To date, cervical carcinoma is the second most common cancer in women worldwide, and one in two women is diagnosed under the age of 35. Due to good cancer screening programs, one third of all cervical cancers in Europe are now diagnosed in early tumour stages. Depending on the type (squamous or adenocarcinoma), stage and lymph node involvement the prognosis is assessed individually.
Surgical treatment of a precancerous stage does not significantly limit fertility and newer surgical techniques also reduce the negative impact on the function of cervical closure in subsequent pregnancies.
Nevertheless, the treatment of a cervical carcinoma can have a quite significant impact on fertility in many ways. In early stages and low tumour extension surgery is primarily a curative therapy with preservation of the ovaries (whenever possible). In higher stages, the uterus has to be removed and a pregnancy would thus no longer be possible.
In the case of a combined radiochemotherapy of the small pelvis, the ovaries can be moved out of the radiation field (translocation) and at the same time ovarian tissue could be removed for freezing (cryopreservation). The damaging effect of radiotherapy depends on the overall dose at the ovaries, and the age of the woman. Very high doses can also cause massive uterine tissue damage preventing a subsequent pregnancy. Potential risks of the translocation of the ovaries, such as metastasis to the ovaries and a possible restricted blood supply must be discussed in advance with all related disciplines.
One way to facilitate the patient’s decision after the consultation regarding fertility-preserving measures is the “Decision Aid” linked here.
This digital decision aid has been developed by psychologists, psychotherapists and reproductive physicians and might help in an individual situation.