Case-based learning
Late reproductive effects of cancer treatment

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Abstract

Gynaecologists are seeing an ever-growing population of cancer survivors who are at risk from developing a broad range of adverse outcomes relating to cancer treatment. This review discusses the most commonly observed reproductive concerns in young people who are awaiting, or have undergone treatment for cancer. We also discuss the options for maintaining fertility in both men and women, and possible subsequent pregnancy outcomes. The fertility preservation options available to any particular cancer survivor will depend on age at the time of diagnosis and treatment, the cancer type and primary site, the stage and the type of treatment.

Section snippets

Case 1: premature menopause

A 21-year-old woman presents to her GP with amenorrhea, hot flushes and night sweats. She has been in remission for 5 years, but in the past has undergone radiotherapy and chemotherapy for Hodgkin’s lymphoma. She has seen the gynaecology team who have explained that she is experiencing symptoms of premature menopause, and they recommended cyclical hormone replacement therapy (HRT). On further questioning the woman admits that she has not been using the HRT prescribed as it makes her feel like,

Case 2: preservation of male fertility

A 25-year-old man has recently been diagnosed with testicular cancer and is to have a left orchidectomy and chemoradiotherapy after his surgery. He has been referred from his oncologist to the fertility clinic to discuss the fertility issues surrounding his treatment. He is not currently in a relationship, but thinks that he may like to have children in the future.

Testicular tumours are amongst the most common tumours that affect young men. Patients with testicular cancer have an excellent

Case 3: primary subfertility

A 26-year-old woman is seen in fertility clinic with an 18-month-history of primary subfertility. Her partner has a child from a previous relationship. She is menstruating regularly and is in good health. As a 5-year-old child she had pelvic irradiation as part of her treatment for Wilms’ tumour. Her GP has measured her early follicular phase (day 2 of menses) follicle stimulating hormone (11 IU/l) and luteinising hormone (7 IU/l) levels.

The human oocyte is very susceptible to damage by

Case 4: pregnancy outcome

A 28-year-old woman presents to the Early Pregnancy Assessment clinic with a silent miscarriage, diagnosed by her dating ultrasound. This is her second pregnancy with the same partner; her first pregnancy ended in spontaneous abortion at 6 weeks gestation. The patient tells you that she had acute lymphoblastic leukaemia in her early teens and had a bone marrow transplant with fractionated radiotherapy. She wishes to discuss with you the implications of this for future pregnancies.

One of the

Conclusion

Advances in the management of childhood malignancies mean that the majority of young people can expect to survive cancer. However, this treatment may have an impact on the reproductive potential of male and female patients. It is therefore important to counsel these young people ideally before undergoing treatment. This will enable them to understand the possible implication on their ability to child-bear. If patient choice dictates, the clinicians may facilitate preservation of fertility and

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