Complications
The most common adverse effects of programmed cell death protein-1 (PD-1) or programmed cell death ligand-1 (PD-L1) inhibitor therapies are: anaemia (45.4%), fatigue (34.3%), dysphagia (30.0%), neutropenia (19.6%), lymphopenia (10.2%), hypertension (9.3%), and elevated lipase (7.2%).[107] Other potential adverse effects include colitis, myocarditis, pericarditis, and skin toxicities.[234]
Guidelines for monitoring of patients and management of complications are available.[235]
Pre-menopausal women may have significant, debilitating menopausal symptoms after bilateral oophorectomy, including hot flushes, night sweats, and genital tract atrophy.
There is a theoretical risk of promoting residual tumour growth and increasing the chance of recurrence if using hormone replacement therapy (HRT) containing oestrogen.
Limited evidence suggests that HRT does not cause significant harm if used after treatment for low-grade, early-stage endometrial cancer.[231][232] Non-hormonal approaches for management of menopausal symptoms are recommended in women with advanced disease or high-risk early-stage cancer.[232]
Patients may have bladder pain, incontinence, urgency, haematuria, or symptoms of cystitis.
Often a complex of both instability and denervation.
Nerve-sparing surgery is potentially one of the advantages of robotic surgery.
Late consequences of radiation.
Maintenance of vaginal patency with vaginal dilators during radiotherapy is important to preserve sexual function and permit adequate follow-up pelvic examinations.[223]
Occurs in approximately 25% of patients.[223]
Patient education and counselling (preferably involving both partners) are very important components of managing sexual dysfunction.
Pharmacological approaches include topical oestrogens and transcutaneous testosterone.
The following patterns of disease spread may occur in women with endometrial cancer: local, involving the vagina; lymphatic (pelvic, para-aortic, or inguinal lymph nodes); haematogenous (lungs, bone, liver, adrenals, brain); transcoelomic to the bladder and bowel.[132]
Leg oedema may occur after lymphadenectomy with or without radiotherapy.
Often dismissed, but common, disfiguring, and disabling.
Variable presentation and predictability; patients may have rash, nausea, hair loss, mouth ulcers, weight loss, gastrointestinal pain, bleeding, diarrhoea, or peripheral neuropathy.[233]
Incontinence is a devastating late consequence of radiotherapy, and commonly requires surgical diversion (i.e., colostomy, urostomy) as primary reconstruction can be difficult because of poor tissue healing.[223]
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