What is the fertility -sparing treatment in women with gynecological cancer?
It is estimated that over 10-20% of women who have gynecological cancer are at reproductive age. In addition, women in developed countries increasingly delay the age of motherhood. While the recommended treatment for any type of cancer in the organs of reproduction is incompatible with future pregnancies, numerous advances and investigations have been developed in recent years. For all these reasons, fertility -sparing treatment of gynecological cancer is currently POSSIBLE in selected women.
For this, we evaluate each individual case, taking into account the following factors:
- The size of the tumor
- The extent of the disease
- The global health status of the patient
- The preferences of the patient and their relatives
Conservative treatment of fertility in a woman with gynecological cancer means preserving at least one of the ovaries and uterus. The factors that we also consider to select patients are:
- Strong motivation of the patient for a future pregnancy
- Adequate professional information regarding the risks, advantages and disadvantages.
- Rigorous evaluation of tumor extension before proposing a conservative treatment
- Proper evaluation of oncological criteria for patient selection
However, a factor that is also fundamental to take into account is the possibility of ensuring a strict follow-up after treatment with the aim of early detection of a possible recurrence of the disease. The selection criteria for the patient is very strict and we must discuss with the patient and her family the advantages and disadvantages of each procedure.
What kind of gynecological tumors can benefit from a fertility -sparing treatment?
Conservative surgical procedures of fertility in women with cervical cancer include:
- Cervical conization
- Cervical conization + pelvic lymphadenectomy with or without chemotherapy
- Radical trachelectomy: it consists in removing only the uterine cervix and its surrounding tissue (parametrium). After that, the vagina is re-inserted into the body of the uterus. This is a highly complex surgical technique that requires special training provided by our team of oncology gynecologists. To do this, our team of surgeons can perform this surgery using the mini-invasive robotic technique to obtain the best results.
Fertility-sparing surgical procedures in women with ovarian cancer include:
- Unilateral oophorectomy: involves the removal of the affected ovary.
- Omentectomy: removal of a fatty tissue attached to the large intestine
- Pelvic and para-aortic lymphadenectomy: removal of the lymph nodes around the main arteries and veins of the abdomen and pelvis.
- Appendectomy: extirpation of the appendix in selected cases of ovarian cancer (mucinous histological variant)
- Multiple peritoneal biopsies: removal of small fragments (3-4 cm) in several regions (8-10) of the peritoneum. The latter is a thin sheet of tissue that lines the intra-abdominal organs and the abdominal wall.
We are committed to the development of innovative surgical techniques for fertility-sparing surgeries in women with ovarian cancer. In this sense, laparoscopic mini-invasive surgery represents the best example of technological development to ensure the best surgical results with faster and safer patient recovery. We perform these procedures in almost 100% of patients by using a laparoscopic mini-invasive approach.
Fertility-sparing surgical procedures in women with uterine-endometrial cancer include:
- Progesterone in high doses administered orally.
- Placement of a hormonal IUD (intrauterine device) (MIRENA) for one year plus the administration of a hormone intramuscularly (GnRH) that decreases the production of estrogen transiently in women.
- Resection of the tumor lesion by hysteroscopy.