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Perturbations hormonales, fertilité et contraception après le traitement d’un cancer

Hormonal status, fertility and contraception after cancer treatment

  • Oncologie
  • Published:
Oncologie

Résumé

Le cancer est la deuxième cause de mortalité chez les femmes de moins de 40 ans en Europe de l’Ouest et aux États-Unis. La survie après cancer s’est nettement améliorée au cours des 30 dernières années. Des avancées majeures ont eu lieu, notamment ces dix dernières années, concernant l’amélioration de la qualité de vie, et particulièrement le développement des techniques de préservation de la fertilité chez les jeunes patientes traitées pour cancer. La chirurgie, la chimiothérapie et la radiothérapie ont des effets délétères variables sur la fertilité féminine. La chirurgie a un impact direct en enlevant l’utérus et les ovaires. La radiothérapie peut affecter les fonctions ovariennes et également la fonction utérine. Les différents agents utilisés en chimiothérapie peuvent agir directement sur la fonction ovarienne. Nous disposons de marqueurs prédictifs des atteintes toxiques potentielles sur les gonades et l’utérus. Différents protocoles de préservation de la fertilité féminine peuvent être proposés, avant la mise en œuvre des traitements anticancéreux ou après le traitement de la tumeur. Cependant, cette prise en charge peut seulement se concevoir si elle n’a aucune conséquence délétère sur la survie des patientes. Outre le problème de la fertilité se pose celui de la contraception, et chez les femmes dont la fonction ovarienne est précocement altérée, celui d’un traitement hormonal substitutif.

Abstract

Cancer is the second cause of death in women under 40 years of age in Western Europe and the United States. Survival after cancer treatment has improved during the past three decades. In line with this, procedures have been developed to optimize the quality of life, in particular the development of fertility-enhancing and fertility-preservation techniques. Surgery, chemotherapy and radiotherapy affect the fertility potential of women in different ways and to different degrees. Surgery has a direct impact by removing the uterus and ovaries. Radiotherapy (external or brachytherapy) may affect ovarian and also uterine function. Different drugs used in chemotherapy may directly influence ovarian function. Some markers have now been evaluated that are predictive of the potential toxic injury to the gonads and uterus. Various procedures could be proposed to preserve fertility potential in women, before delivering anticancer treatments or after treating the tumor. However, such treatments can only be considered if they do not have deleterious consequences on the survival of patients. As well as the preservation of fertility, there is the issue of contraception; and in the case of impaired ovarian function, the issue of a substitute hormonal treatment.

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Authors and Affiliations

  1. Laboratoire d’Histologie-Embryologie-Cytogénétique-Biologie de la Reproduction-CECOS, Hôpital Jean Verdier, F-93143, Bondy, France

    R. Lévy & M. Filali

  2. INSERM U557, Paris 13, France

    R. Lévy & M. Filali

  3. UMR-S0782, Université Paris-Sud, F-92140, Clamart, France

    N. Frydman & N. Prisant

  4. AP-HP, Service d’Histologie-Embryologie-Cytogénétique et Génétique de la Reproduction, Hôpital Antoine Béclère, F-92140, Clamart, France

    N. Frydman & N. Prisant

  5. U782, INSERM, F-92140, Clamart, France

    N. Frydman & N. Prisant

  6. Institut Gustave Roussy, Villejuif, Univ., F-94805, Paris-Sud, France

    P. Morice

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  1. R. Lévy
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  2. N. Frydman
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  5. P. Morice
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Correspondence to R. Lévy.

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Lévy, R., Frydman, N., Filali, M. et al. Perturbations hormonales, fertilité et contraception après le traitement d’un cancer. Oncologie 10, 254–262 (2008). https://doi.org/10.1007/s10269-008-0860-0

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  • DOI: https://doi.org/10.1007/s10269-008-0860-0

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