Cervical Cancer Treatment and Fertility: What We Know and What We Do

Area of Science:

• Gynecology
• Oncology
• Reproductive Medicine

Background:

• Cervical cancer significantly impacts women of reproductive age globally.
• Advances in screening and immunization lead to earlier diagnoses, making fertility preservation crucial.
• Treatment plans must balance oncologic safety with reproductive potential.

Purpose of the Study:

• To systematically review fertility preservation techniques for early-stage cervical cancer (IA1-IB1).
• To analyze surgical and medical treatment approaches for oncologic safety and reproductive outcomes.
• To evaluate strategies like ovarian transposition and cryopreservation.

Main Methods:

• Descriptive synthesis of surgical management (conization, radical trachelectomy) and adjuvant therapies (NACT, radiotherapy).
• Analysis of patient selection criteria, prognostic variables, and obstetric outcomes.
• Investigation of ovarian transposition and cryopreservation for gonadotoxic treatments.

Main Results:

• Conservative surgery for tumors ≤2cm is oncologically safe in selected patients, though evidence is limited.
• Pregnancy rates: 36-55% after conization, 10-38% after radical trachelectomy.
• Ovarian function preservation >60% with transposition, but natural conception <15%, often requiring assisted reproduction.

Conclusions:

• Fertility-preserving management of cervical cancer is feasible and safe in select patients.
• Oncologic outcomes are comparable to radical treatments.
• Further research and randomized trials are needed to optimize treatment and fertility outcomes.