Glucagon-like peptide-1 receptor agonist use and risk of gynecologic cancers: a meta-analysis of multinational real-world cohort studies.

A small pilot trial of virtual group cognitive behavioral therapy for insomnia in gynecologic oncology patients.

VEGF/VEGFR targeting-induced vascular normalization: a key strategy to reverse cold tumor phenotype and potentiate immunotherapy in gynecologic cancers.

Genetic predisposition to hereditary breast and ovarian cancer and Lynch syndrome increases the risk of developing cancer, including epithelial ovarian cancer (EOC). Depending on the pathogenic variant, (e.g., BRCA1 or PMS2) the risk of developing EOC ranges from approximately 3%-60%. To reduce this risk, many individuals are offered risk-reducing salpingo-oophorectomy (RRSO), a procedure in which fallopian tubes and ovaries are removed. Some centers have dedicated programs that provide targeted care for individuals at risk of gynecologic cancers, such as the Hereditary Gynecology Clinic in Winnipeg, Manitoba. To better understand how individuals across a spectrum of risk values for developing EOC interpret their personal risk and make decisions regarding RRSO, we conducted a convergent mixed-methods study involving an online survey and virtual interview. Sixty-three surveys and twenty interviews were completed. Participants viewed objective risk information as a starting point, to which 'experiential knowledge' and perceived control were applied and integrated into their personal subjective risk assessment. Perceived risk was intertwined with cancer worry, and individuals made decisions regarding RRSO based on factors such as perceived risk, control, family planning, hormonal impacts, and recovery. Importantly, healthcare providers exerted both direct and indirect influences on the decision-making process.

AGO Breast Committee recommendations for the surgical therapy of breast cancer: Working Group on Gynecologic Cancers (AGO) update 2026.

351 Background: Cancer survivors receiving treatment or on follow-up face substantial burden of managing their symptoms. Many cancer survivors experience fatigue, pain, nausea/vomit and other symptoms of mild to moderate grade for which they visit hospitals. This increased burden already overburden healthcare facilities. We developed a Symptom Management Toolkit (SMT) to be used by cancer survivors or caregivers to manage symptoms by themselves. This study evaluates the validity and feasibility of SMT among survivors of solid carcinoma. Methods: a validation study was conducted among cancer survivors with diagnosis of solid malignancy who were currently receiving treatment or are on follow up. Participants aged 18-65 years with Eastern Cooperative Oncology Group (ECOG) Performance Score of 2 or less were included in the study. The socio-demographic data was collected through a structured questionnaire which include education, residence, work, medical, family history, smoking, and alcohol history was taken. A 13 symptoms-based SMT was provided to manage the symptoms at home. The symptoms were graded and their management instructions were provided. The content validity was assessed through review by expert. The construct validity was evaluated through group comparison and symptoms correlations. Results: A total of 65 participants were included in this study with 58.5% females and 41.5% being male. 43.1% of participants reported history of tobacco use while alcohol intake was reported in only 29.2% participants. 27.7% patients have hypertension, 23.1% diabetes mellitus as comorbidity. 10.8% participants reported family history of cancer. The study inculded 27.7% breast cancer, 18.5% oral cancer, 16.9% gynaecological cancer, 10.8% lung cancer and 26.2% other solid cancer cases. 63.1% survivors were receiving chemotherapy including targeted therapy, 18.5% chemoradiotherapy, 10.8% radiation therapy and 7.7% was on follow-up. The most common symptoms reported were fatigue (63.1%), pain (56.9%), nausea or vomiting (44.6%), and dry mouth (40%). The content validity shows strong expert agreement with calculation of content validity indices (item-level CVI 0.85–1.00; scale-level CVI 0.92). The criterion validity showed agreement between SMT-based patient self-grading and clinician assessment (κ = 0.70). the feasibility of SMT was high among survivors. Around 86.2% of survivors and their caregivers were able to understand easily the instruction provided. The adherence to the SMT was also higher (73.4%). 64.6% of survivors reported improved symptom management through use of SMT. There were 13.8% decrease in hospital visit after SMT use (24/65 vs 15/65 visit before and during SMT use). Conclusions: The feasibility and high acceptability of SMT can improve symptom management and reduce hospital visits. The SMT can be used as self-management tool to reduce the unscheduled visits to the hospitals.

Accelerated golden-angle radial acquisitions are widely used for dynamic MRI, but compressed sensing (CS)-based reconstruction presents residual artifacts at high acceleration and long computation times. Supervised deep learning (DL) enables fast reconstruction with improved image quality but usually relies on CS because fully-sampled references are unavailable. The proposed SELFIE (SElf-supervised Learning for Fast dynamIc golden-anglE radial MRI) technique enables self-supervised reconstruction that neither requires fully-sampled nor CS training references. SELFIE operates slice-by-slice in the image domain and thus avoids computationally expensive k-space data-consistency operations, allowing for a single forward-pass inference. Self-supervision is achieved by leveraging two properties of dynamic imaging with golden-angle radial sampling: (i) variable temporal resolution to form data-derived self-references at multiple temporal resolutions and (ii) temporal sparsity. SELFIE was evaluated on dynamic contrast-enhanced (DCE)-MRI in patients with gynecologic cancer and on motion-resolved free-breathing abdominal MRI in patients with liver cancer. Reconstructions were compared against CS and supervised DL using quantitative image-quality metrics and qualitative assessment from radiologists. Across both applications, SELFIE achieved image quality and dynamic fidelity (contrast enhancement and motion depiction) comparable to CS and supervised DL, while reconstructing 3D time series in seconds per case, substantially faster than CS. Ranking analysis and reader study favored SELFIE over CS and were comparable to supervised DL, with no statistically significant differences. Overall, SELFIE provides a fast, reference-free reconstruction framework for dynamic golden-angle radial MRI with competitive performance, representing a viable alternative to existing methods.

Gonadotropin-releasing hormone (GnRH) is a peptide hormone forming a central component of the hypothalamic-pituitary-gonadal axis and is critical for controlling reproductive functions. Dysregulated GnRH is implicated in many steroid hormone-dependent diseases, and its receptor, GnRHR, is an attractive and clinically exploited therapeutic target. Mounting evidence suggests that beyond the hypothalamus and pituitary, GnRH and GnRHR are expressed in reproductive and non-reproductive, healthy and malignant peripheral tissues, where they act in an autocrine and paracrine manner. This review provides an updated overview of GnRH and GnRHR signalling with a focus on extrapituitary autocrine and paracrine roles in female reproductive health. We examine the molecular and cellular mechanisms of extrapituitary GnRHR signalling, including G-protein coupling profiles, and alternative cell-specific mechanisms that differ from pituitary signalling. We highlight recent data surrounding the (patho) physiological functions of local GnRH systems, including in the endometrium, ovary, placenta and breast, and their implications for hormone-dependent gynaecological conditions and cancers. Finally, we consider implications of peripheral GnRH/GnRHR systems for therapeutic innovation, including avenues for targeted or biased GnRH-based therapeutics, GnRH/GnRHR-mediated 'off target' effects of GnRH analogues, and explore future translational avenues for the treatment of both hormone-dependent and hormone-refractory diseases.

Non-invasive screening for ovarian cancer by combining serum SERS with interpretable machine learning models.

Gynaecologic malignancies, such as ovarian, cervical, endometrial, vulvar, and vaginal cancers, are a significant health burden in the world, characterised by significant heterogeneity in their mode of expression on the molecular scale, high rates of recurrence, and low rates of sustained response to standard treatment. Recent progress in cancer genomics has essentially redefined the nature of these diseases, discovering multifaceted genetic, epigenetic, and tumour microenvironment-based processes that regulate tumour progression, therapeutic response, and resistance. This review summarises the existing knowledge about the molecular pathogenesis of gynaecologic cancers, including the essential oncogenic pathways, such as PI3K/AKT /mTOR pathways, malfunctioning DNA damage repair, angiogenesis, hormone receptors, and tumour immune interactions. Efforts are also analysed in areas of clinical integration of biomarker-driven targeted therapies, including poly(ADP-ribose) polymerase inhibitors, anti-angiogenic agents, immune checkpoint inhibitors, and emerging antibody drug conjugates, highlighting the areas of progress and current shortcomings. Primary and acquired resistance mechanisms, such as tumour microenvironment-mediated adaptations, are also critically considered together with new approaches to overcome therapeutic resistance using rational combination and treatment sequencing. We also see how the role of molecular biomarkers, companion diagnostics, genomic profiling, and liquid biopsy technologies is growing in allowing precision oncology, but ethical, economic, and access-associated limitations limit equitable application. All this review indicates the redefinition of gynaecologic cancer therapy by molecularly informed therapeutic approaches and a translational roadmap towards sustainably achieved biomarker-driven clinical benefit.

To assess the feasibility of a hybrid surgical approach combining robotic-assisted pelvic and laparotomic upper abdominal cytoreduction for advanced ovarian cancer. We retrospectively reviewed 20 patients with International Federation of Gynecology and Obstetrics stage III-IV ovarian cancer at the National Cancer Center, Korea, who underwent this hybrid approach between July 2023 and September 2024. Robotic surgery was performed for pelvic procedures, whereas upper abdominal cytoreduction was performed through a small laparotomy. Surgical outcomes included residual tumor status, operation time, estimated blood loss, complications, and postoperative recovery. The median age was 53 years, with 75% of patients diagnosed with high-grade serous carcinoma. The median operation time was 342.5 minutes (range, 200.0-505.0), and the median blood loss was 300 mL (range, 5.0-1,500.0). No gross residual disease was achieved in 95% of patients. Intraoperative complications occurred in two patients (10.0%). The median hospital stay was 8 days (range, 6.0-14.0). Foley catheter removal and the first bowel gas passage occurred at a median of 3.5 and 3.0 postoperative days, respectively. Postoperative complications within 30 days included ileus (10.0%), pleural effusion (10.0%), bowel perforation (5.0%), thromboembolism (5.0%), and wound complications (5.0%). Adjuvant chemotherapy began at a median of 17 days postoperatively (range, 10.0-36.0), and 15% of patients were readmitted for ileus, wound complications, or bowel perforation. This hybrid approach demonstrates feasibility with acceptable morbidity in a selected cohort; however, the absence of a comparator group precludes conclusions regarding superiority over conventional approaches. Further prospective studies are required to validate these findings and evaluate long-term oncologic outcomes.

Ovarian cancer is the deadliest gynecological cancer in the developed world. The absence of screening for early detection of ovarian cancer and the non-specific symptoms associated with the disease mean that timely diagnosis is difficult. This study examined time to diagnosis (from first presentation to diagnosis) for epithelial ovarian cancer in Nova Scotia, Canada, and factors associated with a long time to diagnosis (> 75th percentile) and healthcare system use prior to diagnosis. All Nova Scotians diagnosed with epithelial ovarian cancer between January 1, 2007, and December 31, 2016, were identified from the Nova Scotia Cancer Registry. Independent variables were obtained from linked clinical and administrative databases and census data. Time to diagnosis and healthcare system use were descriptively analyzed. Factors associated with time to diagnosis exceeding the 75th percentile were identified using modified Poisson regression models. A total of 652 individuals were included. The median time to diagnosis was 30 days. Factors associated with a long time to diagnosis included health zone, stage at diagnosis, year of first presentation, site of first presentation, and continuity of care. Sensitivity analyses examined factors associated with time to diagnosis exceeding 8 weeks and below the 25th percentile. The emergency department was the site of first presentation for 35.7% of individuals. The median number of physician visits between first presentation and diagnosis was four, and the median number of physician specialties seen in the same time interval was three, with the most common specialties seen being primary care, "other" specialties, and obstetrics/gynecology. Time to diagnosis for ovarian cancer can be long, specifically in some subgroups. Ways to streamline the diagnostic process must be identified.

Objective: This study aims to determine the relationship between cancer worry and gynecological cancer awareness in women, as well as to investigate associated factors.Methods: This is a correlational-descriptive study. The study population included women aged 20 to 65 who visited the outpatient clinics of a University Hospital. A total of 405 women were included in the final sample. Data were collected between February 28 and June 1, 2024, using the Descriptive Information Form, the Gynecological Cancer Awareness Scale, and the Cancer Worry Scale.Results: A positive and statistically significant correlation was found between overall gynecological cancer awareness and its four subscales, as well as the level of cancer-related worry. Higher awareness levels were observed among older women, those with higher levels of education, and those without a family history of cancer (p

Surgical site infection remains a clinically important complication after gynecological oncologic surgery, and the precise molecular consequences of preventive interventions on the wound immune microenvironment remain incompletely understood. We examined whether subcutaneous drainage is associated with altered activation of the Toll-like receptor 4 (TLR4)/myeloid differentiation factor 88 (MyD88)/nuclear factor kappa-B (NF-κB) signaling pathway in a murine model of postoperative wound infection. Female BALB/c mice bearing subcutaneous ID8 ovarian carcinoma tumors underwent simulated surgical resection followed by Staphylococcus aureus wound inoculation and were randomly assigned to four groups: sham surgery control, infection model, drainage intervention, and drainage combined with the TLR4 inhibitor TAK-242. Wound tissues were harvested at postoperative days 3, 7, and 14 for bacterial quantification, inflammatory cytokine profiling by ELISA, histopathological evaluation, Western blot, RT-qPCR, and immunofluorescence analyses of pathway components. Subcutaneous drainage was associated with lower bacterial burden, attenuated TNF-α, IL-1β, and IL-6 concentrations, and improved histopathological and wound healing scores compared with undrained infected wounds. Drainage was accompanied by reduced TLR4 and MyD88 expression at both protein and mRNA levels, preservation of IκBα from degradation, and reduced NF-κB p65 phosphorylation and nuclear translocation, although these measurements were made on bulk tissue and cell-type-resolution evidence is lacking. Exploratory structural equation modeling, interpreted cautiously given the modest sample size, suggested that pathway activation could plausibly mediate a substantial portion of the drainage-injury association; the precise mediated fraction is reported as a tentative estimate rather than a firm quantitative claim. Co-administration of TAK-242 with drainage produced additional pathway suppression (combination index ≈ 0.83), approaching baseline activity levels. Collectively, these findings are consistent with, although they do not by themselves prove, an immunomodulatory contribution of subcutaneous drainage within the wound microenvironment; the implications for gynecological oncology should therefore be framed with appropriate caution pending validation in larger animal systems and in human tissue.

Globally, endometrial cancer (EC) is among the most prevalent gynaecological cancers, with rising incidence driven by demographic and metabolic changes. Accurate early prognostic assessment is essential to guide personalized treatment and improve long-term outcomes. Traditional clinicopathological prognostic methods-including FIGO (International Federation of Gynaecology and Obstetrics) staging, tumor grade, and histological subtype remain the current standard but have limitations in detecting early recurrence risk. In recent years, biomarker-based prognostic signatures and machine-learning (ML) guided risk models, including radiomics and multi-omics approaches, have emerged as promising tools for improving prognostic accuracy. However, no systematic review and meta-analysis have comprehensively evaluated whether these biomarker or ML-based prognostic models offer improved early risk prediction compared with conventional methods in EC. We will undertake a comprehensive search of MEDLINE, Scopus, IEEE Xplore, and Web of Science from 2010 to 2025. Two reviewers will independently perform title/abstract screening, full-text assessment, data extraction, and quality appraisal, with arbitration by a third reviewer where necessary. Studies developing, validating, or evaluating biomarker-based, radiomics-based and ML-guided prognostic models in human EC patients will be eligible for inclusion. Purely laboratory-based biomarker discovery studies that do not develop or evaluate a prognostic model in human participants will be excluded. Outcomes of interest include measures of prognostic performance such as AUC (area under the curve), C-index (concordance index), time-dependent AUC, calibration metrics, hazard ratios for survival outcomes, and decision analytic measures. Risk of bias will be assessed using PROBAST (Prediction model Risk of Bias Assessment Tool) and QUIPS (Quality in Prognosis Studies), and certainty of evidence will be summarized using GRADE (Grading of Recommendations Assessment, Development and Evaluation). When feasible, meta-analysis of performance metrics will be performed using random-effects models with restricted maximum likelihood (REML) estimation, with subgroup analysis restricted to histological subtype when sufficient data permits. This systematic review will synthesize current evidence on the prognostic performance of biomarker and ML-guided prognostic models in EC, comparing them with conventional clinicopathological risk assessment methods. Findings will help clarify whether emerging model types offer meaningful improvements in the early prognostic accuracy, provide insight into methodological limitations of existing models, and identify gaps in evidence requiring future research. This review will support clinicians, researchers, and policymakers seeking to integrate precision-based prognostic tools into EC care. PROSPERO CRD420251230895.

Colposcopy has been provided by nurses internationally since the 1970s. A summary of current evidence regarding the outcomes of nurse-led colposcopy has not been published. The aim is to examine existing literature on outcomes of nurse-led colposcopy internationally and identify benefits and limitations for patients and organizations. CINHAL, PubMed, and Scopus were searched for literature using keywords. Screening was conducted according to inclusion and exclusion criteria, and relevant studies were included in the review. Eight studies were eligible for inclusion in the review. Half of the included studies (n = 4) were conducted in the United States, while the remaining 4 were undertaken in Bangladesh, Ghana, the Netherlands, and the United Kingdom. Three key topics were identified as benefits of nurse-provided colposcopy, comparison with medical officer-provided colposcopy, and cost-effectiveness and organizational impact. In addition, this review mapped the current levels of education required for nurses to perform colposcopy in each country represented in the included studies. The review shows that nurses provide colposcopy services in a wide range of settings internationally and to a similar standard to medical officers. Nurse-led colposcopy is not well defined in many of the included studies, and identified gaps in research suggest that further research is needed. Underserved communities worldwide suffer the burden of gynecological cancers in greater numbers than those in more prosperous communities. This review calls attention to the benefits for patients attending colposcopy provided by nurses and proposes the potential for workforce innovation in resource-poor settings.

Hospital-at-home is an initiative to move health care services that have traditionally been provided in a hospital setting to a patient's home. The objective of this study was to assess the impact of the oncology Huntsman at Home (HH) hospital-at-home program on health care costs from the health care system's perspective. Using a difference-in-difference approach, we compared health care costs between 169 oncology patients enrolled in HH and 198 similar patients who would have been eligible for HH but lived outside the HH service area. Costs were measured from the health system perspective using an innovative cost-accounting tool. We constructed longitudinal datasets spanning the 2 patient-quarters before enrollment and the 2 patient-quarters following an acute episode. Outcomes were total direct medical costs of health care encounters as well as subcategories of cost, including facility, imaging, supplies, pharmacy, labs, and other. We ran fixed effects linear regression models to assess the impact of HH on health care cost outcomes. We found that HH was associated with a statistically significant reduction in cost for the 6 months post-admission (total -$8,337, P=0.012) and the first quarter post-admission (-$10,516, P=0.009), with significant reductions in pharmacy, facility, and other costs. We also examined a subset of patients with gastrointestinal or gynecologic cancers as exemplars of patients at considerable risk for extended complications and found similar cost reductions 6 months (-$8006, P=0.006) and in the first quarter (-$10,438, P=0.004). We found that an oncology hospital at home lowers health care costs, particularly during the 3 months following a care episode.

To assess the feasibility of a specialized ePROMs tool measuring toxicity encountered by oncology patients during routine outpatient intravenous chemotherapy. A proprietary ePROMs tool underwent modification to incorporate a questionnaire focused on nine chemotherapy-associated toxicities within Cabrini Hospital. This tool was piloted in a group of oncology patients receiving intravenous chemotherapy at two outpatient chemotherapy units in a private Australian healthcare center. Patients registered the toxicities and severity through the modified ePROMs tool weekly from the onset of treatment. The collected data were correlated with the specific chemotherapy drugs administered. Of the 133 enrolled patients, 102 completed the 12-week study. The median age was 61 years (range: 23-81), 94 participants were female (71%), and the most common cancer subtypes were breast (26%), gastrointestinal (25%), and gynecological (19%) cancers. Post-study feedback was gathered from 76 of the 102 participants (75% [95% confidence interval {CI}: 69.2-86.0]) who completed the 12-week program. These participants rated the ePROMs tool as user-friendly (100% [95% CI: 96.4-100.0]) and understandable (99% [95% CI: 96.4-100.0]), with a majority endorsing its usage to other patients receiving chemotherapy (96% [95% CI: 94.7-99.9]) and a preference to continue its usage (87% [95% CI: 79.2-93.0]). The findings of the study indicate that implementation of an ePROMs tool for real-time reporting of chemotherapy toxicities during routine outpatient care is feasible and promising. Positive patient feedback highlights its prospective role in patient-centered care and improving the understanding and documentation of chemotherapy toxicities.

Endometrial cancer is one of the gynecological malignancies, currently ranking first in mortality among the three major gynecological cancers. Effective treatment options remain scarce. ATAD2, a chromatin remodeler, is implicated in solid tumor progression, but its role in endometrial cancer (EC) and tumor microenvironment (TME) remodeling remains unclear. This study investigated the functional impact and mechanisms of ATAD2 in EC pathogenesis. Based on the publicly available TCGA Uterine Corpus Endometrioid Carcinoma (UCEC) dataset, we preliminarily clarified the pro-cancer role of ATAD2. To explore its mechanism, this study constructed EC cell lines with stable ATAD2 overexpression and knockdown, and assessed cell proliferation, migration, and invasion capabilities; combined with bioinformatics analysis, we screened potential regulatory pathways. We verified the interaction between ATAD2 and SIRT7 protein using immunoprecipitation, molecular docking, GST-pull-down, and proximity ligation (PLA) techniques. Flow cytometry was used to detect macrophage polarization status, SA-β-galactosidase activity and p53/p21 expression levels were used to assess cellular senescence, and enzyme-linked immunosorbent assay (ELISA) was used to quantitatively analyze senescence-related secreted phenotypic factors. Furthermore, through immune cell infiltration atlas analysis and combined with a xenograft tumor model, we evaluated the in vivo antitumor effect of the ATAD2 inhibitor BAY-850. High ATAD2 expression correlated with poor EC prognosis and enhanced cancer cell proliferation, migration, and invasion. Mechanistic studies have shown that ATAD2 interacts directly with SIRT7 through its bromine domain and enhances its protein stability. SIRT7 regulates p21 transcription by deacetylation of the lysine K382 site of p53 protein, thereby inhibiting cell senescence and SASP secretion.High ATAD2 expression was linked to increased TP53 mutation burden and suppressed anti-tumor immunity. ATAD2 inhibition promotes SASP secretion and induces M1 macrophage polarization, an effect that can be reversed by SIRT7 upregulation. BAY-850 inhibits tumor growth and metastasis in vivo. ATAD2 suppresses cellular senescence and SASP phenotypes via the SIRT7-p53/p21 axis, promoting immune-suppressive TME and driving EC progression and immune evasion. ATAD2 represents a promising therapeutic target for EC.

Endometrial carcinoma (EC) is the most common malignant gynecological cancer with high mortality. Holliday junction recognition protein (HJURP), an E3 ubiquitin ligase dysregulated in various malignancies, has an unclear role in EC. We assessed HJURP's effects on growth, metastasis, and invasion of EC cells in in vivo and in vitro experiments. Proteomics compared protein expression in EC cells with and without HJURP overexpression. Finally, the regulatory network around HJURP was validated using base mutations and immunoprecipitation assays. Data from the clinical samples (n = 47) revealed high expression of HJURP in EC tissues compared with normal tissues. The correlation between HJURP expression and clinicopathology in 94 patients was analyzed, and the results showed that high expression of HJURP was significantly correlated with FIGO stage, tumor stage, and TNM stage (all p < 0.05). Patients with high HJURP expression exhibited significantly lower overall survival and recurrence-free survival rates compared to those with low HJURP expression. Downregulation of HJURP exhibited anti-proliferation and anti-metastasis in vivo and in vitro. Conversely, the forced expression of HJURP had a carcinogenic effect. Notably, HJURP RNA levels were upregulated by transcription factor nuclear factor Y alpha subunit (NFYA). NFYA promoted HJURP transcription by binding to its promoter region. Proteomic analysis showed that HJURP decreased Ras association domain-containing protein 8 (RASSF8) protein level (about 2-fold). Specifically, HJURP may mediate the ubiquitin-dependent degradation of RASSF8 by recruiting E2 or E3 ligases, such as ubiquitin-conjugating enzyme E2O. RASSF8 overexpression weakened the effects of HJURP overexpression. HJURP, transcriptionally activated by NFYA, exerts oncogenic functions via interacting with and destabilizing RASSF8, indicating that HJURP may act as a promising target for EC therapies.