fertility preservation options. Only a small percentage of patients with ovarian cancer and borderline ovarian tumors, are appropriate candidates for fertility preservation (FIGO stage IA and IC epithelial ovarian cancer). Following oophorectomy, ovarian tissue or oocytes are removed from the ovary for the use of cryopreservation; after completion of oncological treatment patient undergoes orthotopic retransplantation of ovarian tissue whereas oocytes may be used for in vitro fertilization. Live birth rates up to 53.8% have been reported after fertility preservation treatment in selected patients. In patients with endometrial cancer fertility preservation treatment means conserving of the uterus. Appropriate candidates for fertility preservation are younger women with well differentiated endometrial cancer, which does not invade the myometrium. Fertility preservation treatment in endometrial cancer is hormonal, based on progestins. After completion of fertility preservation treatment, frequent follow-ups are necessary, with tissue sampling (via curettage or endometrial biopsy) remaining standard approach in follow-up. Live birth rates after progestin therapy are around 60%, or even higher with the help of assisted reproductive procedures. In cervical cancer, fertility preservation treatment can be considered in women with early-stage disease (FIGO IA1, IA2, or IB1). Cone biopsy or conization followed by laparoscopic lymphadenectomy has been described as an appropriate procedure, with conception rates up to 47%.
Fertility preservation in gynecologic cancer patients
Revista Brasileira de Ginecologia e ObstetrÃcia / RBGO Gynecology and Obstetrics
The National Commission Specialized in Gynecology Oncology of the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) endorses this document. The production of content is based on scientific evidence on the proposed theme and the results presented contribute to clinical practice.
ecancermedicalscience, 2020
Gynaecological cancer treatment significantly affects the fertility of women in reproductive age. Surgery, chemotherapy and radiotherapy are the mainstays of ovarian, cervical and endometrial cancers and anatomically or functionally impact the uterus and ovaries. Moreover, the sexual function and psychological wellbeing of patients are highly weakened after a cancer diagnosis: depression, anxiety and impairment of quality of life represent a relevant concern for patient care. The potential loss of fertility could be more distressing than cancer itself. For this reason, it is of paramount importance to try to preserve fertility in women affected by gynaecological cancers. Recently, tailored fertility preservation therapies have been developed to meet the childbearing demand from more than half of women between 18 and 40 years with a diagnosis of cancer. Currently, fertility preservation techniques play a significant role in improving the quality of life of women with gynaecological cancer. In this scenario, we propose a narrative overview of the recent literature about the importance of a multidisciplinary approach in the management of fertility preservation in the case of gynaecological cancers.
Fertility Preservation in Endometrial Cancer: Current Knowledge and Practice
Journal of obstetrics, gynecology and cancer research, 2022
Uterine cancer affects more than 1.28 million people worldwide; considering current world trends in obesity and aging, a +52.7% growth by 2040 is foreseen. Around 5% of endometrial cancer patients are less than 40 years old, meaning that conventional oncologic approaches would result in fertility loss; thus, it is essential to consult patients regarding their fertility and family planning. Owing to developments of oncofertility, patients are now able to preserve their fertility and complete their childbearing, drafting from the standard of care in endometrial cancer. Strict criteria should be applied to make sure of selecting patients who benefit most from the fertility preservation approach. Furthermore, careful selection of patients increases the possibility of successful treatment. Most candidates for fertility preservation have risk factors in common with infertility, including polycystic ovarian syndrome, obesity, increasing of age and irregular menses; therefore, Advanced Reproductive Technology (ART) can improve their chances for pregnancy. Current applied knowledge towards the fertility preservation approach in patients with endometrial cancer is reviewed in this article.
Safe Fertility-Preserving Management in Endometrial Cancer: Is It Feasible? Review of the Literature
Journal of Gynecologic Surgery, 2012
Almost 5% of women with endometrial cancer are under the age of 40, and often have well-differentiated endometrioid estrogen-dependent tumors. Frequently, these women have a strong desire to preserve fertility. Strategies to avoid or reduce the reproductive damage caused by surgery, cytotoxic agents, and radiation are needed. This review addresses options available for safe fertility preservation in endometrial cancer. Clinical treatment with progestin agents may be prescribed after careful evaluation and extensive counseling. Strict criteria should be employed to select suitable patients, using imaging methods and endometrial sampling, once it has been established that standard surgical staging will not be performed. Conservative fertility-sparing treatment should only be offered to patients with a grade 1 well-differentiated tumor, absence of lymph vascular space invasion, no evidence of myometrial invasion, metastatic disease, or suspicious adnexal masses, and strong and diffuse expression of progesterone receptors on immunohistochemistry staining of the endometrial specimen. The presence of co-existing ovarian metastatic of synchronous cancer should be investigated and excluded before the decision to preserve the ovaries. In addition to these conservative therapeutic options, the use of assisted reproductive technology (ART) has made it possible for women with endometrial cancer to give birth to a child without compromising their prognosis. Gamete, embryo, or ovarian tissue cryopreservation techniques can also be employed, although some of these are still considered experimental. Fertility preservation is infrequently applied in the cancer population, and there are scarce good quality studies in the literature, which makes careful staging, thorough counseling, and close follow-up of the patients imperative so as not to jeopardize cancer cure.
Fertility-preservation in endometrial cancer: is it safe? Review of the literature
JBRA Assisted Reproduction, 2016
Almost 5% of women with endometrial cancer are under age 40, and they often have well-differentiated endometrioid estrogen-dependent tumors. Cancer survival rates have improved over the last decades so strategies to avoid or reduce the reproductive damage caused by oncologic treatment are needed. We reviewed the published literature to find evidence to answer the following questions: How should we manage women in reproductive age with endometrial cancer? How safe is fertility preservation in endometrial cancer? Can pregnancy influence endometrial cancer recurrence? What are the fertility sparing options available? Progestins may be prescribed after careful evaluation and counseling. Suitable patients should be selected using imaging methods and endometrial sampling since surgical staging will not be performed. Conservative treatment should only be offered to patients with grade 1 well-differentiated tumors, absence of lymph vascular space invasion, no evidence of myometrial invasion, metastatic disease or suspicious adnexal masses, and expression of progesterone receptors in the endometrium. The presence of co-existing ovarian metastatic of synchronous cancer should be investigated and ruled out before the decision to preserve the ovaries. The availability of Assisted Reproductive Technology (ART) has made it possible for women with endometrial cancer to give birth to a child without compromising their prognoses. Gamete, embryo or ovarian tissue cryopreservation techniques can be employed, although the latter remains experimental. Unfortunately, fertility preservation is rarely considered. Current recommendations for conservative management are based on the overall favorable prognosis of grade 1 minimally invasive tumors. Selected patients with endometrial cancer may be candidates to a safe fertility-preserving management.