Challenges in the Diagnosis and Treatment of Cancer While Preserving Fertility

Dear Colleagues,

The number of young women who have been treated for cancer and want to give birth is increasing due to the shift in age at the time of first childbirth. On the other hand, the disease is more often diagnosed in the early stages, when treatment with conservative methods is more likely to be successful, even in gynecological cancers. Most young women diagnosed with a malignancy can expect to live for decades after treatment, making many life issues such as future fertility more important. This has led to the separation of oncofertility as a new field in oncology, which includes all procedures for the treatment of malignant disease with the aim of preserving fertility, but without compromising the oncological outcomes.

Breast cancer is the most common malignancy, with increasing incidence in young women. Hematologic malignancies, melanomas and thyroid cancer also have a high incidence in the younger population. In most of these situations, ovarian function is impaired as a result of chemotherapy. Today, fertility preservation techniques are available before starting cancer treatment. New reproductive technologies are becoming more widely available and more successful and can give hope to those who have no other pregnancy options.

The treatment of gynecological cancer, as a rule, is associated with permanent loss of function of the reproductive organs, either due to surgical removal or as a result of radio- or chemotherapy. However, even in those cases, preservation of fertility is possible.

Fertility-preserving treatment can only be applied if the tumor is in the initial stage and has favorable prognostic features both clinically and pathologically. A decision on this can only be made by a multidisciplinary team. This team should take care of the patient and her family, provide them with the right information and guide them through the decision-making process on preserving fertility, which is still a non-standard form of treatment for malignant diseases, especially of gynecological organs.

Infertility as a result of cancer treatment has a great impact on the quality of life. Many women who have the problem of infertility as a result of treatment for a malignant disease experience social isolation at the same time as psychological, psychosocial, and sometimes psychiatric disorders, such as anxiety and depression. These issues should be identified during treatment, in the hope that early intervention may prevent more serious long-term consequences.

Oncofertility includes more specialistic field professionals than any other in oncology or reproductive medicine, including gynecologist–oncologists, specialists of related tumor fields, specialists in reproductive medicine, pathologists, medical oncologists, geneticists, psychologists, nurses,  social workers, and sometimes even lawyers.

This Special Issue entitled “Challenges in the Diagnosis and Treatment of Cancer While Preserving Fertility” aims to provide an up-to-date and detailed overview of fertility-preserving treatment in patients with cancer, by gathering contributions that cover all issues related to the field of oncofertility. We invite articles related to the challenges in the diagnosis and/or management of disease, research articles, and review articles, as well as articles providing an in-depth analysis of unclear diagnostic or therapeutic dilemmas.

Topics to consider include:

• Oncofertility: a bridge between oncology and reproductive medicine;
• The burden of cancer in reproductive-aged women;
• Cancer in childhood and adolescence;
• Cancer treatment and infertility;
• Multidisciplinary approach to the cancer patient wishing to preserve fertility;
• Options for fertility preservation, both male and female;
• Assisted reproductive techniques;
• Psychological issues in cancer and fertility;
• Ethical and legal considerations.

Prof. Dr. Vesna Kesić
Guest Editor

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