Gynecologic cancers directly affect a woman's fertility as they typically involve the uterus, cervix, fallopian tubes and ovaries. Depending on the type and stage of the cancer, GYN malignancies are usually treated with surgery, chemotherapy, radiation or a combination of these modalities. While every patient's situation is different, all those treatments can affect fertility.
"Infertility is a common short- and long-term side effect of cancer treatment for many different cancer types,” says Katherine LaVigne Mager, MD, Department of Gynecologic Oncology at Roswell Park Comprehensive Cancer Center. “Fertility preservation is very important to young patients with a cancer diagnosis and it is something that we as oncologists work hard to address. Fertility preservation takes many forms, especially now that there are so many options through assisted reproductive technology and part of our counseling includes discussing which options would be medically appropriate for a given diagnosis.” To minimize the risk to a patient's fertility during cancer treatment, Roswell Park offers fertility-sparing techniques for women of childbearing age. Included in these treatments are approaches that allow women to retain their uterus, cervix and ovaries in highly selected cases.
For women with early-stage endometrial cancer, or cancer that has not spread beyond the uterus, fertility-sparing treatment can involve the use of hormonal therapy to treat the cancerous cells within the lining of the uterus (endometrium) without removing the uterus. Hormonal therapy can be given as a pill, a progestin-releasing intrauterine device (IUD), or both.
Early-stage cervical cancer is commonly treated with surgery to remove the uterus and cervix, but there is also an approach to surgical management that allows the uterus to remain in place while either a portion of the cervix or the entire cervix is removed. These procedures are a cold knife cone biopsy or a radical trachelectomy.
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As with endometrial and cervical cancer, fertility-sparing surgical procedures are available for women diagnosed with early-stage ovarian cancer. The unaffected ovary and the uterus can be left in place while only the ovary of concern is removed.
For more advanced disease requiring more extensive surgery, chemotherapy or radiation, we also work with fertility specialists in the area to help our patients pursue assisted reproductive technology when treatment is likely to have a significant impact on their fertility.
"Anyone who strongly desires future pregnancy should ask their doctor if these options are available," says Dr. Mager. "We are very sensitive to our younger patients' needs and make sure to discuss their fertility plans with them before choosing treatment. We tailor our approach to the patient's fertility goals, age and disease status."