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A mesothelioma diagnosis is a heavy burden for anyone. While not as common, women can be diagnosed with mesothelioma. Periotoneal mesothelioma is more common in women than in men. Overall it is rare to be diagnosed during childbearing years.
Cancer can threaten fertility several ways and can lead to infertility. The cancer, metastatic tumors, treatments, or a combination of these can all limit fertility. Any woman diagnosed with cancer should talk to her medical team about her fertility if that is something important to her. In general, it is not feasible to engage fertility preservation and also complete treatment for cancer.
Infertility in Women
Infertility means not being able to conceive a child. Both men and women can be infertile temporarily or permanently. Fertility may be limited, making conception challenging, but not impossible, or a person may become completely infertile, making pregnancy impossible. A woman may become infertile several ways: her ovaries do not produce mature, viable eggs; her eggs cannot be fertilized because of some damage to the reproductive organs; or her eggs may become fertilized, but will not implant inside the uterus.
How Cancer Can Cause Infertility
Cancer treatment, rather than cancer itself, is most likely to threaten a woman’s fertility. However, some cancers impact fertility directly, regardless of treatments. For example, cancers of the reproductive organs may affect fertility, as may metastatic tumors in these organs that originated as mesothelioma. Tumors affecting the glands producing fertility hormones may also cause infertility.
Chemotherapy and Fertility
Chemotherapy is the most common cancer treatment. It is very effective at shrinking tumors, so most mesothelioma patients will experience this treatment. Chemotherapy drugs kill fast-growing cells, including cancer cells. However, these drugs also affect healthy cells. Certain chemotherapy drugs are more likely to destroy a woman’s ova. These drugs include busulfan, carboplatin, carmustine, chlorambucil, cisplatin, cyclophosphamide, dacarbazine, doxorubicin, ifosfamide, lomustine, mechlorethamine, melphalan, procarbazine, and temozolomide.
A woman is born with a set number of ova (also known as “eggs”). Once destroyed, those ova cannot be recreated. These chemotherapy drugs will not make all all women infertile, but risks are high. Thankfully, other chemotherapy drugs carry a lower risk. Chemotherapy-caused infertility is more likely in women over 35 who receive treatment. For younger women who emerge from treatment with their fertility in tact, their fertility may not last as long as it would normally.
Surgery and Fertility
Surgical treatment for mesothelioma when performed near reproductive organs, also poses a risk to fertility. Certain cancers, such as uterine or ovarian cancer, may require removal of these organs, resulting in infertility. Any abdominal surgery has potential to damage reproductive organs. This could include surgery to remove abdominal tumors in women with peritoneal mesothelioma.
Radiation and Fertility
Radiation may also cause fertility concerns. This treatment aims a beam of high energy radiation at tumors to kill cancer cells. While carefully targeted, this radiation can still damage other organs. When targeted tumors are located in the abdomen, reproductive organs may be affected. Radiation for peritoneal tumors may also damage organs, resulting in fertility limitations. Radiation on metastatic brain tumors can also affect fertility if it damages the pituitary gland, since this gland is responsible for hormones involved in conception.
Peritoneal mesothelioma is the type of mesothelioma most likely to affect fertility in women. This is because peritoneal mesothelioma affects the lining of the abdominal organs. Many women of child-bearing age have been diagnosed with peritoneal mesothelioma. Since this cancer occurs in the same part of the body as reproductive organs, fertility is a significant concern. However, one group of researchers found it possible to preserve fertility in women undergoing surgery and heated intraperitoneal chemotherapy (HIPEC). In this study, surgeons removed as much of the tumors as possible. then, HIPEC was used to inject heated chemotherapy drugs directly into the abdominal cavity. Seven out of seven women participating in the study conceived and gave birth within two years treatment.
Speak up about Fertility, Before Treatment
According to research, women are less likely than men to know the infertility risks of cancer treatment. Therefore, it is important for women to ask for information concerning how cancer and its treatments may affect fertility. They should also ask what can be done to preserve fertility before proceeding with treatments. Young women are not often diagnosed with mesothelioma. They do exist, however, and they may want to have children if they can beat their cancer. If this sounds like you, ask for help. Don’t wait for information that may not come until it’s too late.
While technically there are ways to obtain adequate fertility preservation prior to cancer treatment, it is difficult in the case of mesothelioma. Egg retrieval would need to occur prior to starting on therapy and there would need to be discussions about using a surrogate. This comes with many ethical and emotional considerations that would need to be discussed with a speciality oncology fertility specialist. If this is important to you, speak with your medical care team.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.