Surgery alt The initial treatment for<unk>  is surgery; 90% of women with<unk>  are treated with some form of surgery. Surgical treatment typically consists of hysterectomy including a bilateral salpingo-oophorectomy, which is the removal of the uterus, and both ovaries and Fallopian tubes. Lymphadenectomy, or removal of pelvic and para-aortic lymph nodes, is performed for tumors of histologic grade II or above. Lymphadenectomy is routinely performed for all stages of<unk>  in the United States, but in the United Kingdom, the lymph nodes are typically only removed with disease of stage II or greater. The topic of lymphadenectomy and what survival benefit it offers in stage I disease is still being debated. In women with presumed stage I disease, a 2017 systematic review found no evidence that lymphadenectomy reduces the risk of death or relapse of<unk>  when compared with no lymphadenectomy. Women who undergo lymphadenectomy are more likely to experience systemic morbidity related to surgery or lymphoedema/lymphocyst formation. In stage III and IV<unk> s, cytoreductive surgery is the norm, and a biopsy of the omentum may also be included. In stage IV disease, where there are distant metastases, surgery can be used as part of palliative therapy. Laparotomy, an open-abdomen procedure, is the traditional surgical procedure; however, in those with presumed early stage primary<unk> , laparoscopy (keyhole surgery) is associated with reduced operative morbidity and similar overall and disease free survival. Removal of the uterus via the abdomen is recommended over removal of the uterus via the vagina because it gives the opportunity to examine and obtain washings of the abdominal cavity to detect any further evidence of<unk> . Staging of the<unk>  is done during the surgery. The few contraindications to surgery include inoperable tumor, massive obesity, a particularly high-risk operation, or a desire to preserve fertility. These contraindications happen in about 5–10% of cases. Women who wish to preserve their fertility and have low-grade stage I<unk>  can be treated with progestins, with or without concurrent tamoxifen therapy. This therapy can be continued until the<unk>  does not respond to treatment or until childbearing is done. Uterine perforation may occur during a D&C or an<unk>  biopsy. Side effects of surgery to remove<unk>  can specifically include sexual dysfunction, temporary incontinence, and lymphedema, along with more common side effects of any surgery, including constipation. Add-on therapy There are a number of possible additional therapies. Surgery can be followed by radiation therapy and/or chemotherapy in cases of high-risk or high-grade<unk> s. This is called adjuvant therapy. Chemotherapy Adjuvant chemotherapy is a recent innovation, consisting of some combination of paclitaxel (or other taxanes like docetaxel), doxorubicin (and other anthracyclines), and platins (particularly cisplatin and carboplatin). Adjuvant chemotherapy has been found to increase survival in stage III and IV<unk>  more than added radiotherapy. Mutations in mismatch repair genes, like those found in Lynch syndrome, can lead to resistance against platins, meaning that chemotherapy with platins is ineffective in people with these mutations. Side effects of chemotherapy are common. These include hair loss, low neutrophil levels in the blood, and gastrointestinal problems. In cases where surgery is not indicated, palliative chemotherapy is an option; higher-dose chemotherapy is associated with longer survival. Palliative chemotherapy, particularly using capecitabine and gemcitabine, is also often used to treat recurrent<unk> . Low certainty evidence suggests that in women with recurrent<unk>  who have had chemotherapy, receiving drugs that inhibit the mTOR pathway may reduce the risk of disease worsening compared to having more chemotherapy or hormonal therapy. Though, mTOR inhibitors may increase the chance of experiencing digestive tract ulcers. Radiotherapy Adjuvant radiotherapy is commonly used in early-stage (stage I or II)<unk> . It can be delivered through vaginal brachytherapy (VBT), which is becoming the preferred route due to its reduced toxicity, or external beam radiotherapy (EBRT). Brachytherapy involves placing a radiation source in the organ affected; in the case of<unk>  a radiation source is placed directly in the vagina. External beam radiotherapy involves a beam of radiation aimed at the affected area from outside the body. VBT is used to treat any remaining<unk>  solely in the vagina, whereas EBRT can be used to treat remaining<unk>  elsewhere in the pelvis following surgery. However, the benefits of adjuvant radiotherapy are controversial. Though EBRT significantly reduces the rate of relapse in the pelvis, overall survival and metastasis rates are not improved. VBT provides a better quality of life than EBRT. Radiotherapy can also be used before surgery in certain cases. When pre-operative imaging or clinical evaluation shows tumor invading the cervix, radiation can be given before a total hysterectomy is performed. Brachytherapy and EBRT can also be used, singly or in combination, when there is a contraindication for hysterectomy. Both delivery methods of radiotherapy are associated with side effects, particularly in the gastrointestinal tract. Hormonal therapy Hormonal therapy is only beneficial in certain types of<unk> . It was once thought to be beneficial in most cases. If a tumor is well-differentiated and known to have progesterone and estrogen receptors, progestins may be used in treatment. There is no evidence to support the use of progestagen in addition to surgery for newly diagnosed<unk> . About 25% of metastatic endometrioid<unk> s show a response to progestins. Also,<unk>  stromal sarcomas can be treated with hormonal agents, including tamoxifen, hydroxyprogesterone caproate, letrozole, megestrol acetate, and medroxyprogesterone. This treatment is effective in<unk>  stromal sarcomas because they typically have estrogen and/or progestin receptors. Progestin receptors function as tumor suppressors in<unk>  cells. Preliminary research and clinical trials have shown these treatments to have a high rate of response even in metastatic disease. In 2010 hormonal therapy is of unclear effect in those with advanced or recurrent<unk> . There is insufficient evidence to inform women considering hormone replacement therapy after treatment for<unk> . Targeted therapy Dostarlimab has been approved by the FDA for therapy of<unk>  with specific biomarker Monitoring The tumor marker CA-125 is frequently elevated in<unk>  and can be used to monitor response to treatment, particularly in serous cell<unk>  or advanced disease. Periodic MRIs or CT scans may be recommended in advanced disease and women with a history of<unk>  should receive more frequent pelvic examinations for the five years following treatment. Examinations conducted every three to four months are recommended for the first two years following treatment, and every six months for the next three years. Women with<unk>  should not have routine surveillance imaging to monitor the<unk>  unless new symptoms appear or tumor markers begin rising. Imaging without these indications is discouraged because it is unlikely to detect a recurrence or improve survival, and because it has its own costs and side effects. If a recurrence is suspected, PET/CT scanning is recommended.
Endometrial cancer
Cervical cancer
Uterine cancer
Ovarian cancer
Vaginal cancer
Breast cancer
Intravenous leiomyomatosis
Ovarian disease