New Hope for Ovarian Cancer Patients Seeking Motherhood After Treatment: NY Methodist Experts Discuss Recent Research and Novel Techniques to Help Preserve Fertility
According to Dr. Katherine Economos, Clinical Associate Professor of Obstetrics & Gynecology at Weill Medical College of Cornell University and Director of the Division of Gynecologic Oncology at New York Methodist Hospital, "With the diagnosis of ovarian cancer in a patient of childbearing age, the most important first-step is to consult with both a gynecologic oncologist and a fertility specialist. It is crucial that these two areas of practice and expertise merge to determine the best course of treatment, each step of the way, that will result in a cancer-free diagnosis and the potential for future fertility and motherhood.
Brooklyn, NY (PRWEB) September 5, 2007
Ovarian cancer has a well-deserved reputation as one of oncology's most devastating diagnoses on several fronts; the disease is challenging to diagnose, difficult to treat, and - until recently - eradicating the cancer also severely limited the patient's chances of becoming pregnant after treatment. However, recent research has uncovered a number of novel techniques that can be used to spare fertility options for younger women with ovarian cancer.
"While the majority of ovarian cancer cases occur in patients over the age of 50, we are seeing more and more women in their 30s and 40s being diagnosed with the disease," explains Dr. Katherine Economos, Clinical Associate Professor of Obstetrics & Gynecology at Weill Medical College of Cornell University and Director of the Division of Gynecologic Oncology at New York Methodist Hospital. "Of course, their first concern is for successful treatment of their cancer," she adds, "But these patients also want viable options for resuming their lives after treatment, and for many this means the chance to have a baby."
Dr. Economos notes that, although ovarian cancer is often caught in its later stages in general, nearly half of all younger women with ovarian cancer are diagnosed with Stage I disease that hasn't yet spread to other tissues. Fortunately, the pace of fertility-sparing research for this group has been brisk. Several studies show that, for some patients, it can be a safe and effective alternative to the full hysterectomy (removal of the uterus, ovaries and fallopian tubes) that is standard protocol in the majority of ovarian cancer cases.
Surgeries and techniques that save patients' options
For example, doctors at Memorial Sloan Kettering Cancer Center showed that, for women diagnosed with early-stage epithelial ovarian cancer (the most common type) confined to just one ovary, retaining both the uterus and the unaffected ovary can preserve normal menstruation and result in subsequent healthy pregnancies. More recently, Texas A&M researchers conducted a retrospective of 71 women diagnosed with ovarian germ cell tumors - a rare cancer of the eggs themselves that is almost exclusively found in teenage girls and young women - and treated with fertility-sparing surgery and a special chemotherapy agent. They found that 62 of the patients were still having menstrual periods, and 24 survivors had given birth to 37 babies.
"Fertility sparing surgery is a tremendous asset for a select group of patients, to help them overcome their cancer and go on to achieve healthy pregnancies," notes Dr. George Kofinas, founder and medical director of the Fertility Institute and chief of the section of Reproductive Endocrinology and Infertility at New York Methodist Hospital. "Yet, there are also women diagnosed in the early stages of ovarian cancer for whom this surgery is not feasible because both ovaries and/or the fallopian tubes must be removed," Dr. Kofinas continues. "Other options may be available, however, that can accomplish the same goal of post-treatment fertility." They include:
Embryo Freezing: In-Vitro Fertilization has been used for nearly 25 years to assist infertile couples in having a baby. The process involves harvesting eggs from the ovaries, fertilizing them with the partner's (or a donor's) sperm, and cryopreserving the embryo. This procedure can take up to six weeks to complete, and can only be done if treatment can be delayed for that amount of time.
Cryopreservation of Unfertilized Eggs: Patients without partners who do not wish to use sperm donors can still go through an IVF cycle and freeze unfertilized eggs. Unfortunately, freezing unfertilized eggs is still relatively new and has much lower success rate than IVF, with about 100 babies born worldwide as a result of egg freezing. This process also takes up to six weeks, delaying cancer treatment.
Cryopreservation of Ovaries: Another promising option which is also an area of active research is cryopreservation of ovarian tissue. Theoretically, it's the ideal solution, as it can be done immediately without delaying treatment. A piece of ovary in a young woman contains hundreds if not thousands of eggs, and although only one successful pregnancy has ever been reported as a result of ovarian tissue freezing, it may become more successful in the future. In addition, reintroduction of the ovarian tissue may also restore normal hormone function in younger women. The concern, of course, is that this may also reintroduce some rogue cancer cells that could cause disease recurrence.
With the diagnosis of ovarian cancer in a patient of childbearing age, Drs. Economos and Kofinas agree that the most important first-step is to consult with both a gynecologic oncologist and a fertility specialist. "It is crucial that these two areas of practice and expertise merge to determine the best course of treatment, each step of the way, that will result in a cancer-free diagnosis and the potential for future fertility and motherhood," Dr. Economos concludes.
Ovarian Cancer Facts:
An estimated 20,000 American women will be diagnosed with ovarian cancer in the U. S. this year; more than 15,000 will die of the disease.
Ovarian cancer is the fifth leading cause of cancer death among American women
90% of women diagnosed with Stage I ovarian carcinoma reach 5-year survival, compared with only 20% of those diagnosed when the disease is in stage 3 or 4.
Risk factors include having a family history of the disease, never having taken the birth control pill, never having had children, infertility, early menstruation and late menopause
Symptoms of ovarian cancer are generic and mild, and often mimic symptoms of dozens of other maladies; they include bloating, abdominal discomfort, constipation, nausea, fever, fatigue and/or frequent urination
Dr. Katherine Economos practices Gynecological Oncology and Obstetrics & Gynecology in Brooklyn, New York at New York Methodist Hospital. Dr. Economos is a Clinical Associate Professor of Obstetrics & Gynecology at Weill Medical College of Cornell University and Director, Division of Gynecologic Oncology at New York Methodist Hospital.
Dr. George D. Kofinas, MD is the founder and medical director of the Fertility Institute and chief of the section of Reproductive Endocrinology and Infertility at New York Methodist Hospital. A diplomat of the American Board of Obstetrics and Gynecology, he is board certified in Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility. Dr. Kofinas is a fellow of the American College of Obstetrics and Gynecology, and an active member of the American Society of Reproductive Medicine, the Society of Assisted Reproductive Technology (SART), the Society of Reproductive Endocrinology and Infertility, the Society of Laparoendoscopic surgeons, the Association of Professors in Gynecology and Obstetrics (APGO) and the American Medical Association.
More information about Dr. Economos, Dr. Kofinas, and the reproductive endocrinology/infertility and gynecologic oncology programs at NYM can be found at www. nym. org.
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