Fertility Sparing Surgery: An Option In Early Stage Gynecological Cancers

Dr Suneel Kaushik Komanduri, Surgical Oncologist, Onco Cancer Centre, explains how fertility is preserved in patients of gynaecological cancers. 

Standard surgical treatment for most gynecological cancers involves the removal of the ovaries, uterus and fallopian tubes as a part of the curative surgery to ensure that the disease is completely removed.

This, however, can affect the woman’s ability to have children. But for some patients, especially those who hope to become pregnant, one may have other options which can preserve their ability to have children. This approach of surgical treatment is referred to as ‘Fertility sparing surgery’ for gynecological cancers.

Cervical cancer is the most common gynecological cancer. In the early stages of the disease (when the tumour is very small and confined to cervix with no spread beyond), a less radical surgical procedure like Conization and Trachelectomy surgeries have been found useful in preserving fertility. 

These surgeries can be undertaken without compromising the cancer related outcomes in terms of the risk of the disease coming back and survival. 

Regular screening with Pap smear and HPV testing is advised to detect cervical cancer in early stages.

Ovarian cancer is often considered the most aggressive of gynecological cancers. This disease has a tendency to spread all over the abdomen by the time the symptoms develop and the disease is diagnosed. 

In the early stages of ovarian cancers and selected subtypes of the disease (like borderline tumours, germ cell tumours and sex cord stromal tumors), fertility sparing surgery can be considered after discussing with your oncologist. 

The physician first confirms if the opposite ovary is free of disease and the disease has not spread elsewhere before planning for a conservative surgery.

Uterine cancers, those arising from the endometrium (inner lining of the uterus), are on the rise and are the most common gynecological cancer in urban areas. 

These are more common after menopause, but can be seen in younger women when there is strong contributing genetic factor. In young women, when the disease is in the early stages (confined to the inner lining and not penetrating deep in the uterine wall), hormone therapy with progesterone can keep the disease under check.

Research suggests varying degrees of success (ranging from 60-80%) in terms of successful pregnancy rates among those who underwent these surgeries. There could be a mild increased risk of recurrence of disease, which should be discussed with the treating oncologist on a case to case basis. 

It’s important to note that all these women should undergo a completion surgery after they complete their family, to reduce the risk of disease coming back. 

Improved understanding of the biology of tumours, modern surgical techniques, and more importantly, latest imaging techniques that have enabled early diagnosis of these tumours, have made these fertility sparing options available for young women.