Fertility Preservation in Gynecological Cancer: Current Management and Novel Insights

Gynecological cancers are usually diagnosed in women after menopause, particularly in western countries. However, a non-negligible proportion of cases are diagnosed in younger women in the reproductive age. In these patients, appropriate counseling, including discussing the long-term consequences of the different treatment options on fertility and the possibility of fertility preservation, is mandatory as in any cancer diagnosis. However, women affected by gynecological cancer require considering that the treatment options include hysterectomy and bilateral oophorectomy in most cases. Therefore, in gynecological cancer, often, the standard treatment consists of an inevitable loss of fertility. The direct consequence is that fertility preservation management does not usually include the optimal treatment of the disease, with the risk of worsening oncologic outcomes. Particularly for endometrial cancer and ovarian cancer, the diagnosis in reproductive age additionally carries the risk of hereditary cancer. Therefore, the counseling needs to include discussing a genetic assessment of cancer risk to identify an inherited predisposition. This factor is even more paramount when a fertility-sparing approach to achieve a subsequent pregnancy is considered. Regardless of these general principles, gynecological cancers are heterogeneous, and fertility-sparing management needs to be personalized, with different options for each type of cancer. These options include both fertility preservation treatments already used in other cancers, such as oocyte cryopreservation, and specific therapeutic options unique for each diagnosis. Moreover, given the reproductive organs are involved by the disease, the adoption of the traditional fertility preservation treatments is not always feasible and require specific considerations. This book was thought and written for this complex scenario to provide a complete and detailed overview of the fertility preservation management options in young women affected by gynecological cancers. This book discusses of all the elements involved in the management of these patients: the role of genetic assessment and counseling, the effect of anticancer treatments for gynecological cancer on fertility, the classic fertility preservation techniques adapted to gynecological cancer, the detailed and specific fertility preservation management for cervical, ovarian, and endometrial cancer, and finally the role of a multidisciplinary approach in these patients. This book will provide a starting point to approach the management of highly delicate patients in his total.