Fertility-Sparing Surgery After a Gynecologic Cancer Diagnosis
Updated May 25, 2023
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, using a procedure called a trachelectomy, which involves putting a big stitch around the opening of the uterus to help it stay closed during pregnancy.
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. These conversations should happen before a patient begins treatment—especially surgery—for a gynecologic cancer, experts say. 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. Discussing the possibilities and outcomes in advance can help the surgeon determine the best way to proceed.
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 example, if a patient has ovarian cancer that has spread, possibly to the uterus or parts of the abdomen, the uterus and the other fallopian tube will likely need to be removed.
In the case of ovarian cancer, the good news is that young patients with the disease are more likely to have borderline ovarian tumors. That puts them in a more favorable position for fertility-sparing surgery. And after a patient has recovered from ovarian cancer surgery and has completed treatment, the chances of conceiving naturally are likely very good.