Navigating Fertility Preservation Options in Gynecological Cancers: A Comprehensive Review
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
- Pregnancy OR birth OR reproduct* OR fertility preservation OR fertility sparing OR onco-fertility OR onco-fertility.
- Gynecologic cancer OR cervical cancer OR endometrial cancer OR ovarian cancer OR breast cancer.
- Cancer survivor*.
- Filters: full-text available, research pertaining to humans, publication type as described above.
3. Results
4. Discussion
4.1. Ovarian Cancer
4.2. Cervical Cancer
4.3. Endometrial Cancer
4.4. Breast Cancer
4.5. Future Directions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Type of Cancer | Criteria for Fertility Preservation Surgery |
---|---|
Endometrial cancer |
|
Cervical cancer |
|
Ovarian cancer |
|
Stage | Initial Strategy | Evaluation | Ulterior Strategy |
---|---|---|---|
Stage IA1 | Conization | Negative margins (HSIL or invasive disease) and no LVSI | Surveillance |
Negative margins and LVSI present | Radical trachelectomy and SLN mapping/pelvic lymphadenectomy OR Re-conization and laparoscopic SLN mapping/ lymphadenectomy | ||
Positive margins | Re-conization (to rule out stage IA2/IB disease) OR Radical trachelectomy and SLN mapping/pelvic lymphadenectomy | ||
Stage IA2 | Radical trachelectomy and pelvic lymphadenectomy OR Trachelectomy and SLN mapping OR conization and laparoscopic SLN mapping/pelvic lymphadenectomy | Negative margins and no lymph node involvement | Surveillance |
Positive margins and/or lymph node involvement | Radical non-fertility-sparing surgery OR Chemo-radiotherapy OR re-conization/trachelectomy * | ||
Stage IB1 and selected cases of IB2 | Radical trachelectomy and pelvic +/− para-aortic lymphadenectomy | Recommanded for tumors <2 cm Tumors 2–4 cm must be carefully selected for a fertility-sparing approach as they may require postoperative adjuvant therapy due to pathologic risk factors |
Type of Cancer | Stage | Fertility Preservation/ART Option |
---|---|---|
Cervical cancer | IA1 without LVSI | Conization |
IA1 with LVSI | Radical vaginal trachelectomy/simple trachelectomy + pelvic LND or sentinel node mapping | |
IB1 | Radical vaginal trachelectomy | |
IB2 | Abdominal radical trachelectomy/NAC followed by conization or the simple/radical trachelectomy | |
IB3 | NAC followed by conization or the simple/radical trachelectomy | |
IIA | NAC followed by conization or the simple/radical trachelectomy | |
Advanced disease | Surrogacy
| |
Endometrial cancer | IA1 | Oral progesterone LNG-IUS Hysteroscopic resection + oral progesterone/LNG-IUS |
Advanced disease | Surrogacy/uterine transplant
| |
Ovarian cancer | IA | Unilateral adnexectomy |
IB | Bilateral adnexectomy (with preservation of the uterus and future possibilities of assisted human reproduction) | |
IC |
| |
Advanced disease | Surrogacy/uterine transplant
|
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Chitoran, E.; Rotaru, V.; Mitroiu, M.-N.; Durdu, C.-E.; Bohiltea, R.-E.; Ionescu, S.-O.; Gelal, A.; Cirimbei, C.; Alecu, M.; Simion, L. Navigating Fertility Preservation Options in Gynecological Cancers: A Comprehensive Review. Cancers 2024, 16, 2214. https://doi.org/10.3390/cancers16122214
Chitoran E, Rotaru V, Mitroiu M-N, Durdu C-E, Bohiltea R-E, Ionescu S-O, Gelal A, Cirimbei C, Alecu M, Simion L. Navigating Fertility Preservation Options in Gynecological Cancers: A Comprehensive Review. Cancers. 2024; 16(12):2214. https://doi.org/10.3390/cancers16122214
Chicago/Turabian StyleChitoran, Elena, Vlad Rotaru, Madalina-Nicoleta Mitroiu, Cristiana-Elena Durdu, Roxana-Elena Bohiltea, Sinziana-Octavia Ionescu, Aisa Gelal, Ciprian Cirimbei, Mihnea Alecu, and Laurentiu Simion. 2024. "Navigating Fertility Preservation Options in Gynecological Cancers: A Comprehensive Review" Cancers 16, no. 12: 2214. https://doi.org/10.3390/cancers16122214
APA StyleChitoran, E., Rotaru, V., Mitroiu, M. -N., Durdu, C. -E., Bohiltea, R. -E., Ionescu, S. -O., Gelal, A., Cirimbei, C., Alecu, M., & Simion, L. (2024). Navigating Fertility Preservation Options in Gynecological Cancers: A Comprehensive Review. Cancers, 16(12), 2214. https://doi.org/10.3390/cancers16122214