Ovarian tumours can be quite diverse in nature and have varying prognosis; in the reproductive age the so-called borderline tumours account for a proportion of 31%, epithelial tumours for 50%, and malignant germ cell tumours for of 19%.
In case of a benign ovarian tumour the removal should be performed tissue sparing. In case of a malignant tumour, especially in young women with a current or future desire to have children, it is difficult to decide how aggressive the treatment should be to achieve the best outcome. However, in general all malignant ovarian tumours require the removal of at least the affected ovary. This of course reduces the amount of oocytes available to achieve a pregnancy later. In addition, tissue samples are taken from different parts of the abdomen during surgery in order to detect a possible spread of the disease.
Depending on the type of ovarian tumour, its aggressiveness and possible spread to other organs it might be recommended to additionally remove the second ovary, possibly also the uterus, fallopian tubes and other organs such as the appendix. Depending on the extent of the surgery a subsequent pregnancy may not be possible anymore. In certain situations, chemotherapy is also recommended for treatment.
Fertility preservation is safe but only useful in younger women (<40 years of age) with a unilateral ovarian involvement (FIGO IA G1) showing ovarian cancer or a borderline ovarian tumour.
The cryopreservation of ovarian tissue is currently not recommended due to the concern of a recolonization of tumour cells in case of tissue transplantation later on. To perform a hormonal stimulation for retrieving oocytes seems to be possible in certain cases; however, several treatment cycles may be required to freeze a reasonable number of oocytes. Moreover, whether this procedure leads to an increased risk of recurrence is unknown. If the treatment includes a chemotherapy GnRH agonist administration may be considered.
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.
