I found a recent article about fertility preservation fascinating (see: Fertility Preservation With Cryopreservation of Ovarian Tissue: From Experimental to Mainstream). Physicians removed part of a woman's ovary prior to initiating "gonadotoxic" high dose chemotherapy for a neoplasm and cryopreserved it. Then, post-treatment, they sutured the preserved ovarian tissue back to her ovary. She subsequently began having normal cycles with the release of normal ova. Below is an excerpt from it:
"Fertility preservation is now a key component of the management of young cancer patients," said Dr Gianluca Gennarelli from Clinica Universitaria Sant'Anna in Turin...."Though still a challenging procedure, the cryopreservation of ovarian cortex should still be offered to young women and girls ahead of potentially gonadotoxic cancer treatments with a high risk of ovarian failure," he said....The [reported] case involved a 21-year-old patient scheduled for high dose chemotherapy and bone marrow transplantation. Just before treatment, in July 2003, she was referred for fertility preservation, with ovarian cortical tissue collected by laparoscopy. Bilateral biopsies of ovarian cortex were sampled..., frozen by slow freezing and stored in liquid nitrogen. As feared, chemotherapy was followed by ovarian failure. In March 2010, following the patient's request and investigation for fertility restoration, 32 cortical tissue fragments were thawed and sutured to prepared sites. Two months after the tissue grafting, some ovarian function returned and spontaneous follicular development was observed. Over the following months spontaneous menstrual cycles were repeatedly evident and ovulation was confirmed in at least six cycles. In July 2011, 15 months after the ovarian tissue transplantation, the patient became spontaneously pregnant, and a healthy baby was delivered in March 2012. The birth is believed to be the 22nd in the world from this technique, and a new indication that the restoration of fertility by this technique is feasible, rapidly evolving and worthwhile for a growing number of patients. Given the increase in cancer survival, and the likelihood that many successfully treated young women and girls will live to enjoy their "reproductive" years, interest in the technique -- from both patients and doctors -- is sure to grow....
There is no question but that cancer therapy will continue to be pursued in an aggressive manner with attention on cures rather than mere containment of the malignant malignant neoplasm. Fertility preservation is only one facet of the new field of cancer survivorship (see: Cancer Survivorship and the Role of PCPs in Continuing Care of Cancer Patients; Cancer Survivorship, an Emerging Subdiscipline in Oncology; Revlimid Raises Secondary Cancer Risk for Second Primary Malignancies). Of greater importance for most patients are the so-called late effects of treatment that can also include the development of new neoplasms as a complication of the initial treatment. Here, for example, are paragraphs relating to non-neoplastic late effects in heart and lung (see: Late Effects):
Heart: Heart problems in cancer survivors are most often caused by radiation therapy to the chest and/or chemotherapy (especially doxorubicin [Adriamycin] and cyclophosphamide [Cytoxan, Clafen, Neosar]). People age 65 or older and those who received higher doses of chemotherapy have a higher risk of heart problems. Some survivors may experience the following heart problems:
- Inflammation of the heart muscle
- Congestive heart failure...
- Heart disease
Lung: Chemotherapy and radiation therapy to the chest may cause injury to the lungs. Cancer survivors who received combination treatment of chemotherapy and radiation therapy...may have a higher risk of lung damage. Some of the drugs that may cause lung damage include bleomycin (Blenoxane), carmustine (Becenum, BiCNU, Carmubris), prednisone (multiple brand names), dexamethasone (multiple brand names), and methotrexate (multiple brand names). The late effects may include the following:
- A change in how the lung functions
- Thickening of the lining of the lungs
- Inflammation of the lungs
- Difficulty breathing.
I am sure that most cancer survivors are made well aware of these late effects of therapy but I am less sure that the general public knows much about this topic, focusing frequently on the life-saving aspects of treatment. Nevertheless, most cancer survivors come to accept such late effects as part of the bargain that is being struck. Hopefully and as cancer treatments become more focused as a result of new drugs and so-called personalized medicine, these late effect will become less common and onerous.