FERTILITY PRESERVATION MANAGEMENT FOR CERVICAL CANCER

Cervical cancer is the fourth most common cancer worldwide and nearly a half of the cases are diagnosed in women in their fertile years. The standard surgical treatment is radical hysterectomy, a treatment that impairs future fertility. Especially in a time when many women are delaying their first pregnancy, it is compelling to consider surgical strategies to preserve their possibility of future fertility. Up to five surgical procedures have been validated in the treatment of cervical cancer, all presenting different radicality and different implications. When counselling a patient both the oncological outcomes and obstetrical outcomes are to be taken into account. Radical trachelectomy was firstly introduced in 1994 and it has since been performed with different approaches: vaginal, laparotomic and minimally invasive, laparoscopic or robotic. This procedure allows to treat lesions up to 4 cm offering oncological outcomes similar to those of hysterectomy, while maintaining fertility. Other less invasive procedures as simple trachelectomy or conization can be offered in cases of smaller tumors and are linked to better obstetrical outcomes. The shortened cervical length after fertility sparing surgery obviously represent a challenge in searching for and achieving a pregnancy: many women struggle with infertility after a conservative treatment and it needs to be kept in mind that, even after a pregnancy is obtained, the patient needs to be referred to a specialized center, as those pregnancies carry a higher risk of miscarriages, preterm labor and severe prematurity.