Fertility-Sparing Treatments For Gynecological Cancers

Cervical cancer, when detected early, can be treated using methods that preserve a woman’s ability to potentially have children in the future.

Depending on the progression of the disease, Cervical Cancer patients can consider:

1. Cervical Conization –  for treatment of pre-cancerous and early stage carcinoma-in-situ
2. Cervical conization plus Pelvic Lymphadenectomy with or without chemotherapy – In cases where there is lymphovascular space invasion, but the size of the lesion is small enough, Cervical Conization can be an effective treatment in conjunction with a Lymphadenctomy to remove the lymph node closest to the malignancy to prevent further spread of the disease.
3. Radical Trachelectomy – This is a highly complex procedure that entails the removal of only the uterine cervix and its surrounding tissue (parametria). After that, the vagina is re-attached to the uterine body. This surgery requires special training that our team of gynecologic oncologists has.and is performed with a minimally invasive robotic technique to obtain the best results. Following a Radical Trachelectomy, a Cerclage is required to hold the uterus shut in place of the cervix in order to carry a child to term, and future deliveries must be done through C-section.

Ovarian Cancers are also potential candidates for fertility-sparing treatments, provided that the disease has only impacted one of the two ovaries. Depending on the extent and location of the disease, any of the following treatments may be considered:

1. Unilateral Oophorectomy: the removal of the affected ovary alone.
2. Omentectomy: removal of a fatty tissue linked to the large intestine.
3. Pelvic and para-aortic lymphadenectomy: removal of the lymph nodes around the main arteries and veins of the abdomen and pelvis.
4. Appendectomy: Removal of the appendix in selected cases of ovarian cancer (mucinous histologic variant)
5. Multiple peritoneal biopsies: removal of small fragments (3-4 cm) in different regions (8-10) of the peritoneum. The latter is a tissue layer that covers intra-abdominal organs and the abdominal wall.

Endometrial and Uterine Cancers, when detected early enough, are also potential candidates for fertility-sparing treatments. Fertility-sparing surgical procedures in women with uterine-endometrial cancer include:

• High dose oral progestin 
• Hormonal IUD (MIRENA) insertion and for one more year the administration of an intramuscular hormone (GnRH) which reduces estrogen production transiently in women.
• Removal of the tumoral lesion by hysteroscopy.