Headlines
As reported by HealthDay, July 15, 2005.
Cancer Doesn't Have to Cost You Your Fertility
By Amanda Gardner
Cancer treatment advances are giving younger patients the chance to preserve their fertility, enabling them to start families at a future date, a new review states.
According to a report in the July/August issue of CA: A Cancer Journal for Clinicians, physicians can offer an enhanced chance of protecting fertility without negatively affecting the outcome of cancer treatment or survival.
"This is very good news because it shows that the number of people who are being treated with cancer and living, and are able to be concerned about fertility, is increasing," said Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Clinic Foundation in Baton Rouge, La. "We didn't have this problem years ago because people didn't live."
According to the review, the last two decades have seen enormous progress in the five-year survival rates for most cancers.
Simultaneous with this progress has been an improved ability to preserve fertility without affecting the success of the treatment.
Both radiation and chemotherapy, staples of cancer treatment, can affect men's and women's ability to have children. In addition, surgery for testicular or ovarian cancer can diminish or eliminate the possibility of producing a baby.
For this review, the authors looked at the most common cancers affecting young adults as well as some less common cancers that directly affect the reproductive organs. The cancers included breast, cervical, endometrial, ovarian, and testicular tumors, as well as leukemia and lymphoma.
"The outlook is much more hopeful because technologies have improved and we have begun to understand cancer better so we can offer more conservative therapies," said Dr. Carolyn Runowicz, one of the review's authors. She is president-elect of the American Cancer Society and director of the Neag Comprehensive Cancer Center at the University of Connecticut Health Center in Farmington.
Today, a young woman with ovarian cancer may be able to keep her uterus and to retain one ovary -- or at least tissue from one ovary.
Older strategies of keeping ovaries in a quiescent phase or freezing oocytes (eggs) have had only limited success. Newer, more promising strategies include freezing strips of ovarian tissue, then reimplanting them after the cancer treatment is completed.
In June, a 28-year-old Israeli woman whose ovaries had been destroyed by high-dose chemotherapy gave birth to a healthy baby girl after doctors transplanted some of her own frozen ovarian tissue. This was the first time such a technique was successful.
"To me, this is very exciting," Runowicz said. "It's still obviously investigational but it shows a light at the end of the tunnel."
Cryopreservation (freezing) of semen is recommended for men with testicular cancer who wish to have children in the future. Although the procedure and technology are relatively simple, few men take advantage of this option, the review noted.
"Many times people who are diagnosed with cancer want to get treated yesterday," Brooks said. "The cancer is so pressing they don't think about the fertility issues."
Later, however, when the cancer treatment is over, many men (and women) regain past priorities. By that time, it can be too late.
"Cryopreservation of sperm has been available for a while but when people hear the word cancer, saving sperm seems like an unnecessary delay," Runowicz said. "Then, all of sudden when you're better, they say, 'Gee whiz, I should have done that.'"
"One message for men is cancer doesn't happen like an emergency and is not an emergency in most cases," Runowicz continued. "They have time to explore and bring up that subject [sperm preservation] if the treating physician does not."