Gynecologic Cancers

Shared clinical principles across ovarian, cervical, and uterine (endometrial) cancers — epidemiology, biomarker testing, systemic backbones, and immunotherapy

Key Points

Scope & Shared Framework

Gynecologic oncology encompasses cancers of the ovary/fallopian tube/peritoneum, cervix, and uterine corpus (endometrium), along with rarer vulvar, vaginal, and gestational trophoblastic diseases. Although each site has a distinct natural history, they share enough clinical infrastructure — surgical staging, a platinum/taxane systemic backbone, and increasingly overlapping targeted and immunotherapy strategies — that a unified framework is useful at the point of care. This guide covers the principles common to the three most frequently encountered histologies. For stage-by-stage management,…

Epidemiology & Prevention

Endometrial (uterine corpus) cancer is the most common gynecologic malignancy in the United States, and one of the few cancers whose incidence and mortality are rising — driven largely by the obesity epidemic, since adipose tissue is a peripheral source of unopposed estrogen. Most cases are diagnosed at an early, curable stage because postmenopausal bleeding prompts timely evaluation. Ovarian cancer is less common but disproportionately lethal: the absence of an effective screening test and the vague, nonspecific nature of early symptoms (bloating, early satiety, pelvic discomfort) mean the…

Biomarker Testing at Diagnosis

Universal, histology-directed biomarker testing is now the standard of care and should be initiated at diagnosis rather than at recurrence, because the results define first-line and maintenance eligibility. Ovarian cancer: All patients with epithelial ovarian cancer should undergo germline and somatic BRCA1/2 testing and homologous recombination deficiency (HRD) testing. BRCA status and HRD status stratify the magnitude of benefit from PARP inhibitor maintenance. Folate receptor alpha (FRα) expression should be assessed in platinum-resistant disease to identify candidates for mirvetuximab…

Shared Systemic Backbone

Despite their biological differences, all three cancers rely on a platinum/taxane chemotherapy backbone as the foundation of first-line systemic therapy. Carboplatin plus paclitaxel is the shared workhorse: it is the standard adjuvant and first-line regimen for advanced ovarian cancer, the backbone for advanced/recurrent endometrial cancer, and — with the addition of cisplatin-based chemoradiation — a component of locally advanced cervical cancer management. Carboplatin dosing uses the Calvert formula (AUC × [GFR + 25]); paclitaxel is given by body surface area. Bevacizumab, an anti-VEGF…

Targeted Therapy & Immunotherapy

The most consequential recent advances across gynecologic oncology come from biomarker-directed maintenance, targeted agents, and immune checkpoint inhibition.

Principles of Immunotherapy in Gynecologic Cancers

Immune checkpoint inhibition has moved from late-line salvage to the front line across gynecologic oncology, but its role is tightly linked to biomarker context. In endometrial cancer, the dMMR/MSI-high subset (~25–30% of tumors) is exquisitely sensitive to PD-1 blockade; dostarlimab or pembrolizumab added to carboplatin/paclitaxel is now standard front-line therapy, with the dMMR group deriving the largest benefit. For mismatch-repair-proficient (pMMR) tumors, the pembrolizumab plus lenvatinib combination overcomes some of the relative immune resistance and improves survival after platinum…