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Mesothelioma is a rare and devastating cancer. Not only does the disease cause uncomfortable symptoms, but treatments also cause unpleasant side effects. Those suffering with this aggressive cancer rarely live long and must face the stress and fear of that poor prognosis.
What is Infertility?
Fertility is the ability to produce offspring. For men to produce children, the testicles must produce viable sperm cells. Specific cells within the testicles make sperm, but this can’t happen without certain hormones produced by the pituitary gland in the brain. A man may be infertile if his testicles do not produce sperm, or if they produce sperm that function improperly. Also, if the pathways that release sperm are partially or fully blocked, this can have a negative impact on a man’s fertility. Damage to the pituitary gland can also cause infertility.
How Having Cancer Can Affect Fertility
Cancer itself does not impact fertility in most men. Only cancers that directly affect the testicles or pituitary gland have specific impacts on fertility. For example,testicular cancer can obviously impact fertility and reduce sperm production.
Although mesothelioma does not directly impact fertility, the treatments used against this cancer do. Chemotherapy, radiation therapy, and surgery can all reduce fertility by damaging organs that produce sperm or by directly killing sperm cells. This infertility may be partial or total, and temporary or permanent.
Chemotherapy and Fertility
Chemotherapy is a common treatment for mesothelioma and is most likely to reduce fertility. Chemo drugs are not specific to tumor cells. Instead, they target any fast-growing cells in the body, including healthy sperm cells. Because sperm cells grow and divide rapidly, they are often destroyed by the drugs used in chemotherapy.
The damage caused by chemotherapy varies and depends on several factors. Some men may lose some fertility but still have some sperm-producing cells left after treatment. Others may have all their sperm-producing cells destroyed, rendering them completely and permanently infertile.
Men over 40 are less likely to recover these cells. However, the type of chemotherapy drug used and the dose matters. Certain drugs are more likely to cause infertility than others. Also, higher doses of chemotherapy drugs will cause more damage. Chemotherapy drugs with the highest impact on fertility include actinomycin D, busulfan, carboplatin, chlorambucil, carmustine, cisplatin, Cytoxan, cytarabine, lomustine, ifosfamide, melphalan, mechlorethamine, and procarbazine.
Radiation Therapy and Fertility
Radiation is also used to treat mesothelioma. This therapy uses a concentrated high-energy beam to shrink tumors. Radiation is usually done either before surgery to reduce tumor size, making it easier to remove, or after surgery to reduce the possibility of recurrence. Radiation kills cells, which is why it is aimed directly at a tumor. If the radiation is administered in the vicinity of the testicles, or in the brain near the pituitary gland, it can cause damage that reduces fertility. This may occur during mesothelioma treatments if radiation is being used to shrink metastatic tumors.
Mesothelioma is a rare cancer and the rarest form of mesothelioma affects the testicles. This incredibly rare cancer is officially known as mesothelioma of the tunica vaginalis testis. Only 100 or so cases have ever been reported, some in men as young as 20. The tunica vaginalis is the thin layer of mesothelium that surrounds the testes.
The prognosis for this type of mesothelioma is typically better than for other types. This is because treatment is a simple surgery to remove the tumor. There are potential risks, however, and when surgery is performed near the testes, there could be possible damage to the reproductive organs. In some of the few reported cases of this type of mesothelioma, patients had an entire testicle removed. This obviously had a huge impact on patient fertility.
Talk to your medical team about fertility if you think you may want to have children. It is unlikely you’ll be able to preserve fertility after cancer treatments get started, so if this is something important to you, bring this up with your care team prior to starting. Your doctors may not realize fertility is a concern, so don’t be afraid to ask questions before you undergo any mesothelioma treatments.
Sperm banking is one of the most successful ways to ensure the ability to conceive a child after cancer treatment. Sperm is stored frozen and can used later for in vitro fertilization. Even frozen samples with low sperm numbers can be used successfully to conceive, and frozen samples remain viable for decades.
Fertility preservation during cancer treatment can bring up some strong emotions. Oncology fertility are comfortable with having these conversations and can guide you and your partner through this process. If you are a man with mesothelioma, know your options. If you are considering having children, know that cancer does not mean the end of your fertility.
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.