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Fertility-Sparing Surgery After a Gynecologic Cancer Diagnosis
Standard treatment for most gynecologic cancers can affect a woman’s ability to have children, since it may involve removing the uterus, ovaries, or fallopian tubes—or all three. But in some cases, patients who hope to one day become pregnant may have other options.
Many early-stage gynecologic cancers or pre-cancers—including ovarian and cervical cancers—may be treatable using a surgical approach that can be fertility-sparing. These procedures can effectively treat cancer in women of childbearing age while preserving their fertility.
For instance, borderline ovarian tumors—which are not considered invasive—may be addressed by removing just one ovary and fallopian tube. Small cervical cancers can often be treated by removing just the cervix. “We call that a trachelectomy, which involves putting a big stitch around the opening of the uterus to help it stay closed during pregnancy,” explained Christina S. Chu, MD, a gynecologic oncologist at Fox Chase Cancer Center.
For some types of endometrial cancer, patients may be able to forgo surgery altogether in favor of high-dose hormonal medication to suppress the cancer’s growth.
Specialized care is a must
Patients can have an initial conversation about fertility preservation with their gynecologist or primary care physician. But it’s critical for women to then consult with a gynecologic oncologist—a doctor who specializes in treating gynecologic cancers—about what fertility-sparing treatments are available for their specific cancer.
These conversations should happen before a patient begins treatment—especially surgery—for a gynecologic cancer, experts say.
“It’s a really important discussion to have before you go into the operating room—what the possibilities are and what the outcome might be,” Chu said. Together, a patient and her gynecologic oncologist can discuss best-case scenarios for treatment as well as possibilities for proceeding with treatment if things don’t go according to plan.
For example, some ovarian tumors that appear borderline on imaging tests may be found to be more invasive when a patient is undergoing surgery. That can make it riskier or more difficult for a surgeon to safely preserve a patient’s fertility. “Based on the patient’s age and discussions you’ve had ahead of time, you can decide where to go from there when you’re doing the surgery,” Chu said.
Fertility-sparing surgery is not always an option
While surgical oncologists will work with patients to preserve their ability to have children when possible, fertility-sparing surgeries may not always be an option for women of childbearing age.
“For instance with ovarian cancer, when the disease has spread outside of the ovary, has spread to the uterus or parts of the abdomen, at that point we don’t feel that it’s safe to preserve the uterus or the other fallopian tube or ovary,” Chu explained.
In the case of ovarian cancer, the good news is that young patients with the disease are more likely to have borderline ovarian tumors, Chu noted, putting them in a more favorable position for fertility-sparing surgery. And after a woman has recovered from ovarian cancer surgery and has completed her treatment, her chances of conceiving naturally are likely very good.
There are also other fertility-preservation options for women with gynecologic cancer in addition to fertility-sparing surgery. That’s why if you’re diagnosed with a gynecologic cancer and want to get pregnant at some point, it is crucial to speak with a gynecologic oncologist to discuss all of your options.