Failure patterns in gynecologic cancer.

In reviewing the literature on the patterns of failure in gynecologic malignancies, it is essential to define the type of recurrence resulting from the treatment program pursued. Categorizing them into local recurrences, marginal recurrences, parametrial recurrences, periaortic lymph node recurrences, abdominal recurrences, and distant metastatic disease become an important part in the design of new treatment programs in management. Most recurrences are actually the result of persistent disease. Therefore, the full extent of disease at the time of initial presentation should be determined. Pre-treatment surgical exploration obviously defines more precisely the tumor extent than does clinical stage alone. Samples of retroperitoneal abdominal lymph nodes in cervical, endometrial and ovarian cancer have shown more frequent involvement than previously suspected.