This chapter outlines basic diagnosis, workup, staging, and treatment of cervical cancer. It recommends specific surgical and adjuvant therapies reflecting the most current standards of care. The most common symptom of cervical cancer is abnormal vaginal bleeding specifically, postcoital and intermenstrual bleeding, menorrhagia, and PMPB. Other symptoms include pelvic fullness/pain, unilateral leg swelling, bladder irritability, and tenesmus. Cervical cancer is also commonly asymptomatic, found only following an abnormal Pap smear, colposcopic exam, or cervical biopsy. Common signs of advanced cervical cancer are a fungating cervical mass, unilateral leg edema, and obstructive renal failure. The pretreatment workup of cervical cancer begins with a history and physical exam. The treatment of cervical cancer may involve the use of surgery, chemotherapy, XRT, targeted therapy or a combination of therapies. Finally, the chapter summarizes the evidence-based medicine in support of recommended treatments.

This chapter outlines basic diagnosis, workup, staging, and treatment of tubo-ovarian cancers. It recommends specific surgical and adjuvant therapies reflecting the most current standards of care. Upon review of pathogenesis for high-grade serous adnexal cancers and reflecting standard clinical practice, ovarian, fallopian tube, and PPCs have now been classified uniformly as HGSTOC. Sex cord stromal and GCT are classified separately and considered to originate from the ovary itself. The pretreatment workup includes a history and physical examination, LN survey, and laboratory tests, including a CBC, CMP, coagulation profile, CA 125, and other indicated tumor markers. Colonoscopy and EGD can be considered based on symptoms. Primary treatment can be surgical, PDS or with NACT. Surgery usually consists of an exploratory laparotomy, abdominal cytology, hysterectomy, BSO, omentectomy, and cytoreduction.

Uterine corpus cancer is the most common female gynecologic cancer in the United States, with an estimated 65,950 cases and 12,550 deaths in the United States in 2022. Currently, endometrial AC is the most common malignancy of the female genital tract and ranks as the fourth most common cancer in females. Risk factors for endometrial cancer include the triad of obesity, diabetes, and HTN. Most women present with abnormal uterine bleeding. Other presenting signs and symptoms can be menorrhagia, intermenstrual bleeding, pain, pyometria, hematometria, and an abnormal Pap smear. Treatment is primarily surgical staging to include pelvic washings, total hysterectomy, BSO, assessment of lymph nodes, omentectomy and peritoneal biopsies, and surgical debulking of extrauterine/metastatic disease. Recurrent disease can be broken into local recurrence or distant recurrence. Postoperative HRT, namely estrogen, has been studied for QOL and risk of recurrence.

Vulvar cancer represents 3% to 5% of all female genital cancers and 1% of all malignancies in women. In 2022, there are 6,330 new cases and 1,560 deaths predicted. The average age at diagnosis is 65 Y, although it is trending toward a younger age. Clinical features include pruritus, ulceration, or a mass. Squamous cell carcinoma represents 85% of all vulvar cancers. Other histologic types are basal cell carcinoma, AC, sarcoma, and verrucous carcinoma and melanoma. Malignant melanoma represents 5% of vulvar cancers. There are four histologic subtypes of melanoma: superficial spreading, lentigo, acral, and nodular. Pretreatment workup includes a physical exam with careful evaluation of the vagina and cervix. Biopsy for diagnosis should occur at the center of any suspicious area. The risk for local recurrence is close surgical margins. Nivolumab alone for squamous cell cancers or in combination with ipilimumab for melanoma has been shown to be beneficial.

Vaginal cancer represents 1% to 2% of all female genital tract malignancies. The median age at diagnosis is 60 Y. Most vaginal cancers are metastatic lesions from other sites, including the cervix, uterus, breast, GTD, and the GI tract. Primary vaginal cancers are commonly found in the upper one third of the vagina, often in the posterior fornix. Symptoms include vaginal discharge, vaginal bleeding, tenesmus, pelvic pain, bladder irritation, and pelvic fullness. Risk factors for vaginal cancer include HPV infection, chronic vaginal irritation, prior treatment for cervical cancer, and a history of DES. The pretreatment workup is colposcopy of the entire genital tract and physical examination. Diagnosis is via biopsy often guided with colposcopy. It may be necessary to perform an EUA with cystoscopy and proctoscopy. CXR, IVP, cystoscopy, proctoscopy, and barium enema are FIGO-approved diagnostic studies.

GTD describes a group of tumors that arise from trophoblastic cells. This is usually the result of an abnormal fertilization event and includes molar pregnancy, choriocarcinoma, PSTT and ETT. Risk factors for a molar pregnancy include age (<15 Y or >45 Y of age), history of a prior mole, and Asian ethnicity. Complete and partial moles are usually diagnosed at the time of uterine evacuation. Histopathology is the main diagnostic method. Other abnormal pregnancies/fetuses can be mistaken for a partial mole. These include Turner’s, Beckwith-Wiedemann, and Edward’s syndromes. The pre-treatment workup of GTD is a pelvic US and a CXR. At diagnosis, reimaging with a CT of the chest, abdomen, and pelvis and MRI of the brain should be obtained. If there is uterine hemorrhage, vaginal packing, blood transfusion, and emergent uterine artery embolization can be performed.