Gynecological cancers in the era of fertility preservation: old problems, novel approaches
Valentina Lucia La Rosa
Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
Email address: valarosa@unict.it
Gynaecological cancers are estimated to account for around 17-19% of new cancer cases diagnosed worldwide and their management is a challenge both in women of childbearing age and in elderly women [1,2]. About 21% of women receive a diagnosis of gynaecological cancer under the age of 40 and therefore of reproductive age [3-5]. Another important fact to take into account is that the first pregnancy is now more and more distant in time; consequently, many women get cancer before they become mothers for the first time [4].
Besides this, the different treatment options available have a significant impact on a woman's fertility. Indeed, on the one hand, the surgical management of ovarian, cervical and endometrial cancers requires a radical approach which often consists of hysterectomy and bilateral oophorectomy [6-8]; on the other hand, chemotherapy and radiotherapy may severely decrease ovarian reserve [9,10].
Thanks to the progress made over the years in the field of gynaecological oncology, the survival rate has significantly increased and, therefore, ensuring an adequate quality of life for patients has become a top priority for clinicians [3,11]. In this regard, it is important to consider that the psychological well-being of women is strongly affected by the experience of gynaecological cancer and its treatments [12,13]. Indeed, it has been widely documented how the potential loss of fertility may be for the woman a source of distress comparable to cancer itself [11,14]. To confirm this, many of these patients report high levels of depression and anxiety, suicidal ideation, feelings of anger and shame, low self-esteem, and a poor quality of life [4]. Furthermore, the treatments which the woman must undergo are not without side effects that also alter the body image, with inevitable repercussions on psychological functioning as well as on sexuality [10,15,16].
In this scenario, the perspective of becoming a mother after cancer may significantly improve compliance with treatments and recovery times, and consequently, fertility preservation has fundamental importance for women with gynaecological cancer [3,4,11,14].
Several fertility preservation techniques are available today but the choice of the most suitable one should take into account many factors, such as diagnosis, age of the woman, presence of a partner, financial resources, and time factor [17,18]. To date, fertility-sparing surgery has made great progress and breaks new ground for fertility preservation in patients with gynaecological cancer [19-22]. Embryo cryopreservation, requiring in vitro fertilisation and a male partner, seems to be the most effective fertility preservation technique. In cases of patients who do not require surgical treatment of fertility but undergoing adjuvant therapy with radiation therapy, ovarian transposition and cryopreservation of oocytes or embryos are the preferred treatments [23,24].
According to the literature about this topic, patients need to discuss fertility issues with their clinician and adequate fertility preservation counselling reduces distress and improves satisfaction levels and quality of life [4,11-13].
In light of all these considerations, this Special Issue aims to offer a comprehensive and multidisciplinary overview of the fertility-sparing surgical techniques, oocytes and ovarian tissue conservation and preservation of reproductive function in this particular kind of population. Also, space has been given to the discussion of the psychological implications of gynaecological cancer with particular reference to the impact of fertility preservation counselling and fertility preservation techniques on the quality of life of patients.
Conflicts of interest
No conflicts of interest to declare.
Acknowledgements
No funding was obtained for this study.
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