Gynecologic cancers — cervical, endometrial, ovarian, vulvar, vaginal, and gestational trophoblastic — are treated with surgery, radiation, chemotherapy, targeted therapy, immunotherapy, and hormonal therapy, alone or combined. This topic gathers the shared principles; disease-specific details appear in each cancer topic.

Timing terms for chemotherapy

Surgical procedures

Radiation therapy

• External beam radiation (EBRT) — daily fractions to the pelvis over several weeks; the client is not radioactive
• Brachytherapy — a sealed radioactive source placed in the vagina or uterus (intracavitary) or tissue (interstitial)
  • High-dose-rate (HDR): a few minutes per session, usually outpatient; no radiation remains afterward
  • Low-dose-rate (LDR): source stays in place for about 1–3 days in a shielded room; the client emits radiation while the source is in place
• Radiation injures rapidly dividing normal tissue — bowel, bladder, skin, vaginal mucosa, marrow — causing acute effects during treatment and late effects months to years later

Before treatment — baseline performance status, nutrition and weight, CBC, kidney and liver function, hearing (cisplatin), neuropathy, cardiopulmonary status, fertility wishes, sexual health, support system, and understanding of the plan.

During and after treatment

• Myelosuppression: fever, fatigue, bruising, bleeding
• Radiation effects: diarrhea, abdominal cramping, rectal bleeding (enteritis/proctitis); dysuria, frequency, hematuria (cystitis); red, dry, or peeling perineal skin; vaginal discharge, dryness, narrowing (stenosis); fatigue
• Surgical recovery: incision, vaginal bleeding, bowel sounds, voiding, drains, leg swelling (lymphedema, VTE)
• Psychosocial: anxiety, depression, fear of recurrence, grief over fertility, altered body image and sexuality

Tests used to monitor treatment safety and response:

• CBC with differential before each chemotherapy cycle (ANC, platelets, hemoglobin); chemotherapy is usually held if counts are below protocol thresholds
• Creatinine/eGFR, electrolytes (magnesium, potassium) — cisplatin; carboplatin dose is calculated from kidney function
• Liver function tests; urine protein and blood pressure (bevacizumab); thyroid function (immunotherapy)
• Tumor markers: CA-125 (epithelial ovarian), hCG (GTN)
• Imaging (CT, MRI, PET-CT) for response and recurrence; audiometry with cisplatin if symptoms
• Post-void residual after radical hysterectomy

Chemotherapy and other systemic drugs — key safety (see cancer treatment for full details)

Supportive therapy — scheduled antiemetics before chemotherapy (5-HT₃ antagonist, NK₁ antagonist, dexamethasone, olanzapine), growth factors for high neutropenia risk, transfusions, antidiarrheals for radiation enteritis, pain management, VTE prophylaxis after major pelvic surgery.

Intraperitoneal (IP) chemotherapy — drugs infused into the peritoneal cavity through an implanted port for selected ovarian cancers after optimal debulking; more abdominal pain, nausea, and catheter problems (infection, blockage, leakage, bowel injury).

Listed in priority order.

1. Emergencies during treatment
   • Infusion hypersensitivity: stop the infusion, keep the IV open with saline, assess airway and circulation, give epinephrine and other drugs per protocol
   • Neutropenic fever: temperature ≥ 38.3 °C (101 °F) once or ≥ 38.0 °C (100.4 °F) sustained over 1 hour with low ANC → cultures and IV antibiotics promptly (within 1 hour)
   • Postoperative hemorrhage, VTE, bowel obstruction, sepsis
2. Safe administration — independent double check, labs and hydration verified, blood return before vesicants; extravasation: stop, aspirate, remove, notify, antidote and compresses per protocol
3. LDR brachytherapy radiation safety
   • Private room with warning sign; time, distance, shielding — group care, work efficiently, stand at the side or foot of the bed, use lead shields; wear a dosimeter
   • No visitors who are pregnant or under 18; visits limited (commonly 30 minutes per day, 2 m / 6 ft away)
   • Bed rest, flat or with the head of the bed raised only slightly (commonly no more than about 20–30°) to keep the applicator in place; log-roll with minimal movement
   • Indwelling urinary catheter and low-residue diet (sometimes antidiarrheals) to avoid bowel movements that could move the applicator; VTE prevention (compression devices, ankle exercises)
   • If the source dislodges: never touch it — pick it up with long-handled forceps and place it in the lead container in the room; notify radiation oncology
   • Linens and dressings stay in the room until checked; after removal, the client is not radioactive
4. After radical hysterectomy — catheter care; after removal, measure post-void residuals; teach timed voiding or clean intermittent self-catheterization if needed; watch for watery vaginal discharge (fistula)
5. After vulvectomy
   • Wound care: keep clean and dry; perineal irrigation or cleansing after each voiding and bowel movement; dry with cool air (hair dryer on cool setting) if prescribed; sitz baths once permitted
   • Low-residue diet and stool softeners early to avoid contamination and straining; indwelling catheter for several days
   • Avoid crossing legs and sitting for long periods early after surgery (tension on the wound, reduced circulation); elevate legs; compression garments per plan
   • Monitor groin drains, flap viability, infection, and leg swelling
6. Radiation side effects
   • Skin: gentle cleansing with lukewarm water and mild soap, pat dry; no scented, alcohol-based, or heavy products on the field unless prescribed; loose cotton underwear; avoid heat, tape, and scratching; do not remove skin marks
   • Enteritis: low-residue, low-lactose diet during treatment, fluids, antidiarrheals; report bleeding
   • Cystitis: fluids (unless restricted), avoid caffeine, alcohol, and spicy foods; report hematuria
7. Mucositis, nutrition, and fatigue — soft toothbrush, bland rinses, no alcohol mouthwash; small frequent meals; energy conservation with light exercise
8. Lymphedema prevention and early detection — measure leg circumference, skin care, avoid tight clothing, early physiotherapy referral
9. Psychosocial and sexual care — open questions about sexual concerns; refer to counseling, support groups, palliative care as needed

• Vaginal dilator after pelvic radiation or brachytherapy: start when instructed (often a few weeks after treatment), use with water-based lubricant several times a week for months to years to prevent vaginal stenosis and allow comfortable exams and intercourse
• Surgical or radiation-induced menopause: hot flashes, vaginal dryness, bone loss — discuss treatment options with the oncology team (hormone therapy may or may not be safe depending on the cancer type)
• Fertility: discuss preservation (egg or embryo freezing, ovarian transposition before pelvic radiation) before treatment
• Infection prevention: hand hygiene, avoid sick contacts and crowds during low counts, safe food handling; call for fever of 38.0 °C (100.4 °F) or higher — do not take acetaminophen first and wait
• Bleeding precautions with low platelets: soft toothbrush, electric razor, no aspirin or NSAIDs unless prescribed
• Body fluids after chemotherapy: for at least 48 hours (longer for some drugs), flush the toilet twice with the lid down and wash soiled linens separately; condoms with intercourse during that period
• Contraception during treatment — cytotoxic drugs are teratogenic
• After gynecologic surgery: no heavy lifting or intercourse until cleared (commonly 6–8 weeks); showers but no tub baths until healed; report fever, foul discharge, heavy bleeding, calf pain, dyspnea, or urine leaking from the vagina
• Lymphedema: protect legs from injury, keep skin moisturized, avoid tight clothing and prolonged standing, report swelling or redness early
• Keep all follow-up appointments; recurrences are often found through new symptoms — vaginal bleeding, pelvic or back pain, leg swelling, cough, weight loss

• Concurrent chemoradiation = chemotherapy (e.g., weekly cisplatin) given with radiation to sensitize tumor cells
• Neoadjuvant = before surgery; adjuvant = after; palliative = symptom control
• Radical hysterectomy → bladder dysfunction; check post-void residuals
• LDR brachytherapy: private room, time–distance–shielding, no pregnant or under-18 visitors, bed rest with minimal head elevation, Foley, low-residue diet
• Dislodged source → long-handled forceps into lead container; never touch
• EBRT and HDR: the client is not radioactive after treatment
• Vulvectomy: perineal cleansing after elimination, avoid crossing legs, watch for wound breakdown and lymphedema; no tub soaking or public baths until healed (sitz baths only when ordered)
• Radiation skin: lukewarm water, mild soap, pat dry, no scented or alcohol products
• Vaginal dilators prevent stenosis after pelvic radiation
• Cisplatin: hydrate, kidneys, hearing, magnesium; paclitaxel: hypersensitivity, neuropathy
• Chemotherapy fever ≥ 38.0 °C (100.4 °F) → call immediately
• Body fluids precautions for 48 hours after chemotherapy