1: Reproductive Health and Cancer
Reproductive health involves:
- Management of patients who are pregnant
- Preservation of fertility in men and women
General Issues
Reproductive health involves both fertility and sexual function. Disorders of both can occur due to:
- Local effects of malignancy on external/internal genitals (eg. mass effect, invasion of reproductive organs)
- Hormonal effects of malignancy
- Invasion/dysfunction of hypothalamic-pituitary-gonadal axis (eg. pituitary tumour, craniopharyngioma)
- Ectopic production of hormones by tumour (eg. prolactinoma, sex-cord stromal tumours)
- Treatment effects:
- Surgical
- Structural damage to internal/external genitals
- Damage to nerves innervating these structures (eg. radical prostatectomy and parasympathetic nerves to penis)
- Removal of hormone producing structures (pituitary, gonads)
- Radiotherapy
- Shares similar complications to surgery (local, neural, hormonal)
- Added complication of soft tissue fibrosis (eg. vaginal stenosis)
- Chemotherapy
- Effects are typically on the gonads
- Alkylating agents have the highest incidence of infertility in both men and women
- Combination regimes containing alkylating agents have very high rates of infertility
- Younger women resist chemotherapy agents due to a higher number of follicles
- Surgical