Fertility may be preserved after ovarian cancer

Women with malignant ovarian germ cell tumors who undergo surgery intended to preserve fertility plus platinum-based chemotherapy are very likely to retain menstrual function and fertility, findings from a new study indicate.

Malignant ovarian germ cell tumors - cancerous tumors that form in the egg, or “germ,” cells within the ovary - tend to affect adolescents or young women. The results of the study, described by its authors as “the largest and most comprehensive” survey of its kind in this setting, are reported in the Journal of Clinical Oncology.

Citing a lack of research into the effect of chemotherapy on sexual functioning and the ability to form close relationships after treatment, the investigators compared 132 ovarian germ cell tumor survivors who had been treated with surgery plus platinum-based chemotherapy with 137 women matched for similar characteristics, but who did not have ovarian cancer (controls). The average patient age at diagnosis was 24 years, and average age at the time of the study was 36 years.

Lead author Dr. David M. Gershenson, of the University of Texas M. D. Anderson Cancer Center in Houston, and colleagues found that 71of the 132 cancer patients had undergone fertility-sparing surgery. Of these 71 women, 62 (87 percent) reported that they still had menstrual periods. In addition, 37 children had been born to 24 women following their cancer treatment.

Compared with the controls, the cancer survivors had significantly greater reproductive concerns, less sexual pleasure and lower scores on the Sexual Activity Scale. However, they scored higher in terms of relationships with significant others, within marriages or outside of marriages.

Gershenson told Reuters Health that, based on the survey, “The overall outlook for young patients with malignant ovarian germ cell tumors is excellent.”

He added, however, that only about half the patients in the study group had had fertility-sparing surgery. “This is much too low and reflects the fact that many of the patients underwent primary surgery by non-subspecialists who performed unnecessary sterilizing surgery in many cases.”

Gershenson also emphasized the importance of counseling for young patients and their families about future reproduction and sexuality before they have surgery and chemotherapy.

SOURCE: Journal of Clinical Oncology, July 2007.

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