title: The physical consequences of gynecologic cancer surgery and their impact on sexual, emotional, and quality of life issues.
abstract: BACKGROUND
  Surgical management of gynecologic cancer can cause short- and long-term effects on sexuality, reproductive function, and overall quality of life (QOL) (e.g., sexual dysfunction, infertility, lymphedema). However, innovative approaches developed over the past several decades have improved oncologic outcomes and reduced treatment sequelae.
  
  
  OBJECTIVE
  To provide an overview of the standards of care and major advancements in gynecologic cancer surgery, with a focus on their direct physical impact, as well as emotional, sexual, and QOL issues. This overview will aid researchers and clinicians in the conceptualization of future clinical care strategies and interventions to improve sexual/vaginal/reproductive health and QOL in gynecologic cancer patients.
  
  
  METHODS
  Comprehensive overview of the literature on gynecologic oncology surgery.
  
  
  METHODS
  Conceptual framework for this overview follows the current standards of care and recent surgical approaches to treat gynecologic cancer, with a brief overview describing primary management objectives and the physical, sexual, and emotional impact on patients. Extensive literature support is provided.
  
  
  RESULTS
  The type and radicality of surgical treatment for gynecologic cancer can influence sexual function and play a significant role in QOL. Psychological, sexual, and QOL outcomes improve as surgical procedures continue to evolve. Procedures for fertility preservation, laparoscopy, sentinel lymph node mapping, and robotic and risk-reducing surgery have advanced the field while reducing treatment sequelae. Nevertheless, interventions that address sexual and vaginal health issues are limited.
  
  
  CONCLUSIONS
  It is imperative to consider QOL and sexuality during the treatment decision-making process. New advances in detection and treatment exist; however, psycho-educational interventions and greater patient-physician communication to address sexual and vaginal health concerns are warranted. Large, prospective clinical trials including patient-reported outcomes are needed in gynecologic oncology populations to identify subgroups at risk. Future study designs need clearly defined samples to gain insight about sexual morbidity and foster the development of targeted interventions.
authors: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. carterj@mskcc.org
authors: Jeanne
authors: J
authors: Carter
authors: Cara
authors: C
authors: Stabile
authors: Abigail
authors: A
authors: Gunn
authors: Yukio
authors: Y
authors: Sonoda
mesh_terms: D005260:Female; D059247:Fertility Preservation / Q000379:methods; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000523:psychology / Q000534:rehabilitation; D006801:Humans; D008209:Lymphedema / Q000209:etiology; D008594:Menopause, Premature; D011788:Quality of Life; D060728:Reproductive Health; D012735:Sexual Dysfunction, Physiological / Q000209:etiology* / Q000628:therapy; D019529:Sexuality