Janice S Kwon1, Allison M Case. 1. Department of Obstetrics and Gynecology, University of Western Ontario, London, ON, Canada.
Abstract
OBJECTIVE: (1) To review the effects of cancer treatment on reproduction and fertility in both women and men and (2) to review current and new techniques that could be used to preserve fertility and hormone production in women who have undergone cancer treatment. DATA SOURCES: Entries to MEDLINE and CANCERLIT through to October 2001 were searched for evidence relevant to this article. METHODS OF STUDY SELECTION: This document is primarily based on large retrospective cohort series and case reports, as no randomized trials were available. TABULATION, INTEGRATION, AND RESULTS: The first part of this review article focuses on the effects of radiation and chemotherapy on reproductive function and innovative medical and surgical techniques employed to minimize these effects. The second part of this article describes conservative methods of managing cervical, endometrial, and ovarian cancer for women who wish to preserve their fertility. CONCLUSIONS: Over the last decade, there has been a trend toward trying to preserve reproductive function in young patients with malignancy. Information acquired over the last century on the reproductive effects of radiation and chemo-therapy has enabled us to tailor our treatment of various malignancies affecting young patients. As we learn more about the biology and clinical behaviour of gynaecologic malignancies, we are able to modify surgical management to preserve fertility in select cases. All of these trends are in keeping with our goal to optimize quality of life in cancer care without compromising safety or survival.
OBJECTIVE: (1) To review the effects of cancer treatment on reproduction and fertility in both women and men and (2) to review current and new techniques that could be used to preserve fertility and hormone production in women who have undergone cancer treatment. DATA SOURCES: Entries to MEDLINE and CANCERLIT through to October 2001 were searched for evidence relevant to this article. METHODS OF STUDY SELECTION: This document is primarily based on large retrospective cohort series and case reports, as no randomized trials were available. TABULATION, INTEGRATION, AND RESULTS: The first part of this review article focuses on the effects of radiation and chemotherapy on reproductive function and innovative medical and surgical techniques employed to minimize these effects. The second part of this article describes conservative methods of managing cervical, endometrial, and ovarian cancer for women who wish to preserve their fertility. CONCLUSIONS: Over the last decade, there has been a trend toward trying to preserve reproductive function in young patients with malignancy. Information acquired over the last century on the reproductive effects of radiation and chemo-therapy has enabled us to tailor our treatment of various malignancies affecting young patients. As we learn more about the biology and clinical behaviour of gynaecologic malignancies, we are able to modify surgical management to preserve fertility in select cases. All of these trends are in keeping with our goal to optimize quality of life in cancer care without compromising safety or survival.