This chapter lists the uses of chemotherapy in gynaecological oncology. In endometrial cancer, chemotherapy is used to treat advanced or relapsed cases where surgery and or radiotherapy are considered inappropriate, although hormone treatment is also used in these situations. In some situations, the intent of treatment may be curative, an example being trophoblastic tumours, while in others the intent is palliative, for example in recurrent epithelial ovarian cancer. In all situations, conventional chemotherapy used to kill tumour cells will also kill normal, healthy cells. This gives rise to treatment-related toxicity such as myelosuppression, emesis, alopecia and peripheral neuropathy. In general terms, until recently, the first-line therapy for cervical cancer was a choice between surgery and radiotherapy for early-stage disease with radiotherapy for advanced disease. The malignant non-epithelial tumours comprise mainly sex-cord stromal and germ-cell tumours. Of the sex-cord stromal tumours, granulosa cell tumours may require chemotherapy.

This chapter focuses on the various tumour markers relevant to gynaecological malignancies in premenopausal women and their role in management. No serological markers have been found to be sufficiently sensitive for early-stage disease or specific for screening purposes. Squamous cell carcinoma antigen (SCC) is probably a marker of cellular differentiation of squamous cells. Beta human chorionic gonadotrophin (ßhCG) has been described as an 'ideal tumour marker' in gestational trophoblastic tumours (GTN) and plays a primary role in its management. Alpha-fetoprotein (AFP) has been used as a reliable marker for monitoring treatment and detecting early relapse in nonpregnant women. None of the serum markers has a well-established role in the clinical management of endometrial cancer. The role of serum CA125 in screening women in the reproductive age group with increased risk of familial ovarian cancer is being investigated.