How can my 38-year-old sister manage urothelial carcinoma?

Question

Hello doctor,

My sister is 38 years old and was recently diagnosed with metastatic urothelial carcinoma. The diagnosis came as a shock because she did not have any significant urinary symptoms beforehand. We are very concerned about how this condition may affect her reproductive health. She has always wanted to have a child but has not yet tried to conceive. Her menstrual periods have recently become irregular, and she is worried about whether treatments such as chemotherapy or immunotherapy might affect her chances of becoming a mother in the future.

She is also unsure whether it is safe to continue using her IUD or whether hormonal changes related to the cancer or its treatment could worsen her condition.

Is fertility preservation possible at this stage of metastatic urothelial carcinoma?
Will treatment worsen the hormonal imbalance or cause early menopause?
Is it safe for her to continue using a hormonal intrauterine device during treatment?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am very sorry to hear about your sister’s diagnosis. Metastatic urothelial carcinoma at a young age is uncommon and can be emotionally difficult to process, especially when future fertility is a concern.

Treatments such as chemotherapy, which often include platinum-based agents such as Cisplatin or Carboplatin, can significantly affect ovarian function. These effects may lead to hormonal imbalances, irregular menstrual cycles, or early menopause, which may be temporary or permanent.

Immunotherapy, also used in the treatment of advanced urothelial carcinoma, has less clearly defined effects on fertility. However, immune-mediated effects on the ovaries are possible, although they are relatively uncommon.

Due to the urgency of treatment in metastatic cancer, fertility preservation can be challenging. Oocyte (egg) or embryo cryopreservation (freezing) is usually performed before the initiation of cancer therapy and requires time for ovarian stimulation, typically about two to three weeks. In some cases, oncologists may consider a short delay in treatment depending on the behavior and aggressiveness of the cancer.

In rare situations, ovarian tissue cryopreservation may be discussed, although this approach is still considered experimental, particularly in the metastatic setting. Early consultation with a fertility specialist is essential to assess whether any fertility preservation options are feasible at this stage.

Regarding the intrauterine device (IUD), a hormonal intrauterine device is generally considered safe to keep in place during cancer treatment unless there are specific concerns such as pelvic infection, uterine abnormalities, or hormone-related issues directly linked to the cancer. It is important that both the oncologist and gynecologist review this in the context of the planned treatment regimen and any available hormone receptor testing.

Overall, while the path ahead may involve challenges related to fertility and hormonal health, coordinated care among oncology, gynecology, and fertility specialists can help guide the most appropriate and safe decisions.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.