Late reproductive effects of cancer treatment in children, young cancer survivors

The diagnosis of cancer in children, adolescents and young adults creates specific reproductive challenges for the patients and their families. Reproductive concerns range from perceived or actual alteration of body image to fulfilment of reproductive aspirations. Reproductive counselling is widely held to be a crucial component of pre-treatment work up, yet few patients actually receive these services. Hormone replacement therapy, although widely available, effective and beneficial, poses specific challenges in this group owing to their younger ages. Measures of ovarian reserve are reliable; however they are accessed by few and are not predictive of achieving a live birth. Only patients linked to reproductive services could benefit from the array of fertility preserving options available. Patients exposed to abdominal and pelvic radiotherapy can face further complications even after successful conception. Attendant psychological impacts, relating to genetic, structural and developmental effects on the off spring, warrant specific focus in counselling.