Ovarian and Uterine Functions in Female Survivors of Childhood Cancers

Abstract

Adult survivors of childhood cancers are more prone to developing a number of poor reproductive and obstetrical outcomes than their siblings and the general population as a result of previous exposure to chemotherapy and radiation during childhood. The impact of radiation therapy on the female genital system is greater than chemotherapy regimens because radiation is detrimental to both the uterus and the ovaries, whereas toxic effects of chemotherapy drugs are confined to the ovaries. Therefore, radiation-induced uterine damage accounts for most poor obstetrical outcomes in the survivors. These include infertility, miscarriages, stillbirths, fetal growth restrictions, preeclampsia, and preterm deliveries.

Adverse obstetric outcomes among female childhood and adolescent cancer survivors in Sweden: A population‐based matched cohort study

“…The pediatric cancer survivors in our study had higher risk of IOL, primary and secondary labor dystocia, fetal asphyxia, instrumental delivery and emergency CS, and that the offspring would be small‐for‐gestational‐age compared with the age‐matched comparison group. These adverse outcomes could be dependent on receiving cancer treatment when still quite young, where toxic effects from chemotherapy and radiation therapy may lead to development of late adverse effects on the undeveloped body, such as uterine vascular insufficiency, reduced and/or uneven growth, or vascular and pulmonary dysfunction . The higher risk of adverse obstetric outcomes among pediatric cancer survivors calls for strict monitoring during pregnancy and childbirth.…”

“…These adverse outcomes could be dependent on receiving cancer treatment when still quite young, where toxic effects from chemotherapy and radiation therapy may lead to development of late adverse effects on the undeveloped body, such as uterine vascular insufficiency, reduced and/or uneven growth, or vascular and pulmonary dysfunction. 31,32 The higher risk of adverse obstetric outcomes among pediatric cancer survivors calls for strict monitoring during pregnancy and childbirth.…”

Effects of oncological therapy on bone disorders

“…Najczęściej stosowanym lekiem, który zaburza funkcję jajników, jest cyklofosfamid, ale należy również pamiętać o działaniu antyestrogenów. Ryzyko niewydolności jajników zwiększa się z wiekiem pacjentki, okresem leczenia i całkowitą dawką leku [23]. Mechanizm zablokowania połączenia estrogenu z receptorem estrogenowym prezentują antagoniści receptorów estrogenowych, leki z grupy selektywnych modulatorów receptora estrogenowego (SERM), do których należy m.in.…”

Fertility of adult in survivors of childhood Hodgkin lymphoma

“…В случае расположения очагов ниже диафрагмы в зону облучения могут попадать половые органы -матка, трубы, яичники. Доза облучения 2 Гр (одномоментно) может привести к потере 50% ооцитов [18]. W. Wallace и соавт.…”

“…АМГ секретируется клетками преантральных и антральных фолликулов и таким образом является маркером растущих фолликулов, его уровень существенно не меняется в течение менструального цикла [18]. АМГ можно определить у плода, начиная с 36-й недели гестации, его количество увеличивается по мере роста и развития девочки, достигая максимума к пубертатному возрасту, и не определяется после наступления менопаузы [18].…”