Xiao Mei is 23 years old, just graduated from university and works in a Fortune 500 company. A company physical examination revealed a 5cm lump on the right ovary, which was quickly operated on and the pathology suggested that it was actually ovarian cancer! She was just starting her life, even her boyfriend was not yet …… What would be the fate waiting for her? There are many kinds of malignant tumors in gynecology, the most common are the three major cancers: cervical cancer, endometrial cancer and ovarian cancer. In recent years, the occurrence of cancer has a tendency to be younger. Many young gynecologic cancer patients still retain a strong desire to conceive life. However, there is often a big gap between the ideal and reality, and if we follow the principle, we basically have to cut all of them. As a doctor, we have to take the patient’s idea into full consideration, and after unremitting efforts, we finally figured out a treatment plan that can preserve the fertility function for young patients. The minimum configuration for pregnancy: 1 ovary + 1 uterus To get pregnant on your own, you must be able to provide your own eggs, then you need to have ovaries. It is best to keep both sides, but if not, at least one ovary is available. If you have eggs, you also need a uterus where the fertilized eggs can make their home, without which there is no way to conceive life. It can be said that 1 ovary and 1 uterus is the minimum configuration to have a child. At this time, even if there is a problem with the fallopian tube, it can be helped a little by IVF technology. Therefore, the treatment plan for preserving fertility in gynecological cancers revolves around this minimum configuration. Preservation of fertility in cervical cancer The patients who can opt for preservation of fertility in cervical cancer include patients with stage Ia1, Ia2 and Ib1 (tumor less than 2 cm) and no extra-cervical infiltration or metastasis is found. Of course only precancerous lesions of the cervix are possible. More severe stages, or tumors that are too large, are not suitable. The treatment options are cervical conization with cold knife or LEEP knife, or extensive hysterectomy, either through vaginal surgery or open and laparoscopic surgery; sometimes lymph node dissection of the pelvis needs to be done together. As for the specific choice of modality, it needs to be arranged by a professional gynecologist. Cervical cancer usually has a low risk of metastasis to the ovaries, so basically both ovaries can be preserved. As for the uterus, although the body part of the uterus is preserved, cervical conization will affect the function of the cervix, and with extensive cervical excision, even the cervix will be lost. Therefore, the probability of conception is also reduced in this group of patients, and it is prone to miscarriage and premature birth. The conditions for preserving fertility in endometrial cancer are more stringent, as it must be endometrioid adenocarcinoma grade 1, stage Ia, and without infiltration of the myometrium. Endometrial atypical hyperplasia can also be considered for conservative treatment. The lesions are usually detected by diagnostic or hysteroscopic curettage and can be treated optionally with high doses of highly potent progestins. A minimum of 3 months and a maximum of 1 year should be spent on diagnostic scraping every 3 months during this period to find out how the endometrium is transformed. If transformation is possible, then both ovaries and uterus can be preserved. If there is a combination of obesity, polycystic ovary syndrome and other conditions with high risk of combined endometrial cancer, they need to be treated at the same time. Preservation of fertility in ovarian cancer Since ovarian cancer is prone to bilateral involvement and pelvic metastasis, surgery to preserve fertility is very risky and needs to be done with caution. The standards in China and abroad are somewhat different. The Chinese standard is stricter, requiring stage Ia, highly differentiated cancer. The latest criteria in the United States are a bit more lenient than those in China: very early stage patients or low-risk malignancies (early-stage epithelial ovarian cancer, low-grade malignant potential tumors, germ cell tumors, malignant sex cord mesenchymal cell tumors), etc. Ovarian cancer has a twin sister: ovarian junctional tumors, which are not considered true cancers, but also carry the risk of recurrence and metastasis, and also have the option of preserving reproductive function with similar requirements as the ovary. Oophorectomy of the affected side is usually performed, preserving the uterus and the opposite ovary. However, a full surgical staging, including lymph node dissection + greater omental resection, must be performed to exclude more advanced disease. A few points to emphasize: 1. When gynecologic cancer is detected, full communication must be made, and it can only be performed if the patient and family strongly request to preserve the reproductive function and if they are eligible. 2. Treatment that preserves reproductive function means that there is a risk of missing very small lesions that are already present, and the risk of recurrence and metastasis after surgery is a little higher. Only those patients who are very obedient and will come for review can be selected, and close follow-up reviews must be performed. 3. Those who can retain their reproductive function are invariably very early malignant tumors. How can cancer be detected at very early stage, regular medical checkups are needed. 4. The premise of preserving reproductive function is that the diagnosis and staging must be accurate. This requires comprehensive and adequate examination and evaluation. 5.There are quite a few types of malignant tumors in each site, and not all types are suitable even at very early stage. 6. During the follow-up, if evidence of recurrence and metastasis is found, even if the patient is not yet born, she must be treated promptly and standardized 7. If the patient completes her reproductive function and then shows some abnormal signs, or if she herself wants to come for complete surgery, she can always undergo complete surgical treatment. Fortunately for Xiao Mei’s ending, it was ovarian adenocarcinoma stage Ia. After communication with her parents, she finally chose to remove only one ovary and did a full staging surgery for all of them. So, she is still able to be a complete girl and is currently talking about a boyfriend.