Ovarian cancer The vast majority of cases are detected past point of metastasis beyond ovaries, implicating higher risk of morbidity and a need for aggressive combination therapy. Surgery and cytotoxic agents are typically required. Histology type is almost primarily epithelial, so treatments will refer to this subtype of pathology. Ovarian cancer is highly treatable with surgery for almost all cases with well-differentiated stage-1 tumour. Higher tumour grades may benefit from adjuvant treatment such as platinum-based chemotherapy. Optimal debulking is used to treat cases where cancer has spread to become macroscopically advanced. The goal of this procedure is to leave no tumour larger than 1 cm by the removal of significant portions of affected reproductive organs. Multiple interventions may be used to achieve optimal debulking, including abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymph node sampling, and peritoneal biopsies. There is a lack of randomized controlled trials comparing outcomes between chemotherapy and optimal debulking, so the current standard of care typically involves the sequential administration of both, beginning with surgical interventions. Interval debulking surgery may be employed half way through chemotherapy following primary surgery if tumour remains above 1 cm in diameter. This has been shown to increase median survival of chemosensitive patients by up to 6 months. A second look laparotomy may be used to assess tumour status in clinical trials, but is not a staple of standard care due to a lack of association with improved outcomes. Fertility preserving surgery involves a thorough differential diagnosis to rule out germ cell cancer or abdominal lymphoma, both of which resemble advanced ovarian cancer in presentation but are treatable with gentler methods. Fertility preserving surgery is one of the few cases where a second look laparotomy is recommended for caution. Platinum-based chemotherapy is paramount to treatment of epithelial ovarian cancer. Carboplatin tends to fare better than cisplatin for side effects and use in outpatient setting in randomized clinical trials. Paclitaxel is a particularly effective add-on for late stage ovarian cancer. Some studies suggest that intraperitoneal chemotherapy may be advantageous over an intravenous route. Cervical cancer Cervical cancer is treated with surgery up to stage 2A. Local excision via loop cone biopsy is sufficient if detected in the earliest stage. If a patient presents beyond this point, bilateral lymphadenectomy is performed to assess metastasis to pelvic lymph nodes. If lymph nodes are negative, then excision of the uterus is performed. Otherwise, a combination of hysterectomy and radiotherapy is frequently employed. This combination approach may be substituted with chemoradiotherapy alone in some. Endometrial cancer Hysterectomy and bilateral oophorectomy is performed for early stage disease. More aggressive cases with lymphatic spread are often treated with radiotherapy. Hormone therapy is most commonly used to treat systemic spread, as endometrial cancer patients tend to be older and suffer from other illnesses that make them poor candidates to withstand harsh cytotoxic agents used in chemotherapy. Minimal laparoscopic surgery is used for endometrial cancer more than any other<unk>  cancer, and may confer advantages over classical surgical interventions. Vulvar cancer Low incidence means that evidence-based therapy is relatively weak, but emphasis is placed on accurate assessment of cancerous tissue and reducing lymphatic spread. The minority of non-squamous histological subtypes do not typically require removal of the inguinal nodes. However, this is necessary to prevent spread in squamous cell carcinomas exceeding 1 mm in stromal invasion. If nodal disease is confirmed, adjuvant radiotherapy is administered. Vaginal cancer Treatment depends on the stage of vaginal cancer. Surgical resection and definitive radiotherapy are the first-line of treatment for early-stage vaginal cancer. Surgery is preferred over radiotherapy due to the preservation of the ovaries and sexual function as well as the elimination of the risk of radiation. For more advanced stages of vaginal cancer, external-beam radiation therapy (EBRT) is the standard method for treatment. External-beam radiation therapy involves the delivery of a boost to the pelvic side of the patient at a 45 Gy dose.
Gynecologic oncology
Oncology
Reproductive medicine
Osteology
Nephrology
Obstetric medicine
Gynaecology
Urology