The incidence of malignant tumors in children and adolescents has increased. How to protect the fertility of adolescents?

This article involves professional knowledge and is only for medical professionals to read for reference and is very different from the treatment plan for adults
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In recent years, the incidence of malignant tumors in children and adolescents has continued to rise.
Malignant tumors have become one of the most important causes of death in children, second only to accidental deaths, and require more attention from the whole society
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At the gynecological tumor sub-forum of the Red House Forum meeting on June 6, Professor Di Wen from Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine brought a keynote report on "Protection of Fertility in Women, Children and Adolescents with Malignant Tumors"
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Why emphasize the fertility protection of children and adolescents with malignant tumors? The global incidence of malignant tumors in children and adolescents is not optimistic
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From 2001 to 2010, the annual incidence rate for children (0-14 years old) was 146.
6 per million, and the annual incidence rate for adolescents (15-19 years old) was 185.
3 per million
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Children and adolescents suffer from different types of malignant tumors.
It is particularly noteworthy that the proportion of ovarian germ cell tumors among adolescents’ tumors has reached 2%
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However, although the incidence of malignant tumors in children and adolescents is increasing, the prognosis has improved significantly
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From 1975 to 2010, the mortality of children and adolescents with malignant tumors dropped by 57%, and the 5-year survival rate was greater than 80%
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Because of the improvement of treatment methods and the improvement of medical standards, the survival rate of patients has increased.
Therefore, the treatment goals of malignant tumors in children and adolescents have gradually evolved from treating and prolonging the survival time of patients to improving the quality of life of patients and maintaining the health of patients
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Preserving the patient's fertility function is an important part of humanized treatment
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The treatment of malignant tumors damages fertility.
Common treatments for malignant tumors have certain damages to the damage of the gonads
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1 The effect of chemotherapy on female fertility: Chemotherapy is an important mechanism that causes damage to the structure and function of the ovary
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Clinically, it is manifested as ovarian atrophy, a large number of primordial follicles that have stopped development in the ovaries, and the follicles disappear completely in severe cases
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The impact of chemotherapy on female fertility is not only related to chemotherapy drugs and chemotherapy regimens, but also to the age of the patient.
The older the age, the higher the risk
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2 The influence of radiotherapy on female fertility: The influence of radiotherapy on female fertility is related to the location of radiotherapy, the dose of radiotherapy, and the age of the patient.
The older the age, the higher the risk
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Recommendations for the treatment of fertility protection for malignant tumors in children and adolescents.
In 2006, ASCO issued the first clinical guidelines for the diagnosis and treatment of fertility preservation.
In 2018, ASCO updated the guidelines; in 2014, the Chinese Medical Association Gynecological Oncology Branch formulated A "Guidelines for Clinical Diagnosis and Treatment of Gynecological Malignant Tumors with Preserving Fertility Function", the "Expert Consensus on Fertility Protection and Preservation of Chinese Female Cancer Patients" was released in 2020
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However, there are no guidelines for the protection of fertility in children and adolescents with malignant tumors
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The main obstacle to carry out malignancy fertility protection of children and adolescents include: inconsistent doctors, patients, the treatment of the concept of the guardian between the three; lack of a complete treatment system for the protection of children and adolescents with cancer fertility; high cost of treatment, social and cultural factors
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In the fertility protection and treatment of malignant tumors in children and adolescents, comprehensive consideration should be given to the age of the patient, the type of disease, the prognosis, the risk of recurrence, the impact of the treatment method on fertility, the financial ability of the family, and the wishes of the individual and the family
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In February 2021, The Lancet Oncology published the "Expert Consensus on Fertility Protection in Female Child and Adolescent Cancer Patients", which analyzed the methods of fertility protection treatment
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Fertility protection treatment methods Egg freezing, embryo freezing, ovarian tissue freezing and transplantation surgical treatment (ovarian transposition fixation) Gonadotropin releasing hormone analogues in children and adolescents.
The fertility of malignant ovarian germ cell tumors in children and adolescents is retained in the latest NCCN guidelines.
The principles of surgery for malignant germ cell tumors are: fertility requirements: comprehensive staging surgery that preserves fertility; no fertility requirements: comprehensive staging surgery
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However, the principles of surgery for children and adolescents are different from those for adults, and the treatment is more conservative than that for adults
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Summary: 1.
The fertility protection of children and adolescents with malignant tumors has just started, and it needs to be continuously reviewed and corrected in the clinic; 2.
During the treatment, the children and their families should be fully informed of the risks, and the "standardization, individualization, and individualization" should be mastered.
"Three modernizations" principle; 3.
Establish a systematic multidisciplinary cooperative diagnosis and treatment system to standardize fertility protection and treatment
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Source of this article: Obstetrics and Gynecology Channel of the medical community