Fertility preservation is a top concern for many women of childbearing age who are diagnosed with gynecologic cancer. To make optimal treatment decisions that also allow the potential for future pregnancy, patients should take the time to consult with specialists.

At Fox Chase Cancer Center, our gynecologic oncologists have the knowledge and expertise to counsel women of childbearing age on surgery and treatment options that can spare fertility while still achieving a successful cancer outcome, when possible.

NECESSITY OF PRE-TREATMENT COUNSELING

Decisions surrounding a patient’s wish to preserve their fertility must be made under the guidance of a gynecologic oncologist before treatment begins. Regardless of a patient’s diagnosis, women generally have time to meet with a specialist—ideally two specialists— to seek opinions on fertility-sparing options. “Rarely are these cancers an emergency, and women have the time to get an opinion from a gynecologic oncologist” said Christina S. Chu, MD, Interim Chief of the Division of Gynecologic Oncology at Fox Chase.

Patients and specialists should discuss the desired outcome and clarify a woman’s preferences in the event that a cancer is found to be more advanced than previously thought at the time of surgery. In those instances, a woman’s care team will need to make decisions on her behalf. “Based on the patient’s age and discussions you’ve had ahead of time, you can decide where to go from there during surgery,” Dr. Chu explained.

WHO ARE IDEAL CANDIDATES?

Fertility-sparing surgeries are generally reserved for women under 40 with early-stage cervical or ovarian cancers, or borderline tumors of the ovary. (In some cases, women aged 40 to 45 may also be candidates.) These early-stage cancers haven’t yet spread to the uterus, abdomen, or lymph nodes. “Fortunately, most people with borderline tumors tend to be younger,” Dr. Chu said.

Patients with early cervical cancers less than 2 cm in size or between 2–4 cm in size in select cases may be candidates for removal of the cervix with a permanent stitch placed to hold the uterine opening closed during pregnancy.Patients with early cervical cancers less than 2 cm in size or between 2–4 cm in size in select cases may be candidates for removal of the cervix with a permanent stitch placed to hold the uterine opening closed during pregnancy.

Fertility-sparing, non-surgical options are also possible for some women with early-stage low-grade endometrial cancer that is not growing into the muscular wall of the uterus. Hormonal therapy with pills or a progesterone releasing IUD may help the cancer regress in a significant proportion of patients, allowing for the opportunity to attempt pregnancy. If hormonal therapy is successful, once childbearing is complete, women should then consider hysterectomy.

WEIGHING BENEFITS AND RISKS

Patients with borderline tumors who avoid full removal of the uterus, ovaries, and fallopian tubes to preserve fertility may have a higher rate of cancer recurrence. However, retrospective data shows their overall survival rate isn’t compromised. “Should recurrence occur, because it’s such a good prognosis, cancer patients can get treatment at the time of a recurrence, and the outcomes ultimately will be the same,” Dr. Chu said.

For early-stage ovarian cancer, delaying treatment to get pregnant and have a child before undergoing definitive treatment may also be a viable option. According to retrospective data, this does not compromise one’s outcome.

CHOOSING FOX CHASE

Fox Chase Cancer Center is home to national leaders in gynecologic oncology. Our surgeons excel in performing complex procedures using traditional, minimally invasive, and robotic approaches that control a patient’s cancer and reduce the risk for recurrence while preserving fertility whenever possible. Our collaborative, multidisciplinary treatment model offers patients comprehensive care customized to their needs and goals before, during, and after surgery.