then excision of the uterus is performed. Otherwise, a combination of hysterectomy and radiotherapy is frequently employed. This combination approach may be substituted with chemoradiotherapy alone in some. Endometrial cancer Hysterectomy and bilateral oophorectomy is performed for early stage disease. More aggressive cases with lymphatic spread are often treated with radiotherapy. Hormone therapy is most commonly used to treat systemic spread, as endometrial cancer patients tend to be older and have other illnesses that make them poor candidates to withstand harsh cytotoxic agents used in chemotherapy. Minimal laparoscopic surgery is used for endometrial cancer more than any other gynecologic cancer, and may confer advantages over classical surgical interventions. Vulvar cancer Low incidence means that evidence-based therapy is relatively weak, but emphasis is placed on accurate assessment of cancerous tissue and reducing lymphatic spread. The minority of non-squamous histological subtypes do not typically require removal of the inguinal nodes. However, this is necessary to prevent spread in squamous cell carcinomas exceeding 1 mm in stromal invasion. If nodal disease is confirmed, adjuvant radiotherapy is administered. Vaginal cancer Treatment depends on the stage of vaginal cancer. Surgical resection and definitive radiotherapy are the first-line of treatment for early-stage vaginal cancer. Surgery is preferred over radiotherapy due to the preservation of the ovaries and sexual function as well as the elimination of the risk of radiation. For more advanced stages of vaginal cancer, external-beam radiation therapy (EBRT) is the standard method for treatment. External-beam radiation therapy involves the delivery of a boost to the pelvic side of the patient at a 45 Gy dose. Epidemiology 1 in 70 women will develop ovarian cancer at some point in their life. Scandinavian countries have an incidence appropriately 6.5 times higher than that of Japan's. This is due to multifactorial reasons, both of genetic and environmental nature. Cervical cancer makes up the largest percentage of gynaecological cancers. Women in developing countries tend to present with more advanced cases. Quality of life Sexuality The experience of cancer influences the psychological aspect of sexuality, by posing a risk of developing barriers such as body image issues, low self esteem, and low mood or anxiety. Other barriers include changes to reproductive organs or sex drive as well as potential genital pain. Partners may also be affected by these changes in the relationship, especially with regards to intimacy and sexuality, which may in turn affect gynecological cancer patients by creating