Fertility Sparing Surgery in Ovarian Cancer: Preserving Hope for Future Families

Let’s face it: an ovarian cancer diagnosis is as welcome as a punch to the gut. But for young women dreaming of a future with children, the thought of losing their fertility can feel like a double whammy. That’s where fertility-sparing surgery in ovarian cancer comes in – it’s not just a treatment option; it can become a lifeline for your future family plans.

So let’s headfirst into the world of fertility-sparing surgery. No sugarcoating, no BS: just the facts you need to make informed decisions about your treatment.

What is Fertility Sparing Surgery? (And Why Should You Care?)

Fertility-sparing surgery is exactly what it sounds like: a way to surgically treat the cancerous tumors while sparing your chance to have children by saving any of your reproductive organs. Instead of the scorched earth approach of removing your ovaries, fallopian tubes, cervix, and uterus through a total ovarian cancer hysterectomy,  fertility-sparing treatment and techniques aim to preserve the uterus and at least part of one ovary.

Think of it as a surgical tightrope walk: removing enough to treat the cancer but sparing the uterus or an unaffected ovary. It’s not for everyone, but for the right patients, it can salvage their possibility of having biological children. 

Who’s Eligible for Fertility Sparing?

Let’s be real: fertility-sparing surgery isn’t a one-size-fits-all solution. Your ovarian cancer doctors will look at a few key factors to see if you’re a good fit:

• Age (generally under 40)
• Cancer stage and grade (earlier stages get more options)
• Tumor type (some play nicer than others)
• Overall health (because cancer treatment is no walk in the park)

It’s most often an option for women with early-stage disease and certain tumor types.

What to Expect When You’re Expecting… Surgery

If fertility-sparing surgery is on the table, here’s what’s coming down the pike:

• Tests, tests, and more tests: Imaging studies, blood work — your doctor will want to ensure that fertility-sparing surgery will still deliver the intended results through a more radical approach to surgery.
• Fertility heart-to-heart: Time to chat with a reproductive specialist about your options and the potential “what ifs.”
• Surgical game plan: Your doctor will walk you through what to expect during surgery and recovery.
• Emotional rollercoaster: Many cancer centers offer counseling because — let’s face it — this whole situation can be a mind-bender.

Remember, it’s okay to feel like you’re drowning in information. Take a deep breath, and if it ever gets to be too much, try to tackle one thing at a time.

Fertility-Sparing Surgery for Borderline Ovarian Tumors

Borderline ovarian cancer or borderline ovarian tumors (BOTs) are the rebels of the tumor world: not quite benign, not fully malignant. The upside? BOTs are prime candidates for fertility-sparing approaches.

For BOT patients looking to keep their fertility options open, doctors typically recommend:

• Unilateral salpingo-oophorectomy (that’s another way of saying “removal of one ovary and fallopian tube”)
• Cystectomy (tumor eviction while keeping the ovary)

Studies show fertility-sparing surgery for BOTs is safe and effective. One study found only 2.3% of BOTs evolved to invasive cancer. But (there’s always a but), keep these points in mind:

• Recurrence is a thing: Most comebacks are still borderline, but there’s a tiny chance (2-3%) of progression to a more invasive or malignant type of cancer.
• Not all BOTs are created equal: Mucinous types are slightly more likely to turn invasive than serous types.
• Follow-up is your new BFF: Regular check-ups are crucial to catch any sneaky recurrences.

Bottom line? For young BOT patients, fertility-sparing surgery is a viable and successful option and a solid chance to preserve fertility without compromising your cancer-fighting abilities.

Fertility Sparing Treatment for Epithelial Ovarian Cancer

Epithelial ovarian cancer (EOC) represents the majority of ovarian malignancies, accounting for about 90% of cases. Historically, doctors were not likely to offer fertility preservation for EOC. But times are changing!

Recent research shows that carefully selected women with early-stage EOC can safely undergo fertility-sparing surgery. Current guidelines give the thumbs up for:

• Stage IA, grade 1 tumors 
• Stage IA, grade 2 serous, mucinous, or endometrioid tumors
• Stage IC, grade 1 tumors 

Now, you might be wondering about Stage IB. The research on this one is still unclear. While we have clear guidelines for some Stage IA and IC cases, Stage IB hasn’t been featured as much in fertility-sparing studies. 

The typical fertility-sparing treatment approach for EOC goes something like this:

• Unilateral salpingo-oophorectomy 
• Thorough staging, including peritoneal biopsies and lymph node checks
• Keeping the uterus and other ovary

Now, let’s be real: fertility-sparing surgery for EOC is still a bit controversial, especially for higher-grade tumors or more advanced stages. Your gynecologic oncologist will work with you and your medical team to carefully weigh the risks and benefits for your unique case.

While recurrence risk is generally low for early-stage disease, researchers are still piecing together the long-term puzzle. 

At Not These Ovaries, we’re laser-focused on funding research to fill these knowledge gaps and improve treatment options for all ovarian cancer patients, including those seeking fertility-sparing approaches. 

Despite these challenges, fertility-sparing treatment has helped many EOC patients successfully get pregnant in the future. One study found that 67% of women who tried for pregnancy after fertility-sparing surgery succeeded. 

Fertility-Sparing Surgery for Non-Epithelial Ovarian Cancer

Non-epithelial ovarian cancers, including germ cell tumors and sex cord-stromal tumors, often affect younger women and tend to have a better prognosis than their epithelial cousins. As a result, fertility-sparing approaches are more commonly implemented among the non-epithelial crowd.

Germ Cell Tumors

For most women with germ cell tumors, fertility-sparing surgery isn’t just an option. It’s the gold standard. Why? 

• These tumors are super sensitive to chemotherapy (meaning: it works)
• They usually stick to one ovary 
• Survival rates are typically higher, even with conservative surgery

The game plan typically involves evicting the affected ovary and tube while keeping the uterus and the other ovary intact. Studies show over 80% of women keep their periods after treatment, and pregnancy rates can be as high as 75% to 100% for those who try.

Sex Cord-Stromal Tumors

When it comes to sex cord-stromal tumors (like granulosa cell tumors), things get a bit trickier:

• Stage IA tumors: Fertility preservation gets the green light
• Higher stages: It’s a case-by-case situation

Research shows that for stage I sex cord-stromal tumors, survival rates are similar whether you choose fertility-sparing surgery or more extensive treatment. Keep in mind, though, that these tumors can be sneaky and come back years after treatment, so staying vigilant is key.

Life After Fertility-Sparing Surgery

Choosing fertility-sparing treatment is just the opening act of your cancer journey. Here’s what to keep in mind: 

• Follow-up care: Stick to your check-ups.
• Family planning: Talk to your oncologist about when to start trying for a baby. Some doctors suggest waiting 6 to 12 months after treatment.
• Fertility assistance: If you encounter challenges trying to get pregnant, many women successfully use assisted reproductive technologies after ovarian cancer treatment.
• Mental health check: Cancer can mess with your head. Consider joining a support group or chatting with a therapist. 
• Long-term health: Keep an eye on the big picture: bone density, heart health, and any other consequences that come from losing levels of the important estrogen hormone that’s produced by your ovaries and uterus.

Remember, every woman’s cancer story is unique. The key is to talk honestly with your medical team and make choices that align with your motherhood goals. 

Fertility-sparing surgery in ovarian cancer isn’t just a medical breakthrough. It’s a middle finger to the idea that cancer has to derail your entire life plan. For many young women, it’s a beacon of hope in the storm: hope for kicking cancer, hope for future baby snuggles, and hope for a life that’s even more incredible than before.

If you’re facing an ovarian cancer diagnosis and are concerned about your fertility, don’t stay silent. Ask about fertility-sparing options, seek second opinions if needed, and remember that you’re not alone in this fight. With a dedicated medical team and your inner strength, you can navigate this challenge and emerge resilient. 

At Not These Ovaries, we’re committed to funding our ovarian cancer research fund that will give you more options and better outcomes. Your future family dreams are worth fighting for, and we’re here to help you do just that.