ASCO Reading Room | Controversies in the Surgical Management of Gynecologic Cancer: Balancing the Decision to Operate or Delay

Cancer outcomes are largely measured in terms of disease-free survival or overall survival, which are highly dependent on timely diagnosis and access to treatment methods available in the country’s existing health system. Although cancer survival rates have increased significantly in recent decades, any improvements in 5-year survival for gynecologic cancers have been modest, as in the case of ovarian and cervical cancers, or have declined, as in the case of endometrial cancer.

The lack of effective screening means that many women present with advanced disease and require radical approaches to treatment. Although treatment of early disease can lead to cure, advanced disease is fraught with morbidity and mortality, and recent clinical trials have sought to assess the noninferiority of minimally invasive options to aggressive surgical approaches.

Of particular interest are fertility-sparing treatments for endometrial and cervical cancers, which have recently increased in younger women. Balancing morbidity with the risk of mortality, loss of fertility, and quality of life requires a targeted, patient-centered therapeutic approach. This is an area of ​​intense and ongoing research that can sometimes challenge current therapeutic paradigms.

In this two-part review, we provide an overview of current approaches to the treatment of gynecologic cancer and the need for radical surgical debulking and fertility preservation. We also review the intricacies of treating ovarian cancer and advanced endometrial cancer, exploring the nuances of timing of surgical debulking and its impact on outcomes.

Read an interview about the review here.