Fertility preservation in ovarian cancer

With 21,650 new cases every year, ovarian cancer is currently the fifth leading cause of death from all cancers in women in the USA [1]. Among gynecological cancers, it is the leading cause of death, typically presenting with stage III/IV disease. At present, 12.2% of ovarian cancers occur in women younger than 40 years of age [2]. Most of these cases are tumors of low malignant potential, malignant germ cell tumors and early-stage invasive epithelial cancer. Recent advances in diagnostic tools have led to earlier detection of ovarian cancer. Approximately one quarter of new cases of ovarian cancer are classified as stage I, with excellent 5-year survival rates of over 90% [2]. Owing to increased survival, there is a new focus on the quality of life in cancer patients. Among quality-of-life factors in cancer survivors, fertility preservation in premenopausal women is a high priority. A study by Wenzel et al. reported that survivors of lymphoma, gestational trophoblastic tumor and cervical cancer who were unable to have children after cancer treatment, but who still desired fertility, experienced significant regret [3]. Various fertility-sparing options are now available for women with ovarian cancer, especially in patients with early-stage disease. More conservative surgeries are often seen as the standard of care for some types of ovarian cancer. Emerging technologies, such as embryo, oocyte or ovarian tissue cryopreservation and transplantation, are continuing to evolve as potentially viable options for future fertility for women with ovarian cancer. Low malignant potential tumors Low malignant potential tumors (LMPTs) or borderline ovarian tumors represent approximately 15% of ovarian cancers [2]. Approximately 30% of LMPTs occur in women younger than 40 years of age [4], and are predominantly stage I at diagnosis (82%) with survival of 99% at 5 years [2]. However, recurrences can occur even more than 10 years after diagnosis. These tumors are epithelial in origin but lack definitive stromal invasion. The most common histological type is serous, followed by mucinous [2]. Serous LMPTs are bilateral in 30% of cases and associated with extraovarian lesions in over 30% of cases. The metastatic potential of LMPTs is relatively low and the recurrence rate is 2.1% with long disease-free intervals. Although the prognosis of patients with disease limited to the ovary is excellent, the outcome of patients with disease that is not limited to the ovary is variable. Surgical removal of the tumor is the most important intervention in the management of LMPTs. However, the extent of surgery, including the role of staging procedure, continues to be defined. The mean age for LMPT presentation falls within the childbearing period; therefore, fertility-sparing surgery is a very important issue. Proposed conservative surgical procedures for LMPTs involve conservation of the uterus and salvaging at least a portion of one ovary, and include unilateral adnexectomy, unilateral adnexectomy and contralateral cystectomy, unilateral cystectomy and bilateral cystectomy. Fertility preservation, including unilateral salpingo-oophorectomy or ovarian cystectomy, This article aims to access feasibility and safety of fertility-sparing surgery in women with germ cell malignancies, low malignant potential tumors and early-stage epithelial ovarian cancer who desire to preserve reproductive function. Current data suggest that fertility-sparing surgeries are safe and have promising reproductive outcomes. Cryopreservation has emerged as a fertility preservation option and consists of various forms, including embryo, oocyte and ovarian tissue cryopreservation. Fertility-sparing surgeries for women with early-stage malignancies have proven efficacy in preserving fertility without apparent adverse impact on cancer outcomes. Advances in assisted reproductive technologies have provided patients with more fertility options.