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Treatments for gynaecological cancers

https://doi.org/10.1016/j.bpobgyn.2006.06.006Get rights and content

Gynaecological cancers account for a significant amount of morbidity and mortality in the world, with varying incidences and outcomes depending on the country. These malignancies consist of vulval, vaginal, cervical, endometrial, fallopian and ovarian cancers, and account for between 10 and 15% of women's cancers. Although mainly a disease of post-menopausal women, when affecting younger women, fertility-related consequences exist. Therapeutic interventions for gynaecological cancers include surgery, chemotherapy and radiotherapy, with combination modalities often required. The basis for certain therapies are derived from appropriately conducted randomized clinical trial, whereas in some settings, therapy is based on clinical experience and intuition. This review will endeavour to focus on the evidence base, though inevitably, non-evidence based practice is unavoidable.

Section snippets

Ovarian cancer

The lifetime risk of developing ovarian cancer is about 1in 70 for most parts of the Western World. In the UK, approximately 7000 cases are reported annually, with an associated mortality rate of 5000. The incidence varies worldwide, with the highest in Scandinavian countries at over 20/100,000 women, and lowest in Japan at 3/100,000 (Figure 1). The reasons for this difference are multifactorial including genetic and environmental. The high mortality rates associated with this malignancy are

Cervical carcinoma

Cervical cancer is the most common gynaecological cancer worldwide. Its most marked feature is the fact that the majority of women in the Western regions will present with earlier stage disease than women in developing countries, where the converse is true.

Endometrial cancer

In the main, endometrial cancer presents with postmenopausal bleeding; adenocarcinomas are the predominant histological subtype. Therapeutic options are surgery or radiotherapy. From retrospective analysis, it is considered that surgery probably has the better outcome, but this suggestion is complicated by the nature of the research. Compared to radiotherapy, surgery is quicker and has fewer long-term sequelae. It is important to note that the staging of this disease is both clinical and

Vulval cancer

This is a rare cancer and, by virtue of this alone, the evidence base for treatment is generally not based on RCTs. In the UK there are about 800 reported cases each year. There is a strong clinical impression that there are two types of vulval cancer: that associated with lichen sclerosis et atrophicus (LSA) and postmenopausal women, and that associated with young women and vulval intraepithelial neoplasia (VIN) or those with multifocal, preinvasive disease of the lower genital tract. The

Conclusions

In the main, the management of gynaecological cancers requires multimodal therapies. Generally, the use of cytotoxic agents is based on evidence from clinical trials but other interventions, in particular surgery, have had limited exposure to such studies. The main changes when caring for patients with these conditions are the overall tendency towards more conservative surgery and the increasing use of non-surgical treatments, with a recognition that when multiple therapies are required, the

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