Ablation of Gynecologic Cancers

  • Fady Khoury-Collado
  • Yukio Sonoda
Reference work entry


The use of ablative therapies in gynecologic malignancies can be divided into direct (surgical or intraoperative) and image-guided tumor ablation. In advanced-stage ovarian and endometrial cancers, the primary treatment is surgery, with the goal of removing all visible tumors. In that setting, direct ablative techniques are extremely useful and have become part of the standard modern surgical tools. The most commonly used techniques (argon beam coagulator, ultrasonic surgical aspirator, plasma surgery) along with the evidence supporting their use will be reviewed.

On the other hand, the use of image-guided therapies (radiofrequency ablation, cryotherapy, embolization) in gynecologic cancers is limited and mostly reported in the palliative setting in recurrent disease. Radiofrequency ablation is occasionally used to ablate tumors metastatic to the liver, although there is still no evidence showing a benefit to this practice. Embolization of pelvic vessels is a commonly used modality in the palliative treatment of advanced recurrent pelvic malignancies presenting with genitourinary or gastrointestinal bleeding.

Intraoperative ultrasound has been used to assist in the identification of suspicious lymph nodes, in the assessment of myometrial invasion, and in the diagnoses of adnexal masses. Unfortunately, results have been disappointing for the most part, and the use of intraoperative ultrasound remains investigational.


Ovarian Cancer Cervical Cancer Endometrial Cancer Endometrial Carcinoma Gynecologic Malignancy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Griffiths CT. Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma. Natl Cancer Inst Monogr. 1975;42:101–4.PubMedGoogle Scholar
  2. 2.
    Armstrong DK, Bundy B, Wenzel L, Gynecologic Oncology Group, et al. Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med. 2006;354:34–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Chi DS, Eisenhauer EL, Lang J, et al. What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma? Gynecol Oncol. 2006;103:559–64.CrossRefPubMedGoogle Scholar
  4. 4.
    Winter 3rd WE, Maxwell GL, Tian C, et al. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007;25:3621–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Eisenkop SM, Friedman RL, Wang HJ. Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: a prospective study. Gynecol Oncol. 1998;69:103–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Lambrou NC, Gómez-Marín O, Mirhashemi R, et al. Optimal surgical cytoreduction in patients with stage III and stage IV endometrial carcinoma: a study of morbidity and survival. Gynecol Oncol. 2004;93:653–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Goff BA, Goodman A, Muntz HG, et al. Surgical stage IV endometrial carcinoma: a study of 47 cases. Gynecol Oncol. 1994;52:237–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Chi DS, Welshinger M, Venkatraman ES, Barakat RR. The role of surgical cytoreduction in stage IV endometrial carcinoma. Gynecol Oncol. 1997;67:56–60.CrossRefPubMedGoogle Scholar
  9. 9.
    Bristow RE, Zerbe MJ, Rosenshein NB, Grumbine FC, Montz FJ. Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival. Gynecol Oncol. 2000;78:85–91.CrossRefPubMedGoogle Scholar
  10. 10.
    Eisenkop SM, Nalick RH, Wang HJ, Teng NN. Peritoneal implant elimination during cytoreductive surgery for ovarian cancer: impact on survival. Gynecol Oncol. 1993;51:224–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Rusch VW, Schmidt R, Shoji Y, Fujimura Y. Use of the argon beam electrocoagulator for performing pulmonary wedge resections. Ann Thorac Surg. 1990;49:287–91.CrossRefPubMedGoogle Scholar
  12. 12.
    Bristow RE, Montz FJ. Complete surgical cytoreduction of advanced ovarian carcinoma using the argon beam coagulator. Gynecol Oncol. 2001;83:39–48.CrossRefPubMedGoogle Scholar
  13. 13.
    Brand E, Pearlman N. Electrosurgical debulking of ovarian cancer: a new technique using the argon beam coagulator. Gynecol Oncol. 1990;39:115–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Kizer N, Zighelboim I, Rader JS. Cardiac arrest during laparotomy with argon beam coagulation of metastatic ovarian cancer. Int J Gynecol Cancer. 2009;19:237–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Bristow RE, Smith Sehdev AE, Kaufman HS, Montz FJ. Ablation of metastatic ovarian carcinoma with the argon beam coagulator: pathologic analysis of tumor destruction. Gynecol Oncol. 2001;83:49–55.CrossRefPubMedGoogle Scholar
  16. 16.
    Go PM, Bruhn EW, Garry SL, Hunter JG. Patterns of small intestinal injury with the argon beam coagulator. Surg Gynecol Obstet. 1990;171:341–2.PubMedGoogle Scholar
  17. 17.
    Go PM, Goodman GR, Bruhn EW, Hunter JG. The argon beam coagulator provides rapid hemostasis of experimental hepatic and splenic hemorrhage in anticoagulated dogs. J Trauma. 1991;31:1294–300.CrossRefPubMedGoogle Scholar
  18. 18.
    Hernandez AD, Smith Jr JA, Jeppson KG, Terreros DA. A controlled study of the argon beam coagulator for partial nephrectomy. J Urol. 1990;143:1062–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Thompson MA, Adelson MD, Jozefczyk MA, Coble DA, Kaufman LM. Structural and functional integrity of ovarian tumor tissue obtained by ultrasonic aspiration. Cancer. 1991;67:1326–31.CrossRefPubMedGoogle Scholar
  20. 20.
    van Dam PA, Tjalma W, Weyler J, van Oosterom AT, Buytaert P. Ultraradical debulking of epithelial ovarian cancer with the ultrasonic surgical aspirator: a prospective randomized trial. Am J Obstet Gynecol. 1996;174:943–50.CrossRefPubMedGoogle Scholar
  21. 21.
    Deppe G, Malviya VK, Malone Jr JM, Christensen CW. Debulking of pelvic and para-aortic lymph node metastases in ovarian cancer with the cavitron ultrasonic surgical aspirator. Obstet Gynecol. 1990;76:1140–2.PubMedGoogle Scholar
  22. 22.
    Rose PG. The cavitational ultrasonic surgical aspirator for cytoreduction in advanced ovarian cancer. Am J Obstet Gynecol. 1992;166:843–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Deppe G, Malviya VK, Malone Jr JM. Debulking surgery for ovarian cancer with the Cavitron Ultrasonic Surgical Aspirator (CUSA)–a preliminary report. Gynecol Oncol. 1988;31:223–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Deppe G, Malviya VK, Malone Jr JM. Use of Cavitron Ultrasonic Surgical Aspirator (CUSA) for palliative resection of recurrent gynecologic malignancies involving the vagina. Eur J Gynaecol Oncol. 1989;10:1–2.PubMedGoogle Scholar
  25. 25.
    Rader JS, Leake JF, Dillon MB, Rosenshein NB. Ultrasonic surgical aspiration in the treatment of vulvar disease. Obstet Gynecol. 1991;77:573–6.PubMedGoogle Scholar
  26. 26.
    Matsuo K, Chi DS, Walker LD, Rosenshein NB, Im DD. Ultrasonic surgical aspiration for vaginal intraepithelial neoplasia. Int J Gynaecol Obstet. 2009;105:71–3.CrossRefPubMedGoogle Scholar
  27. 27.
    Donovan JT, Veronikis DK, Powell JL, Lundy LE, Préfontaine M. Cytoreductive surgery for ovarian cancer with the Cavitron Ultrasonic Surgical Aspirator and the development of disseminated intravascular coagulation. Obstet Gynecol. 1994;83:1011–4.CrossRefPubMedGoogle Scholar
  28. 28.
    van Dam PA, Coppens M, van Oosterom AT, Van Marck E, Buytaert P. Is there an increased risk for tumor dissemination using ultrasonic surgical aspiration in patients with vulvar carcinoma? Eur J Obstet Gynecol Reprod Biol. 1994;55:145–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Nahhas WA. A potential hazard of the use of the surgical ultrasonic aspirator in tumor reductive surgery. Gynecol Oncol. 1991;40:81–3.CrossRefPubMedGoogle Scholar
  30. 30.
    Sonoda Y, Olvera N, Chi DS, Brown CL, Abu-Rustum NR, Levine DA. Pathologic analysis of ex vivo plasma energy tumor destruction in patients with ovarian or peritoneal cancer. Int J Gynecol Cancer. 2010;20(8):1326–30.PubMedGoogle Scholar
  31. 31.
    Gervais DA, Arellano RS, Mueller PR. Percutaneous radiofrequency ablation of ovarian cancer metastasis to the liver: indications, outcomes, and role in patient management. AJR Am J Roentgenol. 2006;187:746–50.CrossRefPubMedGoogle Scholar
  32. 32.
    Gervais DA, Arellano RS, Mueller PR. Percutaneous radiofrequency ablation of nodal metastases. Cardiovasc Intervent Radiol. 2002;25:547–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Jacobs IA, Chang CK, Salti G. Hepatic radiofrequency ablation of metastatic ovarian granulosa cell tumors. Am Surg. 2003;69:416–8.PubMedGoogle Scholar
  34. 34.
    Bojalian MO, Machado GR, Swensen R, Reeves ME. Radiofrequency ablation of liver metastasis from ovarian adenocarcinoma: case report and literature review. Gynecol Oncol. 2004;93:557–60.CrossRefPubMedGoogle Scholar
  35. 35.
    Mateo R, Singh G, Jabbour N, Palmer S, Genyk Y, Roman L. Optimal cytoreduction after combined resection and radiofrequency ablation of hepatic metastases from recurrent malignant ovarian tumors. Gynecol Oncol. 2005;97:266–70.CrossRefPubMedGoogle Scholar
  36. 36.
    Schumacher G, Eisele R, Spinelli A, et al. Indications for hand-assisted laparoscopic radiofrequency ablation for liver tumors. J Laparoendosc Adv Surg Tech A. 2007;17:153–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Bleicher RJ, Allegra DP, Nora DT, Wood TF, Foshag LJ, Bilchik AJ. Radiofrequency ablation in 447 complex unresectable liver tumors: lessons learned. Ann Surg Oncol. 2003;10:52–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Baust JG, Gage AA. The molecular basis of cryosurgery. BJU Int. 2005;95:1187–91.CrossRefPubMedGoogle Scholar
  39. 39.
    Solomon LA, Munkarah AR, Vorugu VR, et al. Image-guided percutaneous cryotherapy for the management of gynecologic cancer metastases. Gynecol Oncol. 2008;111:202–7.CrossRefPubMedGoogle Scholar
  40. 40.
    Smith DC, Wyatt JF. Embolization of the hypogastric arteries in the control of massive vaginal hemorrhage. Obstet Gynecol. 1977;49:317–22.PubMedGoogle Scholar
  41. 41.
    Lin YC, Kudelka AP, Lawrence D, et al. Transcatheter arterial embolization for the control of life-threatening pelvic hemorrhage in a patient with locally advanced cervix carcinoma. Eur J Gynaecol Oncol. 1996;17:480–3.PubMedGoogle Scholar
  42. 42.
    Burchell RC. Physiology of internal iliac artery ligation. J Obstet Gynaecol Br Commonw. 1968;75:642–51.CrossRefPubMedGoogle Scholar
  43. 43.
    Spinosa DJ, Angle JF, McGraw JK, Maurer EJ, Hagspiel KD, Matsumoto AH. Transcatheter treatment of life-threatening lower gastrointestinal bleeding due to advanced pelvic malignancy. Cardiovasc Intervent Radiol. 1998;21:503–5.CrossRefPubMedGoogle Scholar
  44. 44.
    Lang EK. Transcatheter embolization of pelvic vessels for control of intractable hemorrhage. Radiology. 1981;140:331–9.CrossRefPubMedGoogle Scholar
  45. 45.
    Mihmanli I, Cantasdemir M, Kantarci F, et al. Percutaneous embolization in the management of intractable vaginal bleeding. Arch Gynecol Obstet. 2001;264:211–4.CrossRefPubMedGoogle Scholar
  46. 46.
    Frati A, Ducarme G, Wernet A, Chuttur A, Vilgrain V, Luton D. Uterine artery embolization as treatment for life-threatening haemorrhage from a cervical choriocarcinoma: a case report. Eur J Obstet Gynecol Reprod Biol. 2008;141:87–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Yamashita Y, Harada M, Yamamoto H, et al. Transcatheter arterial embolization of obstetric and gynaecological bleeding: efficacy and clinical outcome. Br J Radiol. 1994;67:530–4.CrossRefPubMedGoogle Scholar
  48. 48.
    Ryo E. Diagnostic value of intraoperative ultrasonography to assess para-aortic lymph nodes in women with ovarian and uterine corpus malignancy. Ultrasound Obstet Gynecol. 2008;32:91–6.CrossRefPubMedGoogle Scholar
  49. 49.
    Teefey SA, Roarke MC, Brink JA, et al. Bowel wall thickening: differentiation of inflammation from ischemia with color Doppler and duplex US. Radiology. 1996;198:547–51.CrossRefPubMedGoogle Scholar
  50. 50.
    Yang WT, Cheung TH, Ho SS, Yu MY, Metreweli C. Comparison of laparoscopic sonography with surgical pathology in the evaluation of pelvic lymph nodes in women with cervical cancer. AJR Am J Roentgenol. 1999;172:1521–5.CrossRefPubMedGoogle Scholar
  51. 51.
    Cheung TH, Lo WK, Yu MY, Yang WT, Ho S. Extended experience in the use of laparoscopic ultrasound to detect pelvic nodal metastasis in patients with cervical carcinoma. Gynecol Oncol. 2004;92:784–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Yang WT, Yuen PM, Ho SS, Leung TN, Metreweli C. Intraoperative laparoscopic sonography for improved preoperative sonographic pathologic characterization of adnexal masses. J Ultrasound Med. 1998;17:53–61.CrossRefPubMedGoogle Scholar
  53. 53.
    Cline HE, Hynynen K, Watkins RD, et al. Focused US system for MR imaging-guided tumor ablation. Radiology. 1995;194:731–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Gorny KR, Woodrum DA, Brown DL, et al. Magnetic resonance-guided focused ultrasound of uterine leiomyomas: review of a 12-month outcome of 130 clinical patients. J Vasc Interv Radiol. 2011;22:857–64.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Gynecology Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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