Although radiotherapy and surgery offer equivalent disease control for early disease (stage Ia, Ib₁ and IIa) [4], for more advanced disease (i.e. stage Ib₂ and above) chemoradiotherapy is the treatment of choice. Chemoradiation involves the use of a cisplatin chemotherapy given concurrently with external beam treatment. A Meta-analysis of thirteen chemoradiotherapy studies has shown a 6 % improvement in 5 year survival compared to radiation alone [5].

Cisplatin is nephrotoxic, and good renal function is a prerequisite as it is mainly excreted through kidneys. It is essential that renal function is optimised promptly and prior to treatment commencing. Hydronephrosis should be relieved by nephrostomy and/or stent placement before chemoradiotherapy starts. Radiation fields encompass the uterus, cervix upper vagina and pelvic nodes up to the aortic bifurcation. The para-aortic nodal region is only included if clinically indicated. Daily treatment over 5–6 weeks is given followed by intracavity brachytherapy using a radioactive source, allowing a total dose of at least 75–80 Gray (Gy) to be delivered to the cervical tumour. If the patient is frail shorter radiotherapy schedules may be used without the addition of chemotherapy. Palliative care input may be useful in addressing symptom control (particularly pelvic pain) and psychological support.

Metastatic disease is incurable and management is aimed at symptom control. Radiotherapy, chemotherapy or surgery may all be useful at this time.

Cancer of the uterine body predominantly affects post-menopausal women and is the commonest gynaecological cancer with an age-adjusted incidence of 24.7 per 100,000 population [6]. It is increasing in incidence in developed countries, which is almost certainly related to the rising problem of obesity. In developing countries it remains a relatively uncommon malignancy. Risk factors are shown include obesity, unopposed oestrogen exposure (related to hormone replacement therapy, anovulatory cycles, polycystic ovary syndrome), nulliparity, hypertension, diabetes, tamoxifen, genetic predisposition e.g. HNPCC

Surgery is the preferred treatment of uterine cancer. This involves hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy. This may be done either laparascopically or as an open laparotomy.

For early disease (stage 1 and 2) the need for adjuvant radiotherapy is determined by an assessment of risk factors that include tumour grade, depth of myometrial invasion, presence of lymphovascular space invasion and clear cell or serous cell type.

Well-differentiated tumours with minimal muscle invasion are deemed low risk for recurrence and no further treatment is indicated. Where there is deep muscle invasion but the tumour is either well or moderately differentiated and there is no lymphovascular space invasion the risk of recurrence is considered to be in the range of 5–10 % and brachytherapy to the vaginal vault may be offered [9]. Where there is deep muscle invasion, poorly differentiated tumours and clear cell or serous pathology external beam radiotherapy to the pelvis has been shown to reduce the risk of loco-regional relapse [10].

The use of adjuvant chemotherapy in the post-operative setting remains uncertain. There does appear to be a disease free survival benefit, which has yet to be proven to offer an overall survival advantage [11]. Ongoing studies are addressing this [4, 10].

Where patients are unsuitable for a surgical approach, radiotherapy may be considered for primary treatment.

Locally recurrent disease may be successfully treated with surgery or, where it has not previously been used, radiotherapy. Systemic treatment may be of palliative value in recurrent or metastatic disease. In tumours with estrogen and progesterone receptors hormonal manipulation carries a 15–30 % response rate. Similar findings are seen with chemotherapy.

Colorectal cancer is the third commonest cancer in both men and women in the USA. Between 1998 and 2002 the US incidence was 52/100,000 population. Mortality from colorectal cancers has declined mainly because of increased screening and polyp removal [12]. Cancer of the colon and rectum remains, however, one of the leading causes of cancer-related morbidity and mortality in most parts of the developed world [13]. The incidence of colo-rectal cancer increases with age, rising sharply after the age of 60. There is a large geographical variation in incidence with Africa and Asia having a much lower incidence than Western Countries. The majority are found in the rectum (almost 40 %) and sigmoid colon (20 %).

Digital examination may reveal rectal tumours but endoscopic evaluation with biopsy is needed. Assessment of the entire lower gastrointestinal tract is mandatory since about 3 % of tumours are associated with synchronous bowel lesions.