Gonadal Complications

Abstract

OverviewImprovements in cancer therapy over the past 50 years have allowed survivors of pediatric sarcomas and leukemias, and young adults with high‐grade lymphomas, Hodgkin disease, and testicular tumors to reach adulthood but suffer the long‐term consequences of those therapies. Alterations in gonadal function are frequent and distressing side effects of modern cancer therapy. Women face symptoms of premature ovarian failure, including menopause, sterility, and presumably accelerated osteoporosis and possible early heart disease. Men experience oligo‐azoospermia and subclinical Leydig cell dysfunction, leading to infertility and long‐term effects of “andropause” including decreased bone density, lean muscle mass, decreased libido, and increased risk of coronary artery disease.With recognition has come better documentation of the frequency and severity of these complications, more effective patient counseling, and innovative approaches to attenuate gonadal toxicity. Options include hormonal manipulation, selection of alternative treatments, and pretreatment cryopreservation of embryos or germ cells, but these choices must be offered pretherapy, and patients remain uninformed of potential loss of fertility or options to preserve it. As cancer therapies improve and the number of cancer survivors increases, the practicing oncologist must address these issues in a timely and sensitive manner.