Gynecologic Oncology: Molecular Mechanisms, Diagnostics and Therapy

Dear Colleagues,

The evaluation of a pelvic mass requires certain methodical steps. It is necessary to diagnose the primary site or origin of the lesion; whether the lesion is an intra- or extra-peritoneal lesion; attempt to discriminate between the benign or malignant nature of the lesion; formulate a specific diagnosis; and furthermore, in the case of a possible malignant mass, define the stage of the disease's progression. Transvaginal ultrasonography is a dynamic and interactive examination and, as well as an analysis of the echostructure and 'elasticity' of a pelvic mass, it also permits an assessment of site-specific pain in different pelvic areas, and an evaluation of the movement of the mass in relation to adjacent structures. All these 'dynamic' features, together with morphological and vascular parameters, are essential for making a correct diagnosis.

Ovarian cancer is the seventh most common cancer among women in the developed world, and most women with ovarian cancer are diagnosed at an advanced stage of disease, when large intraperitoneal dissemination has already occurred. An accurate preoperative assessment of the tumor dissemination is pivotal for adequate counseling of the risks and benefits of an aggressive surgical procedure, which is often required to achieve a complete cytoreduction. When performed by an experienced sonographer, ultrasound has an invaluable role in the primary diagnosis of gynecological cancer in the assessment of a tumor’s extent in the pelvis and abdominal cavity. Finally, ultrasound allows for a biopsy to be performed in patients with peritoneal carcinomatosis, enabling the obtention of an adequate specimen for histologic diagnosis.

Intraoperative ultrasound techniques have been used for a long time in some surgical areas, especially in liver surgery. However, in gynecology, these methods are not yet commonly employed. An appropriate preoperative evaluation is required to determine the optimal surgical procedure, and recently, intraoperative ultrasound examination has been proposed in this setting as a useful method to guide the surgeon during myomectomy. The ultrasound examiner and surgeon should work together more often to guarantee the best therapeutic management for the patient in the gynecological setting.

Cervical and endometrial cancer staging is based on clinical examination and histological findings. Magnetic resonance imaging is considered the optimal method for staging cervical carcinoma because of its high accuracy in assessing the local extension of disease and distant metastases. Ultrasound has gained increased attention in recent years; it is faster, cheaper, and more widely available than other imaging techniques, and is highly accurate in detecting tumor presence and evaluating the local extension of disease. Both are often used together with computed tomography alone or in combination with positron emission tomography to assess the whole body, in order to more accurately detect pathological lymph nodes and metabolic information about the disease.

Ultrasound examination is an indisputable imaging method in the diagnosis of endometriosis: as the first step in its detection, as the fundamental tool in planning its management, and as the best diagnostic instrument during surveillance of affected women. The prevalence of pelvic urinary tract infiltration on transvaginal ultrasound examination in women with gynecologic malignancy and endometriosis is 10%. Pelvic urinary tract assessment plays a key role during transvaginal ultrasound examination, enabling the management of patients with gynecologic cancers.

I am pleased to announce the launch of a Special Issue entitled, “Gynecologic Oncology: Molecular Mechanisms, Diagnostics and Therapy”.

In this Special Issue, we will explore the current state, challenges, opportunities, perspectives and research directions within gynecology and obstetrics with a particular emphasis on ultrasound technologies and treatment. We encourage clinicians and scientists in the field to submit original articles or reviews that align with these objectives.

Dr. Manuela Ludovisi
Guest Editor

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• ultrasound
• ovarian cancer
• cervical cancer
• endometrial cancer
• uterine sarcomas
• gynecologic oncology
• endometriosis
• ultrasound biopsy
• imaging
• treatment