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Gynecologic Cancer: From Diagnosis to Treatment

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Causes, Screening and Diagnosis".

Deadline for manuscript submissions: 1 July 2024 | Viewed by 16943

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Special Issue Editor

Dr. Vito Andrea Capozzi

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Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy
Interests: laparoscopy; gynecology; oncology

Special Issue Information

Dear Colleagues,

In recent years, enormous progress has been achieved in the diagnosis and treatment of gynecological diseases. Transvaginal ultrasound has now attained diagnostic sensitivities that are superimposable, if not superior, to 'traditional' instrumental investigations. Furthermore, surgical and medical treatment of gynecological pathologies have evolved toward increasingly personalized medicine. The advancement of knowledge has led to the molecular characterization of gynecologic pathologies for better understanding the pathology itself, allowing targeted and personalized therapies. Finally, new research has led to increasingly less invasive surgery in both oncology and benign pathology.

Despite this impressive medical advancement, many questions still remain unresolved. The weight of molecular characterization versus pathological prognostic criteria in endometrial cancer, the role of minimally invasive surgery in cervical cancer, and the role of new maintenance therapies in ovarian cancer recurrence deserve to be better understood.

The purpose of this Special Issue is to provide new insights into the future frontiers of scientific research in gynecology from diagnosis to treatment.

Dr. Vito Andrea Capozzi
Guest Editor

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Keywords

endometrial cancer
cervical cancer
ovarian cancer
borderline ovarian tumor
diagnosis and treatment

Published Papers (13 papers)

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Research

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11 pages, 2803 KiB

Open AccessArticle

P16/Ki67 Dual Staining in Glandular Cell Abnormalities of the Uterine Cervix

by Saša Jeromel, Alenka Repše Fokter and Andraž Dovnik

Cancers 2024, 16(9), 1621; https://doi.org/10.3390/cancers16091621 - 23 Apr 2024

Viewed by 298

Abstract

Very limited information exists about the role of p16/Ki67 dual staining on glandular cells in detecting glandular precancerous lesions and cervical adenocarcinoma. In this study, we investigated the diagnostic accuracy of p16/Ki67 dual staining for the detection of glandular and squamous lesions on the uterine cervix and for cancer of the upper reproductive tract. We performed a retrospective analysis of prospectively collected data on 96 patients with glandular cell abnormalities. We analyzed the diagnostic accuracy of p16/Ki67 dual staining for atypical glandular cells, not otherwise specified (AGC-NOS); atypical glandular cells, favor neoplastic (AGC-FN); adenocarcinoma in situ (AIS); and A-CA (cervical adenocarcinoma). A separate analysis for the detection of squamous precancerous lesions and squamous-cell carcinoma (CIN3+) and for cancer of the upper reproductive tract (EC/OC) was performed. Among patients who had normal histology or a low-grade lesion on final analysis, only 8.5% had positive dual staining. On the other hand, 85.7% of patients with AIS+ on final histology had positive dual staining. The respective specificities of p16/Ki67 dual staining on AGC-NOS for the detection of AIS+ (adenocarcinoma in situ or cervical adenocarcinoma), CIN3+ and EC/OC were 91.5%, 88.7% and 86.4%. High specificity values of p16/Ki67 dual staining on cervical smears labelled as AGC-NOS for the detection of CIN3+ and AIS+ suggest that this method might be a useful addition in cervical cancer screening. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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15 pages, 2990 KiB

Open AccessArticle

Preliminary Experience with Virtual Monoenergetic Imaging and Iodine Mapping in the Primary Staging of Endometrial Cancer

by Stephanie Tina Sauer, Henner Huflage, Sara Aniki Christner, Theresa Sophie Patzer, Matthias Kiesel, Anne Quenzer, Andreas Steven Kunz, Thorsten Alexander Bley and Jan-Peter Grunz

Cancers 2024, 16(6), 1229; https://doi.org/10.3390/cancers16061229 - 20 Mar 2024

Viewed by 619

Abstract

This study investigated whether virtual monoenergetic images (VMIs) and iodine mapping based on dual-energy CT (DECT) provide advantages in the assessment of endometrial cancer. A dual-source DECT was performed for primary staging of histologically proven endometrioid adenocarcinoma in 21 women (66.8 ± 12.0 years). In addition to iodine maps, VMIs at 40, 50, 60, 70, and 80 keV were reconstructed from polyenergetic images (PEIs). Objective analysis comprised the measurement of tumor contrast, contrast-to-noise ratio, and normalized iodine concentration (NIC). In addition, three radiologists independently rated tumor conspicuity. The highest tumor contrast (106.6 ± 45.0 HU) and contrast-to-noise ratio (4.4 ± 2.0) was established for VMIs at 40 keV. Tumor contrast in all VMIs ≤ 60 keV was higher than in PEIs (p < 0.001). The NIC of malignant tissue measured in iodine maps was substantially lower compared with a healthy myometrium (0.3 ± 0.1 versus 0.6 ± 0.1 mg/mL; p < 0.001). Tumor conspicuity was highest in 40 keV datasets, whereas no difference was found among PEIs and VMIs at 60 and 70 keV (p ≥ 0.334). Interobserver agreement was good, indicated by an intraclass correlation coefficient of 0.824 (0.772–0.876; p < 0.001). In conclusion, computation of VMIs at 40 keV and color-coded iodine maps aids the assessment of endometroid adenocarcinoma in primary staging. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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0 pages, 973 KiB

Open AccessArticle

Real-World Data Assessing the Impact of Lymphovascular Space Invasion on the Diagnostic Performance of Sentinel Lymph Node Mapping in Endometrial Cancer

by Carol A. Buechi, Franziska Siegenthaler, Laura Sahli, Andrea Papadia, Flurina A. M. Saner, Stefan Mohr, Tilman T. Rau, Wiebke Solass, Sara Imboden and Michael D. Mueller

Cancers 2024, 16(1), 67; https://doi.org/10.3390/cancers16010067 - 22 Dec 2023

Viewed by 649

Abstract

Background: SLN mapping has emerged as a standard of care in endometrial cancer due to its high sensitivity and significant reduction in morbidity. Although lymphovascular space invasion (LVSI) is a known risk factor for lymph node metastasis and recurrence, evidence on the reliability of SLN mapping in LVSI-positive patients is scarce. The aim of this study was to determine the impact of LVSI on the diagnostic performance of SLN mapping. Methods: This retrospective cohort study included patients with endometrial cancer who underwent primary surgical treatment at the Bern University Hospital, Switzerland, between 2012 and 2022. Results: LVSI was present in 22% of patients and was significantly associated with lymph node metastasis (p < 0.001) and recurrence (p < 0.001). In node-negative patients with only SLN mapping performed, LVSI was an independent predictor of recurrence during multivariable Cox regression analysis (p = 0.036). The negative predictive value of SLN mapping was 91.5% and was significantly lower in tumors with LVSI (75.0%) compared to LVSI-negative tumors (95.6%, p = 0.004). Conclusion: The presence of LVSI was significantly associated with worse oncological outcomes. LVSI was an independent predictor of recurrence in node-negative patients with only SLN mapping performed. Furthermore, the negative predictive value of SLN mapping was significantly lower in LVSI-positive tumors. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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12 pages, 526 KiB

Open AccessArticle

“Things Have Changed”—Laparoscopic Cytoreduction for Advanced and Recurrent Ovarian Cancer: The Experience of a Referral Center on 108 Patients

by Marcello Ceccaroni, Giovanni Roviglione, Francesco Bruni, Susan Dababou, Martina Venier, Carlotta Zorzi, Matteo Salgarello, Giacomo Ruffo, Filippo Alongi, Stefania Gori, Lorenza Driul, Stefano Uccella and Fabio Barra

Cancers 2023, 15(24), 5726; https://doi.org/10.3390/cancers15245726 - 6 Dec 2023

Viewed by 825

Abstract

Objective: To report the feasibility of laparoscopic cytoreduction surgery for primary and recurrent ovarian cancer in a select group of patients. Methods: A retrospective analysis was conducted on a cohort of patients with FIGO stage IIIA-IV advanced ovarian cancer who underwent laparoscopic primary debulking surgery (PDS), interval debulking surgery (IDS), or secondary debulking surgery (SDS) between June 2008 and January 2020. The primary endpoint was achieving optimal cytoreduction, defined as residual tumor less than 1 cm. Secondary endpoints included evaluating surgical complications and long-term survival, assessed at three-month intervals during the initial two years and then every six months. Results: This study included a total of 108 patients, among whom, 40 underwent PDS, 44 underwent IDS, and 24 underwent SDS. Optimal cytoreduction rates were found to be 95.0%, 97.7%, and 95.8% for the PDS, ISD, and SDS groups, respectively. Early postoperative complications (<30 days from surgery) occurred in 19.2% of cases, with 7.4% of these cases requiring reintervention. One patient died following postoperative respiratory failure. Late postoperative complications (<30 days from surgery) occurred in 9.3% of cases, and they required surgical reintervention only in one case. After laparoscopic optimal cytoreduction with a median follow-up time of 25 months, the overall recurrence rates were 45.7%, 38.5%, and 39.3% for PDS, ISD, and SDS, respectively. The three-year overall survival rates were 84%, 66%, and 63%, respectively, while the three-year disease-free survival rates were 48%, 51%, and 71%, respectively. Conclusions: Laparoscopic cytoreduction surgery is feasible for advanced ovarian cancer in carefully selected patients, resulting in high rates of optimal cytoreduction, satisfactory peri-operative morbidity, and encouraging survival outcomes. Future studies should focus on establishing standardized selection criteria and conducting well-designed investigations to further refine patient selection and evaluate long-term outcomes. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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13 pages, 1094 KiB

Open AccessArticle

A Novel Predictive Multi-Marker Test for the Pre-Surgical Identification of Ovarian Cancer

by Andrew N. Stephens, Simon J. Hobbs, Sung-Woon Kang, Maree Bilandzic, Adam Rainczuk, Martin K. Oehler, Tom W. Jobling, Magdalena Plebanski and Richard Allman

Cancers 2023, 15(21), 5267; https://doi.org/10.3390/cancers15215267 - 2 Nov 2023

Cited by 1 | Viewed by 1452

Abstract

Ovarian cancer remains the most lethal of gynecological malignancies, with the 5-year survival below 50%. Currently there is no simple and effective pre-surgical diagnosis or triage for patients with malignancy, particularly those with early-stage or low-volume tumors. Recently we discovered that CXCL10 can be processed to an inactive form in ovarian cancers and that its measurement has diagnostic significance. In this study we evaluated the addition of processed CXCL10 to a biomarker panel for the discrimination of benign from malignant disease. Multiple biomarkers were measured in retrospectively collected plasma samples (n = 334) from patients diagnosed with benign or malignant disease, and a classifier model was developed using CA125, HE4, Il6 and CXCL10 (active and total). The model provided 95% sensitivity/95% specificity for discrimination of benign from malignant disease. Positive predictive performance exceeded that of “gold standard” scoring systems including CA125, RMI and ROMA% and was independent of menopausal status. In addition, 80% of stage I-II cancers in the cohort were correctly identified using the multi-marker scoring system. Our data suggest the multi-marker panel and associated scoring algorithm provides a useful measurement to assist in pre-surgical diagnosis and triage of patients with suspected ovarian cancer. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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24 pages, 5004 KiB

Open AccessArticle

Decreased Gene Expression of Antiangiogenic Factors in Endometrial Cancer: qPCR Analysis and Machine Learning Modelling

by Luka Roškar, Marko Kokol, Renata Pavlič, Irena Roškar, Špela Smrkolj and Tea Lanišnik Rižner

Cancers 2023, 15(14), 3661; https://doi.org/10.3390/cancers15143661 - 18 Jul 2023

Cited by 1 | Viewed by 1765

Abstract

Endometrial cancer (EC) is an increasing health concern, with its growth driven by an angiogenic switch that occurs early in cancer development. Our study used publicly available datasets to examine the expression of angiogenesis-related genes and proteins in EC tissues, and compared them with adjacent control tissues. We identified nine genes with significant differential expression and selected six additional antiangiogenic genes from prior research for validation on EC tissue in a cohort of 36 EC patients. Using machine learning, we built a prognostic model for EC, combining our data with The Cancer Genome Atlas (TCGA). Our results revealed a significant up-regulation of IL8 and LEP and down-regulation of eleven other genes in EC tissues. These genes showed differential expression in the early stages and lower grades of EC, and in patients without deep myometrial or lymphovascular invasion. Gene co-expressions were stronger in EC tissues, particularly those with lymphovascular invasion. We also found more extensive angiogenesis-related gene involvement in postmenopausal women. In conclusion, our findings suggest that angiogenesis in EC is predominantly driven by decreased antiangiogenic factor expression, particularly in EC with less favourable prognostic features. Our machine learning model effectively stratified EC based on gene expression, distinguishing between low and high-grade cases. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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15 pages, 8918 KiB

Open AccessArticle

Diagnostic Potential of Endometrial Cancer DNA from Pipelle, Pap-Brush, and Swab Sampling

by Yinan Wang, Hui Du, Wenkui Dai, Cuijun Bao, Xi Zhang, Yan Hu, Zhiyu Xie, Xin Zhao, Changzhong Li, Wenyong Zhang and Ruifang Wu

Cancers 2023, 15(13), 3522; https://doi.org/10.3390/cancers15133522 - 6 Jul 2023

Viewed by 1400

Abstract

Endometrial cancer (EC) is a major gynecological malignancy with rising morbidity and mortality worldwide. The aim of this study was to explore a safe and readily available sample and a sensitive and effective detection method and its biomarkers for early diagnosis of EC, which is critical for patient prognosis. This study designed a panel targeting variants for EC-related genes, assessed its technical performance by comparing it with whole-exon sequencing, and explored the diagnostic potential of endometrial biopsies using the Pipelle aspirator, cervical samples using the Pap brush, and vaginal specimens using the swab from 38 EC patients and 208 women with risk factors for EC by applying targeted panel sequencing (TPS). TPS produced high-quality data (Q30 > 85% and mapping ratios > 99.35%) and was found to have strong consistency with whole-exome sequencing (WES) in detecting pathogenic mutations (92.11%), calculating homologous recombination deficiency (HRD) scores (r = 0.65), and assessing the microsatellite instability (MSI) status of EC (100%). The sensitivity of TPS in detection of EC is slightly better than that of WES (86.84% vs. 84.21%). Of the three types of samples detected using TPS, endometrial biopsy using the Pipelle aspirator had the highest sensitivity in detection of pathogenic mutations (81.87%) and the best consistency with surgical tumor specimens in MSI (85.16%). About 84% of EC patients contained pathogenic mutations in PIK3CA, PTEN, TP53, ARID1A, CTNNB1, KRAS, and MTOR, suggesting that this small gene set can achieve an excellent pathogenic mutation detection rate in Chinese EC patients. The custom panel combined with ultra-deep sequencing serves as a sensitive method for detecting genetic lesions from endometrial biopsy using the Pipelle aspirator. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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11 pages, 1375 KiB

Open AccessArticle

Optimal Time Interval between Neoadjuvant Platinum-Based Chemotherapy and Interval Debulking Surgery in High-Grade Serous Ovarian Cancer

by Angeliki Andrikopoulou, Charalampos Theofanakis, Christos Markellos, Maria Kaparelou, Konstantinos Koutsoukos, Kleoniki Apostolidou, Nikolaos Thomakos, Dimitrios Haidopoulos, Alexandros Rodolakis, Meletios-Athanasios Dimopoulos, Flora Zagouri and Michalis Liontos

Cancers 2023, 15(13), 3519; https://doi.org/10.3390/cancers15133519 - 6 Jul 2023

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Abstract

Background: There is limited data on the optimal time interval between the last dose of neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) in high-grade serous ovarian carcinoma (HGSC). Methods: We retrospectively identified patients with stage IIIC/IV HGSC who received NACT followed by IDS during a 15-year period (January 2003–December 2018) in our Institution. Results: Overall, 115 patients with stage IIIC/IV HGSC were included. The median age of diagnosis was 62.7 years (IQR: 14.0). A total of 76.5% (88/115) of patients were diagnosed with IIIC HGSC and 23.5% (27/115) with IV HGSC. Median PFS was 15.7 months (95% CI: 13.0–18.5), and median OS was 44.7 months (95% CI: 38.8–50.5). Patients were categorized in groups according to the time interval from NACT to IDS: <4 weeks (group A); 4–5 weeks (group B); 5–6 weeks (group C); >6 weeks (group D). Patients with a time interval IDS to NACT ≥4 weeks had significantly shorter PFS (p = 0.004) and OS (p = 0.002). Median PFS was 26.6 months (95% CI: 24–29.2) for patients undergoing IDS <4 weeks after NACT vs. 14.4 months (95% CI: 12.6–16.2) for those undergoing IDS later (p = 0.004). Accordingly, median OS was 66.3 months (95% CI: 39.1–93.4) vs. 39.4 months (95% CI: 31.8–47.0) in the <4 week vs. >4 week time interval NACT to IDS groups (p = 0.002). On multivariate analysis, the short time interval (<4 weeks) from NACT to IDS was an independent factor of PFS (p = 0.004) and OS (p = 0.003). Conclusion: We have demonstrated that performing IDS within four weeks after NACT may be associated with better survival outcomes. Multidisciplinary coordination among ovarian cancer patients is required to avoid any unnecessary delays. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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9 pages, 1225 KiB

Open AccessReview

PARP Inhibitors: Strategic Use and Optimal Management in Ovarian Cancer

by Nicholas Hirschl, Wildnese Leveque, Julia Granitto, Valia Sammarco, Mervyns Fontillas and Richard T. Penson

Cancers 2024, 16(5), 932; https://doi.org/10.3390/cancers16050932 - 25 Feb 2024

Cited by 1 | Viewed by 1578

Abstract

Poly (ADP-ribose) polymerase (PARP) inhibitors have become an established part of the anticancer armamentarium. Discovered in the 1980s, PARP inhibitors (PARPis) were initially developed to exploit the presence of BRCA mutations, which disrupt the homologous recombination repair of deoxyribonucleic acid (DNA) via synthetic lethality, an intrinsic vulnerability caused by the cell’s dependence on other DNA repair mechanisms for which PARP is an essential contributor. PARPi use expanded with the demonstration of clinical benefit when other mechanisms of high-fidelity DNA damage response were present in cancer cells called homologous repair deficiency (HRD). Recently, new data have resulted in the voluntary withdrawal of later-line treatment indications for all the available PARPis used in ovarian cancer because of a negative impact on overall survival (OS). PARPi switch maintenance to consolidate a response to platinum-based therapy is recommended for earlier treatment lines to have the greatest impact on the chance of cure and length of survival. This article reviews the clinical utility of PARPis and how to integrate them into best practices. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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32 pages, 20883 KiB

Open AccessReview

The Role of Imaging in Cervical Cancer Staging: ESGO/ESTRO/ESP Guidelines (Update 2023)

by Daniela Fischerova, Filip Frühauf, Andrea Burgetova, Ingfrid S. Haldorsen, Elena Gatti and David Cibula

Cancers 2024, 16(4), 775; https://doi.org/10.3390/cancers16040775 - 14 Feb 2024

Cited by 1 | Viewed by 1568

Abstract

Following the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) joint guidelines (2018) for the management of patients with cervical cancer, treatment decisions should be guided by modern imaging techniques. After five years (2023), an update of the ESGO-ESTRO-ESP recommendations was performed, further confirming this statement. Transvaginal/transrectal ultrasound (TRS/TVS) or pelvic magnetic resonance (MRI) enables tumor delineation and precise assessment of its local extent, including the evaluation of the depth of infiltration in the bladder- or rectal wall. Additionally, both techniques have very high specificity to confirm the presence of metastatic pelvic lymph nodes but fail to exclude them due to insufficient sensitivity to detect small-volume metastases, as in any other currently available imaging modality. In early-stage disease (T1a to T2a1, except T1b3) with negative lymph nodes on TVS/TRS or MRI, surgicopathological staging should be performed. In all other situations, contrast-enhanced computed tomography (CECT) or 18F-fluorodeoxyglucose positron emission tomography combined with CT (PET-CT) is recommended to assess extrapelvic spread. This paper aims to review the evidence supporting the implementation of diagnostic imaging with a focus on ultrasound at primary diagnostic workup of cervical cancer. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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12 pages, 1684 KiB

Open AccessReview

Surgery in Recurrent Ovarian Cancer: A Meta-Analysis

by Maria Teresa Climent, Anna Serra, Maria Llueca and Antoni Llueca

Cancers 2023, 15(13), 3470; https://doi.org/10.3390/cancers15133470 - 2 Jul 2023

Cited by 4 | Viewed by 1649

Abstract

Background: The second cytoreductive surgery performed for a patient who has recurrent ovarian cancer remains controversial. Our study analyzes overall survival (OS) and disease-free survival (DFS) for cytoreductive surgery in addition to chemotherapy in recurrent ovarian cancer instead of chemotherapy alone. Methods: A meta-analysis was conducted using PubMed and the Cochrane database of systematic reviews to select randomized controlled studies. In total, three randomized studies were used, employing a total of 1249 patients. Results: The results of our meta-analysis of these randomized controlled trials identified significant differences in OS (HR = 0.83, IC 95% 0.70–0.99, p < 0.04) and DFS (HR = 0.63, IC 95% 0.55–0.72, p < 0.000001). A subgroup analysis comparing complete cytoreductive surgery and surgery with residual tumor achieved better results for both OS (HR = 0.65, IC 95% 0.49–0.86, p = 0.002) and DFS (HR = 0.67, IC 95% 0.53–0.82, p = 0.0008), with statistical significance. Conclusions: A complete secondary cytoreductive surgery (SCS) in recurrent ovarian cancer (ROC) demonstrates an improvement in the OS and DFS, and this benefit is most evident in cases where complete cytoreductive surgery is achieved. The challenge is the correct patient selection for secondary cytoreductive surgery to improve the results of this approach. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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Other

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12 pages, 794 KiB

Open AccessSystematic Review

Optimal Management for Stage IVB Endometrial Cancer: A Systematic Review

by Vito Andrea Capozzi, Elisa Scarpelli, Alessandra De Finis, Isabella Rotondella, Davide Scebba, Asya Gallinelli, Carlotta Montrucchio, Giulia Martignon, Martina Leotta, Tullio Ghi and Roberto Berretta

Cancers 2023, 15(21), 5123; https://doi.org/10.3390/cancers15215123 - 24 Oct 2023

Viewed by 1374

Abstract

(1) Background: Endometrial cancer (EC) is a common gynecological malignancy, often diagnosed at an early stage with a high overall survival rate. Surgical treatment is the primary approach, guided by pathological and molecular characteristics. Stage IVB EC, characterized by intra and/or extra-abdominal metastasis, presents a significant challenge with no clear consensus on optimal management. (2) Methods: A systematic literature review was conducted from January to May 2023, covering studies from 2000 to 2023. Eligible studies included retrospective case series, prospective trials, and randomized clinical trials. (3) Results: Of 116 studies identified, 21 were deemed relevant: 7 on primary surgery, 10 on neoadjuvant chemotherapy (NACT), and 4 on adjuvant treatment. Notably, the impact of residual tumor after primary surgery was a critical factor affecting survival. The use of NACT followed by interval debulking surgery showed promise, particularly in cases deemed unresectable. Adjuvant treatment, combining radiotherapy and chemotherapy, demonstrated improved survival but lacked consensus regarding its role. (4) Conclusions: Stage IVB EC poses a complex challenge with limited evidence to guide management. Optimal cytoreduction remains crucial, and NACT should be considered for unresectable cases. Multimodality adjuvant therapy may benefit patients, even with disease spread beyond the pelvis. Future advances in molecular classification and targeted therapies are expected to enhance treatment strategies. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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15 pages, 936 KiB

Open AccessSystematic Review

Management of Primary Uterine Cervix B-Cell Lymphoma Stage IE and Fertility Sparing Outcome: A Systematic Review of the Literature

by Guglielmo Stabile, Chiara Ripepi, Lara Sancin, Stefano Restaino, Francesco Paolo Mangino, Luigi Nappi and Giuseppe Ricci

Cancers 2023, 15(14), 3679; https://doi.org/10.3390/cancers15143679 - 19 Jul 2023

Cited by 2 | Viewed by 1351

Abstract

The female genital tract can be involved as a secondary manifestation of disseminated lymphomas or leukaemia but can rarely be the primary site of so-called extranodal lymphomas. Primary lymphomas of the female genital tract can affect the uterine corpus, uterine cervix, vulva, vagina, or adnexa. Only about 0.008% of all cervical tumours are primary malignant lymphomas. The most common clinical presentation of primary cervical lymphomas is a history of prolonged minor abnormal uterine bleeding, while unstoppable bleeding at presentation is rarely reported in the literature. “B” symptoms related to nodal lymphomas are usually absent. Since vaginal bleeding is a nonspecific symptom, the first diagnostic hypothesis is usually of one of the more common female genital conditions such as cervical or endometrial carcinoma or sarcoma, fibroids, adenomyosis, or endometriosis. Cervical cytology is usually negative. Preoperative diagnosis requires deep cervical biopsy. No guidelines regarding optimal treatment exists; radiotherapy, chemotherapy, and surgery are used in different combinations. Conservative treatment with the combination of surgery and chemotherapy or surgery and radiotherapy has been reported in a few cases with apparent success. With this review, we aim to understand what the best therapeutic approaches for this rare pathology in young and elderly women are. Moreover, we find favorable pregnancy outcome in patients treated with a fertility sparing approach. Full article

(This article belongs to the Special Issue Gynecologic Cancer: From Diagnosis to Treatment)

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