Kesic V
Institute of Obstetrics and Gynecology, Clinical Center of Serbia, Belgrade.
Recent Results Cancer Res. 2008;178:79-95. doi: 10.1007/978-3-540-71274-9_9.
In a young woman with gynecologic cancer, preservation of fertility is possible. Fertility-sparing surgery may be safe in early ovarian cancer of certain histological subtypes such as ovarian tumors of low malignant potential, malignant ovarian germ cell tumors, and ovarian sex cord stromal tumors. For women with invasive epithelial ovarian cancer who have early-stage disease, fertility-sparing surgery may be an option. In some cases, fertility-sparing surgery may be followed by postoperative chemotherapy. The concept of fertility-preserving surgery in early cervical cancer has been adopted by several leading centers worldwide as an option for stage Ia and small Ib disease without the presence of lymphovascular involvement. Nonsurgical options such as hormonal therapy may be considered for women with early-stage, low-grade endometrial cancer. Improvements in cancer cure rates and the development of conservative treatments mean that many young women with early gynecologic cancer can hope to start a new pregnancy after the treatment. Patients are generally advised to wait 2 years after treatment for any malignancy before attempting pregnancy, but the optimal interval between cure and conception must be carefully determined by a multidisciplinary team including oncologist and obstetrician. Gynecologic surgery and hemotherapy can have an impact not only on fertility, but also on the course of a next pregnancy (increased risk of miscarriage and premature delivery, etc.) These risks must be taken into account by the obstetrician. Management of young women diagnosed with gynecologic cancer should be individualized, with the risk of conservative therapy balanced against the disadvantages of more radical treatment. The patient and the family should be extensively counseled. The alternatives to the traditional and standard radical procedures should be discussed, and the limitation of data regarding many conservative treatment options should be explained. The patients should be aware that by accepting fertility-sparing treatment they are assuming a small but undefined risk for recurrence of the disease. They need to know that these conservative therapeutic approaches are yet not considered "standard." Furthermore, patients need to be assessed for the realistic probabilities of achieving conception on the basis on their age, history, and infertility evaluation. Some of them will require assisted reproduction technology (ARTS) to help achieve a pregnancy, especially in vitro fertilization (IVF). They may also consider ovarian tissue, oocyte, or embryo cryopreservation before definitive cancer therapies. And, finally, patients also need to understand the risk of premature delivery and the consequences of prematurity. The care of the young patient with gynecologic malignancy is extremely complex and challenging. It necessarily requires a multidisciplinary approach with the close collaboration of gynecologist-oncologist, reproductive endocrinologist, and perinatologist.
对于患有妇科癌症的年轻女性来说，保留生育能力是有可能的。保留生育功能手术对于某些组织学亚型的早期卵巢癌可能是安全的，如低恶性潜能卵巢肿瘤、恶性卵巢生殖细胞肿瘤和卵巢性索间质肿瘤。对于患有早期疾病的侵袭性上皮性卵巢癌女性，保留生育功能手术可能是一种选择。在某些情况下，保留生育功能手术后可能需要进行术后化疗。早期宫颈癌保留生育功能手术的概念已被全球多个领先中心采用，作为Ia期和小Ib期且无淋巴管浸润患者的一种选择。对于早期、低级别子宫内膜癌女性，可考虑激素治疗等非手术选择。癌症治愈率的提高和保守治疗方法的发展意味着许多患有早期妇科癌症的年轻女性有望在治疗后开始新的妊娠。一般建议患者在任何恶性肿瘤治疗后等待2年再尝试怀孕，但治愈与受孕之间的最佳间隔必须由包括肿瘤学家和产科医生在内的多学科团队仔细确定。妇科手术和化疗不仅会影响生育能力，还会影响下一胎的妊娠过程（增加流产和早产等风险），产科医生必须考虑这些风险。对被诊断患有妇科癌症的年轻女性的管理应个体化，权衡保守治疗的风险与更激进治疗的弊端。应与患者及其家属进行广泛的咨询。应讨论传统标准根治性手术的替代方案，并解释许多保守治疗选择的数据局限性。患者应意识到，接受保留生育功能治疗意味着他们承担着疾病复发的小但不确定的风险。他们需要知道这些保守治疗方法尚未被视为“标准”。此外，需要根据患者的年龄、病史和不孕评估来评估其受孕的实际可能性。他们中的一些人将需要辅助生殖技术（ART）来帮助受孕，尤其是体外受精（IVF）。他们也可以在确定性癌症治疗前考虑卵巢组织、卵母细胞或胚胎冷冻保存。最后，患者还需要了解早产风险和早产后果。对患有妇科恶性肿瘤的年轻患者的护理极其复杂且具有挑战性。这必然需要多学科方法，妇科肿瘤学家、生殖内分泌学家和围产医学专家密切合作。
