Fertility preserving treatment of gynecological malignant tumors

Czech version

Authors: L. Minář
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN Brno, přednosta prof. MUDr. P. Ventruba, DrSc.
Published in: Ceska Gynekol 2009; 74(6): 420-427

Overview

Objective:
Factsheet on conservative treatment of gynecological malignant tumors allowing preservation of reproductive function.

Design:
Literature review with case reports.

Setting:
Department of Gynaecology and Obstetrics, Faculty of Medicine, Masaryk’s University and Faculty Hospital, Brno.

Methods:
Literature review of conservative treatment of gynecological malignant tumors allowing preservation of reproductive function with illustrative case reports.

Conclusions:
According to the National Oncological Register data in terms of incidence of certain gynecological malignancies, of a not insignificant group of malignancy occurring in women fertile age. This is a very sensitive area of oncogynecology where it is desirable to highly personalized approach, which is based on the stages of the disease and reflects the possibly patients wish to preserve future fertility. It is crucial to detect the disease in the early stages, which allows fertility preserving conservative procedure. Before to the start of conservative treatment to be made compulsory examinations, which is essential from the perspective of oncogynecologist particularly expert gynecological ultrasound pelvis and the abdominal cavity, which is adequate for investigating erudition seems to be the diagnostic method with sufficient accuracy the parameters expressed sensitivity and specificity, and also as a diagnostic method highly efficient in economic terms. A very important part of the team, which participates in the implementation of this specialized care in oncogynecology is also histopathologist specializing in oncogynecological issue and one of the important assumptions is the possibility to carry out work peroperative histopathological examination.

Key words:
fertility, gynecological malignant tumors, hormon therapy, surgical therapy, trachelectomy, expert ultrasonography.

Sources

1. Bartoš, P. Radikální trachelektomie v léčbě časného cervikálního karcinomu. Čes Gynek, 2000, 65, 437.

2. Benedet, JL., et al. FIGO staging classifications and clinical practise guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynecol Obstet, 2000, 70, 207.

3. Cibula, D., et al. Abdominální radikální trachelektomie - technika a zkušenosti. Čes Gynek, 2005, 70, 117.

4. Cibula, D. Chirurgická léčba v onkogynekologii. Mod Gynek Porod, 2007, 16, 533.

5. Dargent, D., et al. Laparoscopic assesment of the sentinel lymph node in early stage of cervical cancer. Gynec Oncol, 2000, 79, 411.

6. DelMachio, A. Estimating the depth of myometrial involvement by endometrial carcinoma: efficacy of transvaginal sonography vs. MRI. Amer J Roentgenol, 1993, 160, 533.

7. Fischerová, D. Využití ultrazvuku v onkogynekologii. Mod Gynek Porod, 2007, 16, 719.

8. Fischerová, D., et al. Transrectal ultrasound and magnetic resonanc imaging in staging of aerly cervical cancer. IJGC, 2007, 17.

9. Hudeček, R., Ventruba, P., Tsompsos, J., et al. Incidence of malignancy occurance in patients treated for infertility with assisted reproduction techniques. Helen J Obstet Gynecol, 2006, 5, 79.

10. Hudeček, R., Ventruba, P., Huser, M., et al. Zhoubné novotvary ovaria v populaci infertilních pacientek České republiky - I. část. Prakt Gyn, 2006, 3, 100.

11. Hudeček, R., Ventruba, P., Huser, M., et al. Zhoubné novotvary ovaria v populaci infertilních pacientek České republiky - II. část. Prakt Gyn, 2006, 4, 136.

12. Huser, M., Juránková, E., Crha, I., et al. Kryokonzervace ovariální tkáně - šance na záchranu fertility žen s rakovinou. Čes Gynek, 2007, 72, 68.

13. Huser, M., Crha, I., Ventruba, P., et al. Prevention of ovarian function damage by a GnRH analogus during chemotherapy in Hodgkin lymphoma patiens. Hum Rep, 2008, 23, 863.

14. Huser, I. Crha, R. Hudecek, R., et al. Ovarian tissue cryopreservation – new oportunity to preserve fertility in female cancer patients. Eur J Gynaec Oncol, 2007, 28, 249.

15. Holub, Z., Kužel, D., et al. Minimálně invazivní operace v gynekologii. Praha: Grada 2005, s. 231.

16. Holub, Z. Laparoskopické operace. Mod Gynek Porod, 2006, 15, 273.

17. Homesley, HD., Zaino, R. Endometrial cancer: prognostic factors. Seminars in Oncology. 21, 71, 1994. 18. Novotvary 2005 ČR, ÚZIS ČR, NOR ČR.

19. Petrenko, M. Adnexální laparoskopická chirurgie. In: Holub, Z., Kužel, D., et al. Minimálně invazivní operace v gynekologii. Praha: Grada 2005, s. 67.

20. Pluta, M. Patogeneze a management prekanceróz endometria. Prakt Gyn, 2004, 2, 6.

21. Querleu, D., et al. Laparoscopic pelvic lymphadenectomy in the staging of early cancer of the cervix. Amer J Obstet Gynec, 1991, 164, 579.

22. Rob, L., et al. Fertilitu zachovávající operace u časného stadia karcinomu děložního hrdla dnes a zítra. Čes Gynek, 2006, 71, 302.

23. Rob, L. Současné trendy v léčbě gynekologických nádorů. Gynek po promoci, 2006, 2, 47.

24. Rob, L. (komentář): Dargent, D. Radikální trachelektomie jako metoda zachovávající fertilitu u časných stadií zhoubných nádorů hrdla děložního hrdla. Gynek po promoci, 2001, 1, 28.

25. Rob, L., Svoboda, B., Robová, H., et al. Guideline gynekologických zhoubných nádorů - Komplexní léčba operabilních stadií zhoubných nádorů děložního hrdla. Mod Gynek Porod, 2007, 16, 226.

26. Robová, H., Rob, L., Svoboda, B., et al. Guideline gynekologických zhoubných nádorů. - Komplexní léčba ovariálních epiteliálních zhoubných nádorů. Čes Gynek, 2006, 71, 237.

27. Svoboda, B., Kubecová, M., Rob, L., et al. Guideline gynekologických zhoubných nádorů - Komplexní léčba zhoubných nádorů děložního těla. Mod Gynek Porod, 2007, 16, 237.

28. Timmermann, D., et al. Ultrasound et endoscopic surgery in obstetrics and gynaecology. London: Springer 2003.

29. Timmermann, D., et al. Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience. UOG, 1999, 13, 11.

30. Valentin, L., et al. Ultrasound characteristics of different types of adnexal malignancies. UOG, 2006, 41, 102.

31. Yang, W. Transrectal ultrasound in the evaluation of cervical carcinoma and comparison with spiral computed tomography and magnetic resonance imaging. Br J Radiol, 1996, 69, 610.

32. Yazbek, J., et al. A comparative study of the risk of malignancy index and ovarian crescent sign for the diagnosis of invasive ovarian cancer. UOG, 2006, 28, 320.