Abstract
Simple SummaryDue to a trend toward late childbearing, fertility preservation has become a major issue in young patients with gynecological cancer. Surgical fertility sparing management is universally acknowledged as an acceptable option in eligible patients with cervical cancer. Excisional cone biopsy or trachelectomy are now standard surgical procedures offered to selected patients with gynecological malignancies who wish to preserve their fertility. Neoadjuvant chemotherapy followed by surgery is another therapeutic option studied currently in numerous clinical trials. However, fertility preserving treatment is generally not recommended in rare histological types of cervical cancer, including clinically aggressive gastric-type endocervical carcinoma. Due to controversies in this emerging topic, a review of literature and international database was carried out, in search of solid evidence on fertility sparing management in gastric-type endocervical carcinoma.Fertility sparing management of cancer is one of the main components of quality-of-life issues. Early-stage cervical cancer, frequently diagnosed in women of reproductive age, can potentially be treated conservatively. However, some rare histological types of cervical cancer present with aggressive clinical behavior. Particularly, in the newly introduced concept of gastric-type endocervical carcinoma, fertility sparing management is ‘a priori’ not recommended. Even so, this issue remains undocumented. For this reason, a selected review of the current literature on gastric type endocervical carcinoma was carried out through PubMed. The keywords included “gastric-type cervical cancer”, “gastric-type endocervical carcinoma”, “conservative surgery”, “conservative treatment”, “fertility sparing surgery”, “radical trachelectomy”, “laparoscopic trachelectomy”, “robotic trachelectomy”, “laparotomic trachelectomy”, “abdominal trachelectomy”, “trachelectomy”, “neoadjuvant chemotherapy”, “conisation”, and “cone resection”. A search in the European Network on Cancer, Infertility and Pregnancy (INCIP) database was performed. The rarity of gastric-type endocervical carcinoma does not allow for conclusions on fertility sparing management with solid evidence. However, diffuse character of the disease and aggressive clinical behavior contraindicate a conservative treatment in young women with gastric type cervical cancer.
Highlights
Cancer survival has improved over the last years
In order to conclude about the recommendation, a selected review of the current literature on gastric type endocervical carcinoma was performed through MEDLINE, Current
The concept of fertility sparing surgery in early-stage cervical cancer has been proposed by Daniel Dargent in 1994 [27,28,29], historically preceded by Aburel [30]
Summary
Cancer survival has improved over the last years. 83% 5-year survival rate within the group of women younger than 45 years diagnosed with cancer [1]. There are many young survivors of reproductive age. According to the National Cancer Institute data, there are around 250,000 cancer survivors aged 20 to 39 years [2]. Fertility preservation and other quality of life issues have become important matters to consider in the management of these patients. Oncofertility has become an important component of cancer care. It places a special importance on the psychological aspect of infertility related to cancer treatment and helps patients to make conscious decisions regarding cancer treatment and fertility, with the objective to reconcile the objective of curing cancer with a hope of maternity
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