Outcome of fertility-preserving surgery for ovarian malignancy in young women

Abstract

Ovarian cancer is considered to be one of the most lethal gynecological malignancies. It is estimated that 10% of ovarian cancer cases will be diagnosed in women of reproductive age and >80% would be in advanced stage. Conservative treatment can be carried out for Stage IA, B, C1, C2, C3 (International Federation of Gynecology and Obstetrics) to preserve fertility. However, accurate staging prior to surgery is difficult and some of these women require chemotherapy after fertility-preserving surgery which affects ovarian reserve, and there are a lot of anxieties regarding the aftereffects of chemotherapy on conception. In this article, cases of three young women who underwent conservative surgery for ovarian cancer followed by chemotherapy and subsequent treatment for infertility are presented. These are immature teratoma, juvenile granulosa cell tumor, and dysgerminoma. There was tumor spill in case of immature teratoma and capsule rupture in case of juvenile granulosa cell tumor. All the three women received chemotherapy and could achieve pregnancy after infertility treatment and had normal children. Tumor spill or rupture did not result in adverse outcomes and hence it should not prompt the surgeon to undertake radical procedure in women desirous of pregnancy. Undergoing chemotherapy subsequently did not result in adverse fetal outcome and there was no recurrence of malignancy among these women.