Endometrial

Treatment
cancer

1A) less than half of myometrium TAH BSO (panhysterectomy)

+Radiotherapy according to grade (teletherapy
Stage 1 Limited to organ
in big tumor >8cm, brachytherapy in small
1b) more than half of myometrium tumor <8cm)

Radical hysterectomy (TAH, BSO, parametrium,

LN)
Stage 2 Genital spread Invasion of cervix
+radiation
+chemo (radiotherapy sensitizing agent)
3a) invade serosa and/or adnexas
(ovaries)
Pelvic extra
Stage 3 3b) vagina
genital
3c) iliac or para aortic LN (regional
Palliative surgery, radio, chemo, hormonal
LN)
(gestagens high dose)
4a) bladder and/or rectum
Stage 4 Distant
4b) distant metastases

cervical cancer Treatment

Local excision by cone

1A: diagnosed by microscopy <5x7mm
biopsy
Radical trachelectomy Wertheim
Stage 1
5-year Limited to cervix with pelvic LN hysterectomy (uterus,
prognosis: 85% 1b1: <4cm dissection and parametrium, upper
prophylactic cervical third of vagina, ovaries,
cerclage internal and external
1b2: >4cm iliac and obturator LN)
Invade beyond
Stage 2 uterus but not to 2a: without parametrial invasion
5-year pelvic wall or
prognosis: 60% lower third of 2b: parametrial invasion
the vagina

Stage 3
5-year Extends to the pelvic wall and lower third of vagina
prognosis: 30% chemoradiation

Stage 4
5-year To bladder or rectum
prognosis: 10%
ovarian cancer Treatment
Desire fertility: unilateral oophorectomy (tube +
1A) one ovary ovary + aspiration cytology + omentum + para
aortic LN + ipsilateral pelvic LN)
Limited to Not desired: TAH BSO
Stage 1
ovaries
1b) both ovaries
1c) one or both ovaries but capsule
ruptured or malignant ascites

2a: to uterus or fallopian tubes

Advanced stage:
Stage 2 Pelvic extension 1) neoadjuvant chemotherapy (down staging)
2b: to other pelvic intraperitoneal 2) staging laparotomy (uterus, tubes, ovaries,
tissue peritoneal cytology, infracolic omentectomy,
3a: retroperitoneal node only para aortic LN, pelvic LN, appendectomy, any
Peritoneum infiltrated resectable organ), don’t leave any
Stage 3 outside pelvis 3b: peritoneal metastases <2cm residual tissue >0.5cm
and LN 3) adjuvant chemotherapy
3c: peritoneal metastases >2cm

Stage 4 Distant metastases

vulvar
Treatment
cancer

1A) lesion <2cm or stromal invasion <1mm Wide local excision

Limited to
Stage 1 If Lateral lesion at least 2cm from midline:
vulva
1b) lesion >2cm or stromal invasion >1mm modified radical vulvectomy and unilateral
groin dissection

Extension to perineal structure: lower one-third of urethra or

Stage 2
vagina or anus.

3a) 1 LN >5mm or 1 to 2 LN <5mm

Extension to Wide radical local excision or radical
Stage 3 inguinofemoral 3b) 2 or more LN >5mm or 3 or more <5mm vulvectomy and bilateral groin node
LN dissection
3c) extra capsular spread Sentinel node dissection
4a: upper urethra or vagina or bladder or rectum, or fixed to
pelvic bone, or fixed or ulcerated LN
Stage 4
4b: distant metastases