Women of reproductive age may develop gynecologic cancers. Not only do they stress over their health, but all of a sudden they have to come to terms with the prospect of not being able to bear children.
In carefully selected patients with first stage gynecologic cancer, with the agreement of the Tumor Board, fertility preservation (uterus and/or one ovary) may be attempted, so as to allow for childbearing.
Depending on the cancer type, the fertility preservation options available are, in brief, the following:
Early cervical cancer:
Clinical stage IA1 = cervical conization
Clinical stages IA2 and IB1 = radical trachelectomy with preservation of the uterine body and one or both ovaries/fallopian tubes AND surgical staging.
Early endometrial cancer:
Clinical stage IA with hysteroscopy criteria. Pelvic MRI and anatomic pathology examination without additional risk factors = Oral progestogens(e.g. Megestrol, Megace) or levonorgestrel-releasing intrauterine system (Mirena).
Secondary hysteroscopy and endometrial curettage every 3 months. 6 months from remission under medication, the patient is usually able to bear children.
In IA cases of higher risk = comprehensive surgical staging.
In such cases, the following options may be considered:
1. prior to staging, initiation of ovarian stimulation to harvest ova for cryopreservation or IVF (in-vitro fertilization) and surrogacy;
2. during the staging surgical procedure, extraction of half of the ovaries, if not affected, for cryopreservation of ovarian tissue; and
3. preservation of one ovary, since the metastasis possibility in the context of IA stage is rather small.
Early ovarian cancer:
IA or IB clinical stage without risk factors = uterus and one ovary preservation (for IA stage) AND surgical staging. Possible complementary administration of 3-cycle chemotherapy depending on additional risk factors.
In addition to our cooperation with the acclaimed Athens Tumor Board, we have been actively cooperating with the Stanford Women’s Cancer Center, STANFORD University, USA, since 2007. If our team deems necessary or our patients wish so, it is possible to seek confirmation of a critical diagnosis or a second opinion for less common or more complex cases.
Moreover, working together with human reproduction and IVF specialists is crucial in determining the safest solution for the patient’s health, and maintaining her childbearing hopes.
This is an operation to remove the entire uterus, as well as the fallopian tubes & ovaries, and its quite common, in case of endometrial (uturine) cancer.
Briefly describing the most common surgical procedures performed to treat cervical dysplasia (Ablation/vaporization & Conization).
We have been using the DaVinci® robotic system since 2002 at Stanford University Hospital, California, long before the it became known in Europe.