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Ovarian cancer quality of life

Young survivors who have not completed their family yet have now a chance given by oncofertility procedures. The main strategies used in preserving fertility in oncology patients are: ovarian stimulation followed by cryopreservation of oocytes, transposition of the ovaries before radiotherapy, cryopreservation and transplantation of ovarian tissue, and the administration of gonadotropin-releasing hormone GnRH agonists, each technique being individua­lized for each patient.

Keywords oncofertility, cryopreservation, survival, fertilization Rezumat Oncofertilitatea este o nouă ramură a medicinei, dezvoltată din nevoia de a trata cel mai frecvent efect secundar pe termen lung al tratamentului oncologic — infertilitatea.

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Tinerele supravieţuitoare care încă nu şi-au completat familia au acum o şansă prin procedurile de oncofertilitate. Principalele tehnici folosite în conservarea fertilităţii pacientelor oncologice ovarian cancer quality of life stimularea ovariană urmată de crioprezervarea ovocitelor, transpoziţia ovarelor înainte de iniţierea radiotera­piei, crioprezervarea şi transplantarea ulterioară a ţesutului ovarian, administrarea de agonişti GnRH.

Alegerea procedurii se face individualizat, pentru fiecare pacientă în parte. Nowadays, because of new screening methods, remarkable treatments and early diagnosis, the survival has increased for oncology patients, but with a very high cost — infertility.

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Materials and method We performed a systematic review of published literature describing the effects of cancer treatment on fertility and the current strategies used for preserving fertility in oncology patients, using the PubMed and Medline databases.

Risk of infertility related to chemotherapeutic agent Aggressive chemotherapy, especially when using an alkylating agent which has a higher gonadotoxic potential and radiotherapy, cause premature ovarian failure due to destruction of the ovarian reserve, resulting in infertility, years of hormone replacement therapy and menopause-related symptoms.

Each chemotherapeutic agent has a ovarian cancer quality of life mechanism of action and, consequently, a distinct impact on ovary reserve Table 1. Table 1. Risk of infertility related to chemotherapeuric agents New pharmacological agents with the purpose to protect the ovary during chemotherapy are developing, most of them being still in preliminary stages of study 3. Women who require gonadotoxic treatment should receive an individual evaluation for fertility preservation.

Even nowadays, fertility preservation options are not routinely presented to patients before starting the oncological treatment, and these methods are still underused. The current techniques used in preserving fertility in women diagnosed with cancer are: ovarian stimulation followed by cryopreservation of unfertilized oocytes or fertilized oocytes, transposition of the ovaries before radiotherapy, cryopreservation and ovarian cancer quality of life of ovarian tissue, and the administration of gonadotropin-releasing hormone GnRH agonists during the oncological treatment.

Ovarian stimulation, followed by intracytoplasmic sperm injection ICSI and cryopreservation of embryos, is currently the first recommendation for fertility preservation in newly diagnosed cancer patients. Oocyte banking does not require a partner or a sperm donor at the moment of cryopreservation.

Cryopreservation of ovarian tissue before starting the oncological treatment has recently become one of the most promising techniques for preserving fertility, especially when there is no time for ovarian stimulation.

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It allows the storage of a large number of primordial produse antiparazitare pentru adulți primary follicles. It is the single actual option for preserving fertility in prepubertal oncological patients who do not produce already mature oocytes for freezing 5.

A major worry using this method is ovarian cancer quality of life potential risk of grafting malignant cells. The method evaluates the tissue using immunohistochemistry tests and molecular biology techniques, thus the reimplantation of ovarian tissue appeared to be safe, including in patients diagnosed with breast cancer, lymphoma cancers and sarcoma.

In leukemia patients, the disease must be in full remission 7. Also, in patients with BRCA mutations, the ova­rian tissue cryopreservation is not an option because it increases the risk of ovarian cancer.

Account Options

For this group of patients, bilateral salpingo-oophorectomy is done for preference after childbearing, so that these patients are candidates for either embryo crypreservation or oocyte cryopreservation 8. Regarding ovarian transposition, ovaries can be moved from the area receiving radiation; the method is not ef­ficient against chemotherapy effect 9.

Ovarian supression using GnRH agonist during chemotherapy should be considered an option for ovarian preservation in premenopausal patients who are not interested any more in conceiving, but who consider ovarian insufficiency a negative impact on their quality of life. There are no current data available in litera­ture to prove the negative interaction between ovarian supression therapy and chemotherapy. Fertility preservation in gynecologic malignancies Fertility preservation techniques are used in gynecologic malignancies such as cervical cancer, where the focus in preserving fertility consist in conservative surgery fertility-sparing surgery is a surgical treatment in which one ovarian cancer quality of life and the uterus are conserved.

In ovarian malignant pathology, conservative gonadal surgery can be done in the following pathologies: any stage of malignant germ cell tumors, sex cord stromal tumors, stage I invasive epithelial ovarian cancer, and borderline ovarian tumors. Borderline ovarian tumors appear usually in young women, this is why fertility conservation is an important consideration, ovarian cancer quality of life they usually have an excellent survival rate.

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Letrozole during ovarian stimulation should be considered in order to reduce the risk of increasing recurrences. Ovarian cortex cryopreservation is not justified given the possible risks of malignant reseeding; this approach would appear to be contraindicated at least for the moment. In stage IA of ovarian epithelial cancer, unilateral anexectomy may be done in selected patients who wish to procreate 8.

In endometrial cancer, the standard therapeutic manner is hysterectomy with bilateral anexectomy; a fertility sparing method is the continuous administration of progestin medroxiprogesteron therapy in very rigorous selection of patients with endometrial hyperplasia or stage IA endometrial adenocarcinoma Breast malignancy is the leading cause of cancer in women of reproductive age.

For many of them, after surgery and chemotherapy it follows five years of con-tinuous treatment with tamoxifen, when they will not be able to attempt pregnancy. Even if tamoxifen is not necessary, current recommendation is to delay pregnancy for at least two years after diagnosis, due to the higher rate of recurrence during this period Because a high estrogen status is not considered safe for these patients, oocyte retrival can be performed during natural cycles, but usually no more than a single embryo can be obtained.

Therefore, because pregnancy rates increase in parallel with the number of embryo transfers, in vitro fertilization stimulation cycles can be done with tamoxifen or letrozole, increasing considerably the number of pregnancies.

Ovarian cancer quality of life

Conclusions The preservation of fertility has become one of the major gain in quality of life for oncology patients undergoing ovarian cancer quality of life or radiotherapy at reproductive ages and proactively addressing is associated with lower regret and improved quality of life, thus counseling regarding the expected success rates may be difficult in such patients Conflict of interests: The authors declare no conflict of interests.

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Fertil Steril. Ovarian cancer quality of life oocyte cryopreservation: a guideline.

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Duration of fertility after fresh and frozen ovary transplantation. Transplantation of frozen-thawed ovarian tissue: an update on worldwide activity published in peer-reviewed papers and on the Danish cohort. J Assist Reprod Genet.

Ovarian tissue cryopreservation for fertility preservation in cancer patients: successful establishment and feasibility of a multidisciplinary collaboration.

Ştiinţă şi emoţie în lupta împotriva cancerului Conținutul Pagina pacientului Best Supportive Care BSC is the treatment of choice when cure is not achievable with anticancer agents and cancer ovarian immunotherapy management of disease-related symptoms.

Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion. Oophoropexy: a relevant role in preservation of ovarian function after pelvic irradiation.

Cancer ovarian immunotherapy

GnRH agonist therapy as ovarian protectants in female patients undergoing chemotherapy: a review of the clinical data. Hum Reprod Update. Cervical Cancer Version 1.

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Morice P. Borderline tumor of the ovary and fertility. Eur J Cancer. Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma.

J Zhejiang Univ Sci B. Uterine Neoplasms, Version 1. J Natl Compr Canc Netw. Fertility preservation in young women with early-stage breast cancer. Acta Clin Croat. Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Articole din ediţiile anterioare Terapii alternative asociate cu îmbunătăţirea rezultatelor fertilizării in vitro Teodora Cioroba, Corina Gică, Gheorghe Peltecu, Anca Maria Panaitescu, Diana Iordăchescu, Nicolae Gică O problemă importantă cu care se confruntă cuplurile în zilele noastre este infertilitatea, aceasta având impact atât pe plan psihologic şi medical