Spanos Constantine P, Mamopoulos Apostolos, Tsapas Apostolos, Syrakos Theodore, Kiskinis Dimitris
Department of Surgery, Aristotelian University, 15 Fitziou Street, N751, Panorama, Thessaloniki, 55236, Greece.
Int J Colorectal Dis. 2008 Aug;23(8):735-43. doi: 10.1007/s00384-008-0483-3. Epub 2008 May 6.
It is estimated that the incidence of cancer in women aged 40 years or less is 8%. Females under the age of 40 are in their childbearing years. In the Western world, colorectal cancer (CRC) is the most common malignancy of the gastrointestinal tract. It is the third most commonly diagnosed cancer and the second leading cause of cancer-related death in the USA. The incidence of CRC in patients under 40 is 3-6%. Over the past decades, there has been a significant improvement in survival rates due to progress in cancer treatment, including CRC. This has been achieved with advances in adjuvant chemotherapeutic regimens. In the case of locally advanced rectal cancer, radiation therapy is also used. Treatment for CRC may have adverse effects on female fertility. The purpose of this paper is to discuss the effects of treatment of CRC on female fertility as well as the options for fertility preservation.
A review of relevant English language articles was performed on the basis of a MEDLINE search of the keywords: female, fertility, fecundity, colon, rectal cancer, fertility preservation, chemotherapy, and radiation.
Surgical resection for colon cancer possibly has no effect on female fertility. Resection below the peritoneal reflection may adversely affect fertility, based on lower fertility and fecundity rates associated with pelvic surgery for ulcerative colitis and familial adenomatous polyposis. Standard 5-FU-based chemotherapy may not have significant effects. The advent of oxaliplatin in adjuvant chemotherapy may be more harmful. Adjuvant and neoadjuvant radiation therapy may cause premature ovarian failure using current dosing schedules. The effect of pregnancy and female hormones on the incidence, progression, and recurrence of CRC remains unclear. Established methods for fertility preservation include ovarian transposition and embryo cryopreservation. Oocyte cryopreservation has yielded inferior results. An investigational fertility preservation method is ovarian tissue cryopreservation, with promising results. Ovarian suppression and the use of apoptotic inhibitors are also investigational at present.
Young female patients need to be informed about the effects of treatment on fertility and options for fertility preservation. A multidisciplinary approach for appropriate consultation of these patients is mandatory.
据估计，40岁及以下女性的癌症发病率为8%。40岁以下的女性正处于生育年龄。在西方世界，结直肠癌（CRC）是胃肠道最常见的恶性肿瘤。它是美国第三大最常被诊断出的癌症，也是癌症相关死亡的第二大主要原因。40岁以下患者的结直肠癌发病率为3%至6%。在过去几十年中，由于包括结直肠癌在内的癌症治疗取得进展，生存率有了显著提高。这是通过辅助化疗方案的进步实现的。对于局部晚期直肠癌，也会使用放射治疗。结直肠癌的治疗可能会对女性生育能力产生不良影响。本文的目的是讨论结直肠癌治疗对女性生育能力的影响以及生育力保存的选择。
基于对关键词“女性、生育能力、生殖力、结肠、直肠癌、生育力保存、化疗、放疗”的MEDLINE搜索，对相关英文文章进行了综述。
结肠癌手术切除可能对女性生育能力没有影响。基于与溃疡性结肠炎和家族性腺瘤性息肉病盆腔手术相关的较低生育力和生殖力率，腹膜反折以下的切除可能会对生育能力产生不利影响。基于5-氟尿嘧啶的标准化疗可能没有显著影响。奥沙利铂在辅助化疗中的出现可能更具危害性。使用当前的给药方案，辅助和新辅助放疗可能会导致卵巢早衰。怀孕和女性激素对结直肠癌的发病率、进展和复发的影响仍不清楚。已确立的生育力保存方法包括卵巢移位和胚胎冷冻保存。卵母细胞冷冻保存的效果较差。一种正在研究的生育力保存方法是卵巢组织冷冻保存，结果很有前景。卵巢抑制和凋亡抑制剂的使用目前也在研究中。
需要告知年轻女性患者治疗对生育能力的影响以及生育力保存的选择。对这些患者进行适当咨询的多学科方法是必不可少的。
