Open access
Open access
Powered by Google Translator Translator

Oncology – Gynecologic

Clinical Overview of Cervical Cancer: Screening, Treatment, and Future Directions

6 Jan, 2025 | 10:00h | UTC

Introduction: This summary provides a concise review of a comprehensive guideline on cervical cancer, covering its epidemiology, risk factors, clinical presentation, and current therapeutic strategies. The aim is to highlight best practices for prevention, screening, and management, as well as emerging treatments that may shift the standard of care.

Key Recommendations:

  1. Prevention and Screening
    • Encourage HPV vaccination before exposure, ideally in adolescence.
    • Perform regular screening with a Papanicolaou test, HPV testing, or both, based on national guidelines.
    • Use colposcopy and directed biopsies for women with abnormal screening results.
  2. Early-Stage Disease (FIGO IA to IB2)
    • Offer radical hysterectomy plus pelvic lymphadenectomy; ovarian preservation may be considered for endocrine benefits.
    • Less radical surgery (simple hysterectomy or conization) is now acceptable for smaller tumors (<2 cm) confirmed by imaging and pathology.
    • In selected cases, fertility-sparing radical trachelectomy can be considered, though the SHAPE trial supports more conservative approaches for certain early tumors.
  3. Locally Advanced Disease (FIGO IB3 to IVA)
    • Recommend concurrent chemoradiation therapy (daily external-beam radiotherapy, brachytherapy, and weekly cisplatin).
    • Immunotherapy (pembrolizumab) is approved in combination with chemoradiation for FIGO III to IVA disease, demonstrating improved survival.
    • Ensure treatment completion within optimal time frames to maximize therapeutic efficacy.
  4. Pelvic Exenteration
    • Consider total pelvic exenteration for isolated central recurrence in patients without distant disease.
    • Thorough psychosocial evaluation is critical before proceeding with this extensive procedure.
  5. Metastatic or Recurrent Disease (First-Line Therapy)
    • A platinum-based regimen (cisplatin or carboplatin) combined with paclitaxel, with or without bevacizumab, remains a standard option.
    • For PD-L1–positive tumors, adding pembrolizumab has shown a survival advantage.
    • Bispecific immunotherapy and novel therapeutic regimens are under investigation to improve outcomes further.
  6. Second-Line Therapy
    • Tissue factor–directed antibody–drug conjugates (e.g., tisotumab vedotin) are effective for patients whose disease progresses after frontline therapy.
    • HER2-targeted therapies (e.g., trastuzumab deruxtecan) may benefit individuals with HER2-overexpressing cervical tumors.
    • Immune checkpoint inhibitors (cemiplimab, nivolumab) can be used in PD-L1–positive recurrent disease, although prior treatment with pembrolizumab may affect efficacy.

Conclusion: By combining targeted vaccination, robust screening programs, and multidisciplinary treatment strategies, cervical cancer can be dramatically reduced worldwide. Advanced management incorporates state-of-the-art surgical procedures, chemoradiation, immunotherapies, and emerging targeted therapies to extend survival and enhance quality of life. Ongoing research aims to optimize treatment sequencing, define new biomarkers, and advance global eradication efforts.

Reference:
Tewari KS. Cervical Cancer. New England Journal of Medicine. (2025). Link: https://www.nejm.org/doi/full/10.1056/NEJMra2404457

 

RCT: Atezolizumab with Chemotherapy Extends Progression-Free Survival in dMMR Advanced Endometrial Cancer – Lancet Oncol

18 Aug, 2024 | 18:27h | UTC

Study Design and Population: The AtTEnd trial is a randomized, double-blind, placebo-controlled phase 3 study conducted in 89 hospitals across 11 countries. It enrolled 551 patients with advanced or recurrent endometrial carcinoma or carcinosarcoma, all of whom had not received prior systemic chemotherapy for recurrence.

Main Findings: The addition of atezolizumab to chemotherapy was associated with an improvement in progression-free survival, particularly in patients with mismatch repair-deficient (dMMR) tumors. In the overall population, progression-free survival and overall survival also showed positive trends.

Implications for Practice: The study suggests that atezolizumab may offer benefits when added to standard chemotherapy in patients with dMMR advanced or recurrent endometrial carcinoma, warranting further investigation as a potential first-line treatment option.

Reference: Colombo, N. et al. (2024). Atezolizumab and chemotherapy for advanced or recurrent endometrial cancer (AtTEnd): a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet Oncology, 24(8), 334-346. DOI: https://doi.org/10.1016/S1470-2045(24)00334-6.

 

RCT: Radiation therapy alone superior to chemoradiation in low-grade localized endometrial cancer recurrences

1 May, 2024 | 21:41h | UTC

This randomized clinical trial assessed the effectiveness of radiation therapy alone versus concurrent chemoradiation in treating localized recurrences of endometrial cancer. Conducted from February 2008 to August 2020, the study involved 165 patients who were randomized to receive either radiation therapy alone or chemoradiation with weekly cisplatin. Findings indicate that radiation therapy alone resulted in longer progression-free survival (PFS) compared to chemoradiation, with a median PFS not reached for radiation alone versus 73 months for chemoradiation. Additionally, radiation therapy demonstrated lower rates of acute toxicity. The study concluded that for patients with low-grade and primarily vaginal recurrences, radiation therapy alone is the preferable treatment option, offering excellent outcomes without the added toxicity of chemotherapy.

 

Reference (link to abstract – $ for full-text):

Ann H. Klopp et al. (Year). Radiation Therapy With or Without Cisplatin for Local Recurrences of Endometrial Cancer: Results From an NRG Oncology/GOG Prospective Randomized Multicenter Clinical Trial. Journal of Clinical Oncology. DOI: 10.1200/JCO.23.01279

 

Systematic Review | Pegylated liposomal doxorubicin for relapsed epithelial ovarian cancer

8 Aug, 2023 | 13:11h | UTC

Pegylated liposomal doxorubicin for relapsed epithelial ovarian cancer – Cochrane Library

 

RCT | Niraparib after first-line platinum-based chemotherapy extends PFS vs. placebo in newly diagnosed advanced ovarian cancer

31 Jul, 2023 | 13:58h | UTC

Treatment With Niraparib Maintenance Therapy in Patients With Newly Diagnosed Advanced Ovarian Cancer: A Phase 3 Randomized Clinical Trial – JAMA Oncology

See also: Visual Abstract

Commentary: Niraparib Maintenance in Newly Diagnosed Advanced Ovarian Cancer – The ASCO Post

 

Review | Radiomics-based fertility-sparing treatment in endometrial carcinoma

24 Jul, 2023 | 13:00h | UTC

Radiomics-based fertility-sparing treatment in endometrial carcinoma: a review – Insights into Imaging

 

FIGO staging of endometrial cancer: 2023

29 Jun, 2023 | 13:53h | UTC

FIGO staging of endometrial cancer: 2023 – Gynecology & Obstetrics

 

#ASCO23 – RCT | Simple hysterectomy shown non-inferior to radical hysterectomy in low-risk early-stage cervical cancer

5 Jun, 2023 | 13:43h | UTC

An international randomized phase III trial comparing radical hysterectomy and pelvic node dissection (RH) vs simple hysterectomy and pelvic node dissection (SH) in patients with low-risk early-stage cervical cancer (LRESCC):  A Gynecologic Cancer Intergroup study led by the Canadian Cancer Trials Group (CCTG CX.5-SHAPE). – American Society of Clinical Oncology (link to abstract – not published yet)

Commentaries:

SHAPE Trial: Radical Hysterectomy May Not Be Needed for Early-Stage, Low-Risk Cervical Cancer – ASCO Daily News

Simple Hysterectomy May Be a Safe Option for Patients With Early-Stage, Low-Risk Cervical Cancer – The ASCO Post

 

Clinical Trial Update | Olaparib plus bevacizumab first-line maintenance in ovarian cancer

5 Jun, 2023 | 13:07h | UTC

Olaparib plus bevacizumab first-line maintenance in ovarian cancer: final overall survival results from the PAOLA-1/ENGOT-ov25 trial – Annals of Oncology

Original Study: Olaparib plus Bevacizumab as First-Line Maintenance in Ovarian Cancer – New England Journal of Medicine

 

Clinical Trial Update | Lenvatinib plus pembrolizumab in previously treated advanced endometrial cancer

15 May, 2023 | 12:43h | UTC

Lenvatinib Plus Pembrolizumab in Previously Treated Advanced Endometrial Cancer: Updated Efficacy and Safety From the Randomized Phase III Study 309/KEYNOTE-775 – Journal of Clinical Oncology

Original Article: Lenvatinib plus Pembrolizumab for Advanced Endometrial Cancer – New England Journal of Medicine

 

Enhanced recovery after surgery (ERAS) society guidelines for gynecologic oncology: addressing implementation challenges

5 May, 2023 | 14:53h | UTC

Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges – 2023 update – Gynecologic Oncology

 

Review | Cancer treatment-related cardiovascular toxicity in gynecologic malignancies

26 Apr, 2023 | 14:14h | UTC

Cancer Treatment-Related Cardiovascular Toxicity in Gynecologic Malignancies: JACC: CardioOncology State-of-the-Art Review – JACC: CardioOncology

 

Commentary on Twitter

 

RCT | Intraperitoneal carboplatin achieves modest PFS gains in advanced ovarian cancer

25 Apr, 2023 | 14:24h | UTC

Intraperitoneal Carboplatin for Ovarian Cancer — A Phase 2/3 Trial – NEJM Evidence

 

Commentary on Twitter

 

SR | Angiogenesis inhibitors for the treatment of epithelial ovarian cancer

25 Apr, 2023 | 14:22h | UTC

Angiogenesis inhibitors for the treatment of epithelial ovarian cancer – Cochrane Library

Summary: Do medicines that restrict new blood vessel growth (angiogenesis inhibitors) help women with epithelial ovarian cancer? – Cochrane Library

 

M-A | Anthracycline-containing and taxane-containing chemotherapy for early-stage operable breast cancer

17 Apr, 2023 | 12:59h | UTC

Anthracycline-containing and taxane-containing chemotherapy for early-stage operable breast cancer: a patient-level meta-analysis of 100 000 women from 86 randomised trials – The Lancet

News Release: Taxane and anthracycline combination therapy is shown to be most effective chemotherapy for early stage breast cancer – University of Oxford

 

Review | Comprehensive care of women with genetic predisposition to breast and ovarian cancer

5 Apr, 2023 | 13:32h | UTC

Comprehensive Care of Women With Genetic Predisposition to Breast and Ovarian Cancer – Mayo Clinic Proceedings

 

RCT | Pembrolizumab plus chemotherapy in advanced endometrial cancer

3 Apr, 2023 | 13:48h | UTC

Pembrolizumab plus Chemotherapy in Advanced Endometrial Cancer – New England Journal of Medicine (link to abstract – $ for full-text)

News Release: Adding Pembrolizumab to Standard Chemotherapy, Followed by Pembrolizumab Maintenance, Results in Longer PFS in Patients with Advanced or Recurrent Endometrial Cancer – ESMO

 

Commentary on Twitter

 

RCT | Dostarlimab for primary advanced or recurrent endometrial cancer

3 Apr, 2023 | 13:46h | UTC

Dostarlimab for Primary Advanced or Recurrent Endometrial Cancer – New England Journal of Medicine (link to abstract – $ for full-text)

Commentary:

RUBY Trial: Dostarlimab Plus Carboplatin and Paclitaxel in Advanced Endometrial Cancer – The ASCO Post

Dostarlimab Plus Chemotherapy Elicits PFS Benefit in Recurrent Endometrial Cancer – OncLive

 

Consensus Statement | Management of vaginal intraepithelial neoplasia

28 Mar, 2023 | 14:37h | UTC

The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD), and the European Federation for Colposcopy (EFC) Consensus Statement on the Management of Vaginal Intraepithelial Neoplasia – Journal of Lower Genital Tract Disease

 

Cohort Study | Risk of endometrial polyps, hyperplasia, carcinoma, and uterine cancer after tamoxifen treatment in premenopausal women with breast cancer

2 Mar, 2023 | 12:56h | UTC

Risk of Endometrial Polyps, Hyperplasia, Carcinoma, and Uterine Cancer After Tamoxifen Treatment in Premenopausal Women With Breast Cancer – JAMA Network Open

Commentary: Risk of Uterine Diseases, Cancers Up With Tamoxifen Treatment – HealthDay

 

Commentary on Twitter

 

Recent advances in the classification of gynecological tract tumors: updates from the 5th edition of the WHO “Blue Book”

16 Feb, 2023 | 14:35h | UTC

Recent Advances in the Classification of Gynecological Tract Tumors: Updates From the 5th Edition of the World Health Organization “Blue Book” – Archives of Pathology & Laboratory Medicine

 

M-A | Risk of endometrial cancer in postmenopausal women in relation to ultrasonographic endometrial thickness

8 Feb, 2023 | 12:21h | UTC

Risk of endometrial cancer in asymptomatic postmenopausal women in relation to ultrasonographic endometrial thickness: systematic review and diagnostic test accuracy meta-analysis – American Journal of Obstetrics & Gynecology (link to abstract – $ for full-text)

 

Commentary on Twitter

 

Diagnostic Study | Usefulness of CT radiomics in differentiating histologic subtypes of epithelial ovarian carcinoma

27 Jan, 2023 | 12:01h | UTC

Computed Tomographic Radiomics in Differentiating Histologic Subtypes of Epithelial Ovarian Carcinoma – JAMA Network Open

 

Commentary on Twitter

 

Meta-analysis reaffirms benefits of O-RADS MRI for diagnosing indeterminate adnexal lesions

24 Jan, 2023 | 14:05h | UTC

Commentary: Meta-Analysis Reaffirms Benefits of O-RADS MRI for Diagnosing Indeterminate Adnexal Lesions – Diagnostic Imaging

Original Study: O-RADS MRI: A Systematic Review and Meta-Analysis of Diagnostic Performance and Category-wise Malignancy Rates – Radiology (link to abstract – $ for full-text)

 

Commentary on Twitter

 

Review | Advances in the diagnosis and early management of gestational trophoblastic disease

19 Jan, 2023 | 14:08h | UTC

Advances in the diagnosis and early management of gestational trophoblastic disease – BMJ Medicine

 

Stay Updated in Your Specialty

Telegram Channels
Free

WhatsApp alerts 10-day free trial

No spam, just news.