When Gynecologic Cancer Strikes Younger Women

Maureen Wagner's daughter probably saved her life. The 33-year-old was pregnant with her first child in 2002 when she abruptly went into labor five weeks early.

That early delivery led to the discovery of what doctors thought was an ovarian cyst. It turned out to be cancer, and when her daughter was five-months old, Ms. Wagner underwent a full hysterectomy and said goodbye to her dreams of carrying another child.

Although most gynecologic cancers strike women in mid-life and beyond, they can affect women at any age, even infants. For instance, 11 percent of women diagnosed with ovarian cancer are under 65,¹⁶ while nearly half of all cases of cervical cancer are diagnosed before age 35.¹⁷ Endometrial cancer in premenopausal women is rarer, with just 2.9 percent of endometrial cancers occurring in women under 40.¹⁸

A diagnosis of gynecologic cancer is devastating to any woman, but particularly to young women still in their childbearing years, experts say. That's because the primary treatment for most gyn cancers is hysterectomy and/or fertility-destroying radiation and chemotherapy. Additionally, if the ovaries are removed, a woman is plunged into surgical menopause.

But younger women have more options today than their mothers did 30 years ago. The use of menopausal hormone therapy-considered critical for women who undergo surgical menopause-can help with the abrupt withdrawal of estrogen and other hormones that comes with the loss of ovaries and uterus. Additionally, advances in surgical and assisted reproductive technology, as well as a better understanding of the various treatment options of these cancers, provide more alternatives for preserving or protecting fertility in younger women today.

For instance, endometrial cancer can sometimes be treated medically, with progestin, rather than surgically. And younger women diagnosed with ovarian cancer may be able to have just one ovary removed, instead of both. Plus, younger women tend to have rarer forms of ovarian cancer, called germ cell or stromal ovarian cancer, which are fairly responsive to chemotherapy and may not require a hysterectomy, says Thomas J. Herzog, MD, who directs the division of gynecologic oncology at Columbia University's College of Physicians and Surgeons in New York City.

In cervical cancer, a relatively new procedure called a radical trachelectomy, may be performed. In this procedure, the surgeon removes most of the cervix and tissue around it, preserving the uterus for a later pregnancy. Even if the uterus and cervix are removed, sometimes the ovaries can be spared, says Carolyn Y. Muller, MD, associate professor of gynecologic oncology at the University of Texas Southwestern Medical Center in Dallas.

Promising assisted reproductive techniques such as egg retrieval and embryo freezing may provide new options for women diagnosed with gynecologic cancers who still want to have a biological child of their own.^19,20 A woman diagnosed with cervical cancer, for instance, might be able to freeze her eggs, then later use in-vitro fertilization to create an embryo that a surrogate mother could carry.

None of these options was available for Ms. Wagner. Instead, she had to learn to cope overnight with menopause, care for an infant while undergoing chemotherapy, and battle her employer for time off to take care of herself.

That's another issue older women may not have to face, she says: work issues. "When it costs your workplace so much money in insurance costs because of your treatment, they may not want you working there," she says. Ms. Wagner eventually left the job she held when she was first diagnosed, and today works as director of corporate support for a PBS television station in Chattanooga, TN.

And while she mourns the loss of the additional biological children she'll never have, she's eternally grateful to the daughter she is raising, whom she named "Valerie." The name was carefully chosen for its meaning, explains Ms. Wagner: healthy and strong.X