Paradigm Shift in the Management of Gynaecological Cancers

Abstract

In this review we highlight novel aspects of diagnostic imaging in gynaecological cancers, the paradigm shift in the surgical management of certain female pelvic cancers, as well as potential new molecular targeted therapies. In the last decade, ultra-radical surgery has been shown to increase survival in advanced ovarian cancer (OVC) when extended surgical procedures are included during primary cytoreductive surgery or at interval debulking procedures after neoadjuvant chemotherapy. In cervical cancer (CVC) and endometrial cancer (EMC) endoscopic (laparoscopic or robotic) operations have been shown to significantly reduce the morbidity without altering the cancer-related survival. Although the sentinel lymph node concept is already established in early-stage vulvar cancer, its diagnostic accuracy in EMC and CVC is still under debate. Novel molecular targeted therapies including blocking agents against new blood vessel formation (anti-angiogenesis) and polyadenosine diphosphate ribose polymerase inhibitors have been shown to prolong the progression-free survival in advanced OVC. Other molecular therapies, single or combined, are under investigation in OVC and EMC.