Cervical Cancer Treatment and Fertility: What We Know and What We Do

Abstract

Cervical cancer is a major health issue worldwide, with approximately 660,000 new cases a year, particularly in women of reproductive age (47.4 ± 12.8 years at diagnosis). Current advances in screening and immunization have shifted cervical cancer diagnoses to earlier stages; as a result, fertility preservation is an essential component of building a treatment plan. Objectives: This systematic review aims to synthesize the existing techniques for fertility preservation with a focus on early-stage cervical cancer (cancer stage IA1-IB1). We will describe the different surgical and medical approaches for the treatment of cervical cancer, followed by an analysis of their oncologic safety and the associated reproductive risks and outcomes. Methods: A descriptive synthesis of the strategies for surgical management, including conization, radical trachelectomy, neoadjuvant chemotherapy (NACT), and radiotherapy, was completed. Fertility and successful pregnancy rely on patient selection, prognostic variables, and obstetric outcomes. The use of transposition of the ovaries and cryopreservation in the context of gonadotoxic treatment plans also requires investigation. Results: For patients meeting conservative eligibility criteria, conservative surgery for tumors up to 2 cm has been considered a safe oncological management strategy, although evidence remains limited. Pregnancy rate after conization ranged from 36 to 55% and 10 to 38% after radical trachelectomy. Ovarian function can be successfully preserved in >60% of laparoscopic transposition cases but resulted in a less than 15% chance of natural conception; the need for assistive reproductive techniques was often required. Conclusions: Fertility-preserving management of cervical cancer is safe and feasible in carefully selected patients, with oncologic outcomes comparable to more radical management. Continued innovation and randomized control trials in treatment paths and oncologic and fertility outcomes will benefit the field.

Keywords: cervical cancer; conservative surgery; early-stage cervical cancer; fertility preservation; neoadjuvant chemotherapy; ovarian transposition; radical trachelectomy.

Figure 1

Pelvic MRI (coronal T2-weighted image without contrast) revealing a cervical tumor that measures approximately 3.11 × 2.39 cm, with the lesion appearing hyperintense compared to surrounding cervical stroma, as demonstrated on the images. The lesion is contained to the cervix, which correlates with FIGO stage IB2 cervical carcinoma.

Figure 2

Flow chart on fertility-sparing surgery depending on FIGO stage.