Abstract
Purpose
It is estimated that the incidence of cancer in women aged 40 years or less is 8%. Females under the age of 40 are in their childbearing years. In the Western world, colorectal cancer (CRC) is the most common malignancy of the gastrointestinal tract. It is the third most commonly diagnosed cancer and the second leading cause of cancer-related death in the USA. The incidence of CRC in patients under 40 is 3–6%. Over the past decades, there has been a significant improvement in survival rates due to progress in cancer treatment, including CRC. This has been achieved with advances in adjuvant chemotherapeutic regimens. In the case of locally advanced rectal cancer, radiation therapy is also used. Treatment for CRC may have adverse effects on female fertility. The purpose of this paper is to discuss the effects of treatment of CRC on female fertility as well as the options for fertility preservation.
Materials and methods
A review of relevant English language articles was performed on the basis of a MEDLINE search of the keywords: female, fertility, fecundity, colon, rectal cancer, fertility preservation, chemotherapy, and radiation.
Results
Surgical resection for colon cancer possibly has no effect on female fertility. Resection below the peritoneal reflection may adversely affect fertility, based on lower fertility and fecundity rates associated with pelvic surgery for ulcerative colitis and familial adenomatous polyposis. Standard 5-FU-based chemotherapy may not have significant effects. The advent of oxaliplatin in adjuvant chemotherapy may be more harmful. Adjuvant and neoadjuvant radiation therapy may cause premature ovarian failure using current dosing schedules. The effect of pregnancy and female hormones on the incidence, progression, and recurrence of CRC remains unclear. Established methods for fertility preservation include ovarian transposition and embryo cryopreservation. Oocyte cryopreservation has yielded inferior results. An investigational fertility preservation method is ovarian tissue cryopreservation, with promising results. Ovarian suppression and the use of apoptotic inhibitors are also investigational at present.
Conclusion
Young female patients need to be informed about the effects of treatment on fertility and options for fertility preservation. A multidisciplinary approach for appropriate consultation of these patients is mandatory.
Similar content being viewed by others
References
O’Connell JB, Maggard MA, Liu JH et al (2004) Do young colon cancer patients have worse outcomes? World J Surg 28:558–562
Marhhom E, Cohen I (2007) Fertility preservation options for women with malignancies. Obstet Gynecol Surv 62(1):58–72
Meyerhardt JA, Mayer RJ (2005) Systemic therapy for colorectal cancer. N Engl J Med 325(5):476–487
Gill S, Blackstock W, Goldberg RM (2007) Colorectal cancer. Mayo Clin Proc 82(1):114–129
Strong M, Peche W, Scaife C (2007) Incidence of fertility counselling of women of child-bearing age before treatment of colorectal cancer. Am J Surg 194:765–768
Davis VJ (2006) Female gamete preservation. Cancer 107(suppl 7):1690–1694
Maltaris T, Boehm D, Dittrich R et al (2006) Reproduction beyond cancer: a message of hope for young women. Gynecol Oncol 103:1109–1121
Bleyer A, O’Leary M, Barr R, Ries LAG (eds): Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975–2000. National Cancer Institute, NIH Pub. No. 06-5767. Bethesda, MD 2006
Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, Horner MJ, Howlader N, Eisner MP, Reichman M, Edwards BK (eds). SEER Cancer Statistics Review, 1975–2004, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2004/, based on November 2006 SEER data submission, posted to the SEER web site, 2007
O’Connell JB, Maggard MA, Liu JH, Etzioni DA, Ko CY (2004) Are survival rates different for young and old patients with rectal cancer? Dis Colon Rectum 47(12):2064–2069
Endreseth BH, Romunstad P, Myrvold HE, Hestrik UE, Bjerkeset T, Wibe A (2006) Rectal cancer in the young patient. Dis Colon Rectum 49(7):993–1001
Saif MW (2005) Management of colorectal cancer in pregnancy: a multimodality approach. Clin Colorectal Cancer 5:247–256
Bernstein MA, Madoff RD, Caushaj PF (1993) Colon and rectal cancer in pregnancy. Dis Colon Rectum 36:172–178
Ochshorn Y, Kupfermine MJ, Lessing JB, Pausner D, Gera E, Daniel Y (2000) Rectal carcinoma during pregnancy: a reminder and updated treatment. Eur J Obstet Gynecol Reprod Biol 91:201–202
Puig-La Calle JP, Ng J, Syn GL, Vuolo MA, Guillem JG (1999) Colorectal cancer recurrence during pregnancy—unique and poorly understood clinical entity. Dis Colon Rectum 42:673–675
Minter A, Malik R, Ledbetter L et al (2005) Colon cancer in pregnancy. Cancer Control 12(3):196–202
Campbell-Thompson M, Lynch IJ, Bhardwaj B (2001) Expression of estrogen receptor (ER) subtypes and ERb isoforms in colon cancer. Cancer Res 61:632–640
Wong NACS, Malcomson RDG, Jodrell DI, Groome NP, Harrison DJ, Saunders PTK (2005) ERb isoform expression in colorectal carcinoma: an in vivo and in vitro study of clinicopathological and molecular correlates. J Pathol 207:53–60
Eberhart CE, Coffey RJ, Radhika A et al (1994) Up-regulation of cyclooxygenase-2 gene expression in human colorectal adenomas and adenocarcinomas. Gastroenterology 107:1183–1188
Lim H, Paria BX, Das SK et al (1997) Multiple female reproductive failures in COX-2 deficient mice. Cell 91:197–208
Gorgun E, Remzi FH, Goldberg JM, Thornton J, Bast J, Hull TL, Loparo B, Fazio VW (2004) Fertility is reduced after ileal pouch–anal anastomosis: a study of 300 patients. Surgery 136:795–803
Olsen KO, Joelsson M, Laurberg S, Oresland T (1999) Fertility after ileal pouch–anal anastomosis in women with ulcerative colitis. Br J Surg 86:493–495
Olsen KO, Svend J, Berndtsson I, Oresland T, Laurberg S (2002) Ulcerative colitis: female fecundity before diagnosis, during disease, after surgery compared with a population sample. Gastroenterology 122:15–19
Olsen KO, Juul S, Buelow S, Järrinen HJ, Bakka A, Björk J, Oresland T, Laurberg S (2003) Female fecundity before and after operation for familial adenomatous polyposis. Br J Surg 90:227–231
Oresland T, Palmblad S, Ellstrom M et al (1994) Gynecological and sexual function related to anatomical changes in the female pelvis after restorative proctocolectomy. Int J Colorectal Dis 9:77–81
Bhardwaj R, Parker MC (2007) Impact of adhesions in colorectal surgery. Colorectal Dis 9(suppl II):45–53
Twelves C, Wong A, Nowacki MP et al (2005) Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 352:2696–704
Azem F, Amit A, Merimsky O, Lessing J (2004) Successful transfer of frozen–thawed embryos obtained after subtotal colectomy for colorectal cancer and before fluorouracil-based chemotherapy. Gynecol Oncol 93:263–265
Andre T, Boni C, Mounedji-Boudiaf L et al (2004) Oxaliplatin, fluorouracil and leucovorin as adjuvant therapy for colon cancer. N Engl J Med 350:2343–2351
Wallace WHB, Thomson AB, Kelsey TW (2003) The radiosensitivity of the human oocyte. Hum Reprod 18(1):117–121
Maltaris T, Senfert R, Fischl F et al (2007) The effect of cancer treatment on female fertility and strategies for preserving fertility. Eur J Obstet Gynecol Reprod Biol 130(2):148–155
Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1:1479–1482
Swedish Rectal Cancer Trial (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer [published correction appears in N Engl J Med 1997;336:1539]. N Engl J Med 336:980–987
Kapiteijn E, Marijnen CA, Nagtegaal ID, Dutch Colorectal Cancer Group et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646
Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123
Sauer R, Becker H, Hohenberger W, German Rectal Cancer Study Group et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740
Tepper JE, O’Connell M, Niedzwiecki D et al (2002) Adjuvant therapy in rectal cancer: analysis of stage, sex, and local control: final report of intergroup 0114. J Clin Oncol 20:1744–1750
Morice P, Juncker L, Rey A et al (2000) Ovarian transposition for patients with cervical carcinoma treated by radiosurgical combination. Fertil Steril 74:743–748
Bisharak M, Tulandi T (2003) Laparoscopic preservation of ovarian function: an underused procedure. Am J Obstet Gynecol 188:367–370
Morice P, Haie-Meder C, Pautier P et al (2001) Ovarian metastasis on transposed ovary in patients treated for squamous cell carcinoma of the uterine cervix: report of two cases and surgical implications. Gynecol Oncol 83:605–607
Oktay K, Cil AR et al (2006) Efficiency of oocyte cryopreservation: a meta-analysis. Fertil Steril 86:70–80
American Society of Reproductive Medicine (ASRM) and Society for Assisted Reproductive Technology Practice Committee (2006) Ovarian tissue and oocyte cryopreservation. Fertil Steril 86(suppl 4):S142–S147
Oktay K, Buyuk E, Veek L et al (2004) Embryo development after heterotopic transplantation of cryopreserved ovarian tissue. Lancet 363:837–840
Oktay K, Sonmezer M (2004) Ovarian tissue banking for cancer patients. Fertility preservation, not just ovarian cryopreservation. Hum Reprod 19(3):477–480
Meirow D, Levron J, Eldar-Geva T (2005) Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy. N Engl J Med 353(3):318–320
Blumenfeld Z (2003) Gynaecologic concerns for young women exposed to gonadotoxic chemotherapy. Curr Opin Obstet Gynecol 15(5):359–370 Review
Meirow D (2000) Reproduction post-chemotherapy in young cancer patients. Mol Cell Endocrinol 169(1–2):123–131 Nov 27
Pal L, Leykin L, Schifren JL et al (1998) Malignancy may adversely influence the quality and behaviour of oocytes. Hum Reprod 13(7):1837–1840
Morice P, Pautier P, Fanchin R et al (2007) Therapy insight: fertility in women after cancer treatment. Nat Clin Pract Endocrinol Metab 3:819–826
Acknowledgment
We would like to thank Ms. I. Ciammili for her assistance in the preparation of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Spanos, C.P., Mamopoulos, A., Tsapas, A. et al. Female fertility and colorectal cancer. Int J Colorectal Dis 23, 735–743 (2008). https://doi.org/10.1007/s00384-008-0483-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-008-0483-3