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Survivors of Rare Ovarian Cancer may Retain Menstrual Function and Reproductive Ability

A new prospective study suggests that ovarian germ cell tumour patients treated with platinum-based chemotherapy and fertility-sparing surgery may retain their menstrual function and reproductive ability.

The study, published in the Journal of Clinical Oncology, also found that despite having reproductive and sexual concerns, survivors were more likely than their healthy counterparts to be involved in meaningful, positive relationships.

Researchers at The University of Texas M. D. Anderson Cancer Center and the Gynecologic Oncology Group claim that this is the largest and most comprehensive survey of survivors ever conducted.

Lead author of the study, Dr. David Gershenson, says that germ cell tumours, a disease in which malignant cells form in the germ or egg of the ovary, constitute just five percent of all ovarian cancers diagnosed.

He explains that there has been a tremendous amount of interest in fertility because it relates to germ cell tumour survivors. Ovarian germ cell tumours often occur in girls and young women, with the average age of diagnosis occurring in the teenage years.

"Before the 1970s, there was no effective treatment for ovarian germ cell tumour patients and the death rate was extremely high. However, with the introduction of platinum-based combination chemotherapy, there's been a dramatic increase in survival, with cure rates now reaching close to 100 percent.

Simultaneously in the 1970s, gynaecologic oncologists began to realize that fertility-sparing surgery could be performed safely and without compromising a woman's curability," says Dr. Gershenson.

During the study, the researchers surveyed 132 germ cell tumour survivors formally enrolled in M. D. Anderson or Gynecologic Oncology Group clinical trials all over the nation. Each patient received platinum-based combination chemotherapy following surgery. The women were compared to 137 health y women, all acquaintances of the survivors. Both the survivors and the acquaintances filled out questionnaires, and were matched for age, race, and education.

Seventy-one of the 132 survivors had fertility-sparing surgery as part of their treatment. The researchers noted that of the 71 patients who had fertility-sparing surgery, 62 women (87 per cent) were still having menstrual periods and 24 survivors had given birth to 37 babies.

"At the time of the study, the median survivor's age was just 35.5 years - this is a very young cohort of survivors. One can only assume that the women will have, or likely already have had, more children since the study," says Dr. Gershenson.

It was also observed that as compared to the healthy women, germ cell tumour survivors had significantly greater reproductive concerns and experienced less sexual pleasure and more sexual discomfort, although the survivors were more likely to be in partnered, meaningful relationships.

"The finding should allow oncologists and therapists to better inform and counsel patients and their families about expectations in the perioperative period, during primary treatment and long term. Ultimately as a cancer community, we need to develop better interventions and pay much more attention to both the psycho-social and fertility issues of our patients," says Dr. Gershenson.

He also stressed the importance of having fertility-sparing surgery performed by a board-certified gynaecological oncologist who understands the clinical behaviour of ovarian germ cell tumours, and who is trained to optimise patients' probability of undergoing appropriate surgery and chemotherapy.

"Still in 2007, despite medical advances, too many of these patients are operated on by general obstetricians and gynaecologists or general surgeons who do not make a proper diagnosis during surgery, or may not truly understand the biology of this disease. As a r esult, both ovaries and the uterus are removed, leaving a patient unnecessarily sterile," he said.


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