Jinekolojik Kanserlerde Güncel Tedavi Yaklaşımları
Özet
Bu çalışma, endometrium, epitelyal over/tüp/periton, germ hücreli over, serviks, vulva ve vajina kanserleri gibi jinekolojik malignitelerin güncel tanı, cerrahi ve adjuvan tedavi yaklaşımlarını kapsamlı bir şekilde ele almaktadır. Gelişmiş ülkelerde en sık rastlanan jinekolojik kanser olan endometrium kanseri, evresine ve risk faktörlerine göre cerrahi, brakiterapi, pelvik radyoterapi ve sistemik kemoterapi (karboplatin-paklitaksel) ile tedavi edilirken; düşük riskli hastalarda adjuvan tedaviye ihtiyaç duyulmaz. En ölümcül jinekolojik kanser olan epitelyal over tümörlerinde temel amaç maksimum sitoredüktif cerrahi ile geride gözle görülür tümör bırakmamaktır (R0); ileri evre veya cerrahiye uygun olmayan olgularda neoadjuvan kemoterapi ve interval sitoredüksiyon tercih edilir. Genç hastalarda görülen germ hücreli tümörlerde kemoterapiye yüksek hassasiyet nedeniyle metastatik evrede dahi fertilite koruyucu cerrahi ön plandadır. Serviks kanserinde tedavi FIGO evrelemesine göre radikal cerrahi veya kemoradyoterapi olarak belirlenir; nüksler genellikle ilk iki yılda izlenir. Nadir görülen vulva kanserlerinde cerrahi eksizyon ve lenfadenektomi temel yaklaşımken, lokal ileri evrede kemoradyoterapi etkilidir. Genellikle metastatik karakterde olan vajinal kanserlerde ise organ koruyucu avantajı nedeniyle radyoterapi ilk seçenektir. Son olarak, jinekolojik tümörlerde lenf ödemi azaltmak amacıyla indosiyanin yeşili gibi boyalarla sentinel lenf nodu biyopsisi güncel bir alternatif olarak öne çıkmaktadır.
This study comprehensively covers current diagnosis, surgery, and adjuvant treatment approaches for gynecological malignancies, including endometrial, epithelial ovarian/tubal/peritoneal, germ cell ovarian, cervical, vulvar, and vaginal cancers. While endometrial cancer, the most common gynecological cancer in developed countries, is treated with surgery, brachytherapy, pelvic radiotherapy, and systemic chemotherapy (carboplatin-paclitaxel) based on its stage and risk factors, adjuvant therapy is not required for low-risk patients. In epithelial ovarian tumors, the most lethal gynecological cancer, the primary goal is maximal cytoreductive surgery to leave no visible residual tumor (R0); neoadjuvant chemotherapy and interval cytoreduction are preferred for advanced stages or cases unsuitable for primary surgery. Due to high chemosensitivity, fertility-sparing surgery is prioritized even in metastatic stages for germ cell tumors seen in younger patients. Treatment for cervical cancer is determined as radical surgery or chemoradiotherapy according to FIGO staging, with recurrences mostly occurring within the first two years. In rare vulvar cancers, surgical excision and lymphadenectomy are the main approaches, while chemoradiotherapy is effective in locally advanced disease. For vaginal cancers, which are generally metastatic, radiotherapy is the first choice due to its organ-preserving advantage. Finally, sentinel lymph node biopsy using dyes like indocyanine green stands out as a current alternative to reduce lymphedema in gynecological tumors.
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