Survivors of Rare Ovarian Cancer Retain Fertility
CancerWise - August 2007
Women who had fertility-sparing surgery and combination platinum-based chemotherapy for ovarian germ cell cancer have a high likelihood of retaining the ability to have children and being in positive, meaningful relationships with significant others, according to a study published in the July 1 issue of the Journal of Clinical Oncology.
Compared to the healthy women in the study, however, germ cell tumor survivors also experienced less sexual pleasure and more sexual discomfort, the report says.
Significance of results
The study is the largest and most comprehensive of women who have received these treatments for this rare cancer that forms in the egg (or germ) of the ovary. Research was conducted by M. D. Anderson and the Gynecologic Oncology Group, a National Cancer Institute-sponsored organization that conducts collaborative clinical trials related to gynecological cancers.
Since the average age of diagnosis for ovarian germ cell cancer is in adolescence, physicians are interested in how the disease and treatments affect future fertility, adds David Gershenson, M.D., professor and chair of M. D. Anderson's Department of Gynecologic Oncology.
In this study, 132 survivors of germ cell cancer completed questionnaires about their health and reproductive issues. These women were enrolled in clinical trials during the 1980s and 1990s at M. D. Anderson or other cancer treatment centers across the nation through the Gynecologic Oncology Group. Their treatment consisted of surgery followed by combination platinum-based chemotherapy.
The women were compared to 137 healthy women. The survivors and healthy women filled out questionnaires and were matched for age, race and education.
Of the 71 survivors who had fertility-sparing surgery:
- Sixty-two, or 87%, were still having menstrual periods
- Twenty-four women had given birth to 37 babies
“At the time of the study, the median age was just 35.5 years, so this is a very young group of survivors,” Gershenson says. “One can only assume that the women will have, or likely already have had, more children since the study.”
Compared to the healthy women in the study, germ cell tumor survivors had:
- Greater reproductive concerns
- Less sexual pleasure
- More sexual discomfort
However, the survivors were more likely to be in positive, meaningful relationships than the healthy women.
Germ cell tumors make up only 5% of ovarian cancers. Although the tumors are aggressive malignancies, they tend to involve only one ovary.
Fertility-sparing surgery leaves part of the reproductive organs intact so the patient might become pregnant in the future. For instance, surgeons may remove one ovary but leave the opposite ovary and uterus.
“Before the 1970s, there was no effective treatment for patients with ovarian germ cell tumors, and the death rate was extremely high," Gershenson says. "However, with the introduction of platinum-based combination chemotherapy, a dramatic increase in survival has brought cure rates close to 100%. Simultaneously in the 1970s, gynecologic oncologists began to realize that fertility-sparing surgery could be performed safely and without compromising a woman's prognosis."
“The finding should allow oncologists and therapists to better inform and counsel patients and their families about expectations,” Gershenson says.
He says it's important for patients to be treated by board-certified gynecologic oncologists who understand the clinical behavior of germ cell tumors and are trained in appropriate surgical techniques and chemotherapy protocols.
– From staff reports
- Ovarian cancer
- General Information about ovarian germ cell tumors (National Cancer Institute)
- Department of Gynecologic Oncology (M. D. Anderson)
- Gynecologic Oncology Center (M. D. Anderson)
- Gynecologic Oncology Group
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