Title:Quality Survival with Fertility after Gynaecological and other Cancers
Volume: 12
Issue: 2
Author(s): Shakuntala A. Chhabra
Affiliation:
Keywords:
Cancers, survival, fertility preservation, quality life.
Abstract: Introduction: Earlier, diagnosis of cancer ultimately led to death but now with complex
therapies, not only many survive, but they have quality life too. Even preservation of fertility is possible.
In addition to this, with early diagnosis, complete cure is possible.
Objectives: To look into the existing evidence, challenges and possibilities.
Methodology: Simple review of literature was done with the help of various search engines, Pubmed,
Google, Uptodate and other databases to evaluate the relevant studies, reviews and short commentaries to
get information as per the objectives.
Evidence: Because of long-term effects of various cancers and their therapies, problems like quality of life,
sexuality and fertility are the real concerns. Gonadal dysfunction is common, especially in gynaecological
cancers and their therapies. Germ cell tumors of ovary are most common in young girls but with
conservative surgery and chemotherapy the results are excellent. Same is true even for stage I epithelial
ovarian cancers. Conservative therapies for cervical cancer, conization, simple / radical trachelectomy can
do wonders. Endometrial cancer usually occurs after menopause, and there are no standard recommendations
for conservative management, which is possible in younger women. Choriocarcinoma is highly malignant
but has high cure rate too. So, quality survival is possible. Studies with Breast cancer, Hodgkin lymphoma
have also revealed menstrual function resumption after chemotherapy. Presurgery assessment and close
follow-up are necessary. Side effects of radiochemotherapy are real. Effects are drug, dose, and age
dependent with possibilities of infertility and adverse pregnancy outcomes. Gonadotoxic effects may
cause early menopause. Challenges increase if cancer occurs during pregnancy.
Preventive Possibilities and Conclusion: Mission of any cancer therapy needs to be quality long life,
preservation of pregnancy prospects: natural or assisted. Prepubertal ovary is least susceptible to
gonadotoxicity with chances of better reproductive life. Ovarian transposition / shielding or
transplantation is possible. Ovarian tissue rather than oocyte or embryo cryopreservation is better. Early
diagnosis and safe therapy can do miracles for women who are diagnosed with cancer. Conservative
surgery, safe chemotherapy and focused radiation can reduce gonadotoxicity and preserve fertility.
Multidisciplinary treatments are essential. Role of psychotherapy is important. For quality survival with
reduced risk of cardiac, renal, neurological problems, bone osteoporosis and also for preservation of
fertility, therapy needs proper planning for all cancers.
