Can cervical cancer cause infertility?
Cervical cancer treatment can cause issues with fertility, leaving women unable to become pregnant or carry a child through pregnancy. When cervical cancer is diagnosed early and treatment is provided successfully, infertility issues can usually be avoided. If cervical cancer is diagnosed at advanced stages, more extensive treatment is required, which will likely result in infertility.
Surgery for cervical cancer
If a patient has early-stage cervical cancer, it may be possible to have surgery to remove the cancer but leave all other reproductive organs in place so that she might be able to still become pregnant. Cone biopsy and radical trachelectomy are surgical options for early-stage cervical cancer that preserve fertility.
A cone biopsy may be recommended for early-stage cervical cancer (stage 1a) which removes a cone-shaped piece of cervical tissue. It may be performed with or without surgical exploration of the pelvic lymph nodes. The scientific literature suggests that patients who had a cone biopsy tend to have shorter pregnancies (shorter by 3 weeks) but very rarely the earlier delivery is harmful to the newborn baby.
A radical trachelectomy may be recommended for cervical cancer stages 1a or 1b and involves removal of the entire cervix and the tissue next to the cervix (parametria). Sometimes, a permanent stitch (cerclage bandage) can be placed around the internal opening of the cervix to hold it closed. This procedure is mostly done in combination with a removal of pelvic lymph nodes. This procedure preserves the uterus for fertility reasons.
Cancer Research UK reports babies have been born safely to women who have had this type of operation. However, there is a higher risk of miscarriage or having the baby born prematurely. In pregnant women who have had a radical trachelectomy, the baby must be born by caesarean section due to the permanent stitch.
A radical hysterectomy with or without removing a safety margin around the cervix is an option if fertility is not desired. Radical hysterectomy removes the uterus, cervix, and soft tissue around the cervix and the top of the vagina. The ovaries can be removed or preserved, depending on some factors, including the patient's age. The procedure is often offered along with a removal of pelvic lymph nodes.
Radiation or chemotherapy
Treatment of cervical cancer stages 2 to 4 cannot rely on surgery alone because the tumour is too advanced and cannot be removed completely with a safety margin.
In these patients, radiation treatment, chemotherapy or a combination of both play important roles to achieve good patient outcomes. Radiotherapy treatment for cervical cancer may stop the ovaries from producing female hormones and cause menopause. If radiotherapy is required, but the ovaries do not need to be treated, it is possible for one or both of the ovaries to be temporarily moved higher into the abdomen, so they are not exposed to the radiation treatment. This is a surgical procedure called ovarian transposition, and it may help to keep the ovaries functioning.
Depending on a women’s age and individual circumstances, losing fertility can be distressing, while for others it may not be as concerning. Even if the patient was not planning to have children, the loss of your fertility can be emotional. Surgery that includes removal of the ovaries will induce surgical menopause, and all the symptoms that may come along with menopause.
Your doctor will take into account your wishes to become pregnant when deciding on treatment. If you have been diagnosed with cervical cancer and are concerned about your fertility, ask your doctor to refer you to a fertility specialist. They can talk about what options might be available, such as egg freezing.
If you wish to discuss treatment options for cervical cancer please contact Dr Obermair for an appointment. Prof Obermair can also refer patients to fertility specialists who he works closely with, as part of the treatment process.