Staying fertile after cancer
Young women diagnosed with an early stage of ovarian cancer may be able to have surgery for the disease without losing their fertility.
Traditionally, treatment of ovarian cancer involves removal of both ovaries and the uterus, which puts younger women into menopause and ends their chances of bearing a child. But a study published today in the journal Cancer, by researchers at Columbia University College of Physicians and Surgeons, showed that five-year survival rates for stage 1 ovarian cancer patients were the same for patients who had both ovaries removed and women who had only the cancerous ovary removed.
The five-year survival rates were similar among patients who had the uterus removed compared with those who didn’t.
“If the woman is young, premenopausal and is considering future childbearing, she does not need a hysterectomy and she does not to be completely castrated,” said Dr. Beth Y. Karlan, director of the Women’s Cancer Research Institute at Cedars-Sinai Medical Center. Karlan was not involved in the research. “It is safe to do a conservation procedure and still effect cure and allow the woman to appreciate her life goals. We’re seeing more women cured of ovarian cancer. With stage 1, cure is a very realistic goal.”
Other research on fertility-preserving surgery shows that most patients can become pregnant safely, even after chemotherapy.
Ovarian cancer, the fifth leading cause of cancer deaths in women, occurs most often in postmenopausal women and is often detected only at advanced stages.
However, up to 17% of ovarian cancers occur in women 40 or younger, a rate believed to be rising. So doctors are paying more attention to options that don’t cause menopause.
Removal of both ovaries and the uterus, which produce hormones, is unappealing for reasons other than fertility, too, said Dr. Jason Wright, lead author of the study and an assistant professor of women’s health.
“If the other ovary is preserved, that essentially means women don’t go through the menopause. They don’t experience hot flashes, vaginal dryness, osteoporosis. There is additional data that women who undergo the removal of their ovaries before age 55 are also at increased risk for cardiovascular disease, earlier death and dementia.”
That means organ-preserving surgery could benefit premenopausal cancer patients even when fertility is not an issue.
But “for postmenopausal women, the risks may outweigh the benefits,” Wright said.
The retrospective study focused on 1,186 patients diagnosed between 1988 and 2004, of whom 36% had one ovary conserved.
Further research, such as a randomized, controlled trial, is needed to test whether the procedure should be recommended to all younger women with early-stage ovarian cancer, Wright said. But for now, he said, it’s a “reasonable” option that doctors should discuss with patients.
Karlan added: “It is important to ensure they are stage 1. Part of that includes sampling the lymph nodes and making sure the cancer hasn’t spread to the nodes or upper abdomen.”
Wright also reported earlier this year that removing the ovaries had no effect on five-year survival rates of early-stage endometrial cancer in women age 45 and younger.