Conservative approach in gynecologic malignancies

Objective: This review was undertaken with the purpose of highlighting the options of a conservative approach in the management of gynecologic cancers so that clinicians exhibit some restraint before deciding on extensive surgeries as the management option. Background: Ovarian function and fertility are the main concerns while treating young women with gynecologic cancers. A conservative approach in management addresses these issues and aims at preserving the uterus and/or ovarian tissue. Early cervical and endometrial cancers, germ cell ovarian tumors, borderline ovarian tumors, and even early epithelial ovarian tumors are the gynecologic cancers where there is scope for a conservative approach. It may be in the form of radical trachelectomy for cervical cancer, medical (hormonal) treatment for endometrial carcinoma, or uterus/ovary-preserving surgeries for ovarian malignancies. On other end of the spectrum, there are advanced malignancies that may require extensive surgeries, which may further add to the morbidity. A less radical approach is in vogue in advanced ovarian malignancies where neoadjuvant chemotherapy followed by interval surgery is practiced instead of extensive primary debulking surgery. Similarly, the concept of sentinel lymph node sampling avoids unnecessary extensive lymphadenectomy in cervical cancers. Methods: A detailed literature search was made entering the terms conservative, fertility sparing, germ cell, borderline, epithelial, ovarian, trachelectomy, cervical, endometrial, neoadjuvant, and chemotherapy. Conclusions: Each relevant identified article was reviewed and a detailed overview of conservative options while managing gynecological malignancies is made.