Introduction:
Gynecologic cancers are a group of cancers affecting women in Singapore. It is even more devastating when discovered at an early age as it will affect fertility.
The following are the 5 main types of gynecologic cancers
Cervical Cancer
It starts from the cervix, the narrow and lower end of the uterus (womb).
Ovarian Cancer
This begins in the ovaries found on either side of the uterus. Others may emerge in the fallopian tube.
Vaginal Cancer
This cancer starts in the vagina, the hollow channel connecting the lower uterus and the outside of the woman’s body. It is a rare type but more common in older women.
Vulvar Cancer
This type of cancer begins in the vulva which is on the outer parts of a woman’s sex organs. It is also very uncommon.
Uterine (Endometrial) Cancer
This cancer starts from the uterus, the muscular organ that allows room for the baby to grow in a pregnant woman. The cancer mostly starts in the lining of the uterus.
Fertility Sparing Surgery; What is It?
This is a surgery done on women who have gynecologic cancers but would want to preserve their fertility and later have kids. Fertility sparing surgeries are performed when the doctor confirms it is safe to do so i.e.when the cancer is diagnosed at stage 1 only.
Fertility Sparing For Ovarian Cancer
Fertility sparing can be a treatment option for a woman with early cancer in one of the ovaries but would wish to bear a child at a later date. This is achieved through the removal of the affected ovary provided the other ovary is normal.Sometimes chemotherapy is necessary after surgery but patients can go on to have children after that. Another option is to preserve the eggs from the normal ovary before embarking on chemotherapy.
Fertility Sparing for Cervical Cancer
Fertility sparing surgery can also be performed on a patient in her early stages of cervical cancer. One of these procedures isa large cone biopsy of the cervix for Stage IA1 microinvasive cancer. For Stage IA2 and Stage IB, a speisl procedure called radical trachelectomy can be performed, where the gynecologic oncologist will remove the cancerous section of the cervix, and preserve the remaining non-cancerous section and the uterus and reattach the uterus back to the vagina.
Fertility Sparing treatment for endometrial cancer
For endometrial cancer, surgery would result in infertility as the uterus is removed. However, for stage I patients, hormonal treatment with high doses of progestogen can potentially reverse the early cancer changes to preserve fertility. However the success is only about 60 to 70% and patients are usually advised to seek IVF methods for pregnancy after treatment as the recurrence is very high after stopping treatment.
Both vulva and vaginal cancers are rare in young women. If discovered at an early stage, it is possible to have children after surgical treatment.
Conclusion
Fertility sparing surgeries for affected women who have early gynaecological cancers can help maintain a woman’s fertility such that she can conceive later without affecting her long-term prognosis.
