The principles of palliative care form an important part of disease management and are encouraged as part of good practice for all health professionals caring for the women. Knowledge and application of the principles of palliative care should be part of the practice of health care professionals. This chapter discusses the management of the common symptoms associated with gynaecological malignancies. Hypercalcaemia of malignancy is common in cervical carcinoma and is a poor prognostic indicator. Clinical features include anorexia, nausea, vomiting, constipation, drowsiness and confusion but it should be looked for in patients who are deteriorating with no clear reason. Although syringe drivers are used at the end of life, they can be appropriate at other stages of illness. The chapter tabulates the drugs which can be mixed with morphine or diamorphine in a syringe driver. Provision of palliative care to women with gynaecological cancer requires excellent communication and team working.

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.

The widespread use of ultrasound in the first trimester for dating and for viability and nuchal fold assessment has increased the detection of ovarian masses. The use of high-frequency transvaginal probes has allowed the detailed imaging of cystic pelvic masses. Cervical and ovarian cancers are the gynaecological malignancies most frequently diagnosed in pregnancy. Most non-benign ovarian cysts found in pregnancy are borderline tumours or germ cell tumours. Ultrasound imaging of ovarian cysts or masses is helpful in identifying lesions that are of a suspicious nature. A significant proportion of germ cell tumours in pregnancy are dysgerminomas. Presentation and diagnosis at an early stage of pregnancy does not always warrant termination of pregnancy as there are several reports of uneventful term pregnancies despite administration of chemotherapy. If malignancy is suspected, a full staging laparotomy is needed either immediately or after delivery.