From the Guidelines
The National Comprehensive Cancer Network (NCCN) guidelines for serous carcinoma in the female pelvis recommend comprehensive surgical staging, including total hysterectomy, bilateral salpingo-oophorectomy (TH/BSO), and surgical staging, as the initial approach, with chemotherapy being the primary treatment for stages IB, II, III, and IV, as indicated in the guidelines 1.
Key Recommendations
- The guidelines suggest that the degree of surgical staging to assess disease status depends on intraoperative findings, and multidisciplinary expertise is recommended 1.
- For stage IA with no myometrial invasion, observation or chemotherapy with or without vaginal brachytherapy or tumor-directed radiation therapy (RT) is recommended, while for stage IA with myometrial invasion, chemotherapy with or without tumor-directed RT is suggested 1.
- For stages IB, II, III, and IV, chemotherapy is the primary treatment, with the specific regimen depending on the stage and extent of disease 1.
Diagnostic Workup
- The guidelines recommend biopsy for diagnosis, with optional CA-125 testing, and imaging studies such as MRI, CT, or PET as clinically indicated 1.
- Surgical staging, similar to that for ovarian cancer, is also recommended, including TH/BSO and assessment of lymph nodes and peritoneal surfaces 1.
Treatment Approach
- The treatment approach for serous carcinoma in the female pelvis is based on the stage and extent of disease, with a focus on comprehensive surgical staging and chemotherapy as the primary treatment modalities 1.
- The guidelines emphasize the importance of multidisciplinary expertise and individualized treatment planning to optimize outcomes for patients with this aggressive and high-risk malignancy 1.
From the Research
NCCN Guidelines for Serous Carcinoma in Female Pelvis
- The NCCN guidelines for serous carcinoma in the female pelvis recommend comprehensive surgical staging, including total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, and peritoneal biopsies 2.
- Adjuvant chemotherapy with platinum/taxane-based regimens is recommended for patients with high-grade serous carcinoma, with or without radiotherapy 3, 4.
- Optimal cytoreduction and adjuvant chemotherapy appear to improve survival in patients with uterine papillary serous carcinoma (UPSC) 3, 4.
- Therapeutic pelvic lymphadenectomy is a viable option for patients with stage I endometrial adenocarcinoma, with favorable outcomes in terms of survival and morbidity 5.
Surgical Management
- Comprehensive surgical staging is essential for accurate diagnosis and treatment of serous carcinoma in the female pelvis 2, 3, 4.
- Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy are recommended as part of the surgical management 2, 5.
- Omentectomy and peritoneal biopsies should also be performed to rule out metastatic disease 2, 3, 4.
Adjuvant Therapy
- Platinum/taxane-based chemotherapy is recommended as adjuvant therapy for patients with high-grade serous carcinoma 3, 4.
- Radiotherapy may be considered for patients with high-risk features or residual disease 3, 4.
- Bevacizumab maintenance monotherapy and olaparib maintenance monotherapy may be considered for patients with recurrent or persistent disease 6.