Emergencies in gynaecological oncology are influenced by the site of cancer, stage of disease, presence of associated comorbidities and the treatment received. Women with advanced cervical cancer may develop distressing symptoms and may present with acute admissions. Vaginal bleeding caused by endometrial cancer can be usually managed conservatively. If there is an associated pyometra, operative treatment for endometrial cancer should be preceded by intravenous antibiotic treatment to avoid septicaemia and other septic postoperative complications. In severe cases, respiratory compromise may require omission of laparoscopy or conversion to laparotomy and postoperative ventilatory support. Catastrophic haemorrhage after gynaecological cancer surgery is uncommon, owing to the extensive use of electronic haemostatic devices; however, persistent oozing from large dissected surfaces may lead to haematomas. The most common complications, which require admission during chemotherapy, are febrile neutropenia and vomiting. Complications of radiotherapy depend on radiation-related factors and patient-related characteristics.

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.

During the 1970s and 1980s, gynaecological surgeons with a special interest in oncology surgery established a number of services throughout Britain, mainly in university teaching hospitals. Most women diagnosed with cervical, uterine, ovarian, vulval or vaginal cancer continued to be managed within small district general hospitals or teaching hospitals by generalist obstetricians and gynaecologists. The Royal College of Obstetricians and Gynaecologists (RCOG) provides a complete set of standards for the provision of a streamlined service. The clinicians and commissioners should use these standards to develop national quality accounts. Research in the field of gynaecological oncology is performed as a separate entity, or the subspecialty training is extended to 3 years to include a significant component for research. Quality assurance minimum standards of care in gynaecological oncology relate to the timeliness of treatment, the functionality of multidisciplinary teams and audits of various outcomes.