Preserving Fertility After Cancer
Cancer Treatment and Fertility
According to a newly published report, physicians can offer patients with cancer a better chance of preserving fertility without negatively affecting the outcome of cancer treatment or survival. The article appears in the July/August 2005 issue of CA: A Cancer Journal for Clinicians.
According to Carolyn D. Runowicz, MD, president-elect of the American Cancer Society and one of the review's authors, "Historically, fertility concerns of patients with cancer have not been foremost in the mind of treating physicians. Cancer was seen as a death sentence and saving the patient's life was the priority."
In the last 20 years there have been significant increases in the 5-year survival rates for most cancers. "Today's patients with cancer want to live as normal a life as possible," Dr. Runowicz says. "Young women and men with cancer are demanding from physicians treatments that are not only safe and effective, but also allow them to maintain their fertility. In response to this demand, the medical community has begun to offer these patients surgical and medical therapies that are conservative, helping to preserve fertility." The authors looked at the most common cancers that affect young adults, for whom fertility is an issue, as well as some less common cancers of reproductive organs. These include breast cancer, cervical cancer, endometrial cancer, leukemia and lymphoma, ovarian cancer, and testicular cancer.
The challenges in trying to maintain fertility are great in patients with cancer. Many standard treatments have negative effects on fertility. For women with ovarian cancer and men with testicular cancer, surgery is often the treatment of choice, vastly diminishing (if not completely eliminating) fertility. Radiation and chemotherapy destroy cancer cells, but can also hurt the cells needed for fertility. For example, due to the risk of ovarian damage that persists after treatment for some malignancies, researchers have begun to evaluate new ways of preserving ovarian tissue, including freezing ovarian strips for use after the patient has completed her therapy. However, this procedure is still under investigation.
For men with testicular cancer, both radiation and chemotherapy damage healthy sperm. Semen cryopreservation after masturbation is the recommended method for men who wish to have a baby in the future. However, historically few men being treated for cancer "bank" sperm and oncologists do not, as a rule, speak about this option to their patients.
Historically, this has been the case for women as well. When the goal is to prolong or save a life, fertility is often an afterthought among treating physicians.
The authors write that "reproductive endocrinologists and urologists continue their efforts to perfect cryopreserving technologies to retain ovarian and testicular function." But, they say that "Patients must be aware of standard therapies and benefits of conservative treatment, and the need for careful follow-up."
Simon B, Lee SJ, Partridge AH, Runowicz CD. Preserving Fertility after Cancer CA Cancer J Clin 2005;55:211-228.
CA: A Cancer Journal for Clinicians is a peer-reviewed journal of the American Cancer Society providing cancer care professionals with up-to-date information on all aspects of cancer diagnosis, treatment, and prevention. Published six times per year, CA is the most widely circulated oncology journal in the world, mailing to approximately 90,000 individuals, including primary care physicians; medical, surgical, and radiation oncologists; nurses; other health care and public health professionals; and students in various health care fields. CA is published for the American Cancer Society by Lippincott Williams