Search Results (350)

Cisplatin was the first metal-based anticancer drug introduced into clinical use. It is a “small” molecule, but it represented a very “big” discovery. Since it was introduced on the market, it has not been withdrawn, despite being not free of side effects, owing to its peculiarity of being highly effective in the treatment of cancer. Anticancer activity of the platinum-based complexes was discovered with this molecule; since then, several other platinum-based drugs have been developed and tested in preclinical studies against cancer cells; however, only a few of them reached clinical trials, and their side effects are not much less than cisplatin. Despite the constraints of drug resistance and side effects, chemotherapy remains a fundamental strategy in cancer treatment. Nowadays, cisplatin remains one of the most-used anticancer agents in treating lung, colon, ovary, testicles, bladder, cervix, and many more cancers, although cisplatin resistance represents a major hurdle in cancer treatment. Will there ever be another drug that can overcome the side effects of cisplatin but at the same time be able to block tumors as does cisplatin? Full article

Background: The integration of artificial intelligence (AI) into cervical cancer diagnostics has shown promising advancements in recent years. AI technologies, particularly in the analysis of cytological images, offer potential improvements in diagnostic accuracy and screening efficiency. However, challenges regarding model generalizability, explainability, and operational integration into clinical workflows persist, impeding widespread adoption. Aim: This narrative review aims to critically evaluate the current state of AI in cervical cancer diagnostic cytology, identifying trends, key developments, and areas requiring further research. It also explores the potential for AI to improve diagnostic processes, alongside examining international guidelines and consensus on its adoption. Methods: A narrative review was conducted through a comprehensive search of PubMed and Scopus databases. Thirty studies published between 2020 and 2025 were selected based on their relevance. Results: The literature review reveals a growing interest in the application of AI for cervical cancer diagnostics, particularly in the automated interpretation. However, large-scale clinical adoption remains limited. Most studies are experimental or application-based in controlled settings. Consensus efforts and specific recommendations for this domain are still limited and not specific. Key barriers include limited model generalizability, lack of explainability, challenges in integration into clinical workflows, and regulatory and infrastructural constraints. Conclusions: A sustainable and meaningful integration of AI in cervical cancer diagnostics requires a unified framework that addresses both technical challenges and operational needs, supported by context-specific strategies and broader consensus-building efforts. Full article

Background/Objectives: Image-guided adaptive brachytherapy is a standard modality in the treatment of locally advanced cervical cancer. However, the availability of isotope-based brachytherapy is limited in countries with lower resources. The objective of this study is to report the first institutional dosimetric and clinical data on intracavitary electronic brachytherapy. Methods: A total of 25 patients with histologically proven cervical cancer stage IB-IVA were treated with concurrent chemoradiotherapy and electronic brachytherapy. The patients were followed up for a median of 12 months (range 6–24). Toxicity was evaluated by the radiation oncologist and gynecologist on each visit and scored by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results: All patients completed the treatment successfully with a median overall treatment time (OTT) of 52 days (range 39–89). The desired target coverage was achieved in all patients, and the dose limits for the organs at risk were achieved in 88% of the patients. No Grade 3 toxicities occurred. A total of 84% of the patients achieved local control in the cervix, and a complete response was noted in 72% of the patients. Conclusions: Electronic brachytherapy provides the option to deliver a high dose of radiation to the uterine cervix without leading to severe toxicity. Further improvements to the treatment protocol could provide better locoregional and systemic control of the disease. Studies with larger cohorts and longer follow-up are necessary. Full article

Objectives: Persistent Human Papillomavirus (HPV) infection in the cervix and the preinvasive lesions it causes are significant risk factors for cervical cancer. Therefore, a treatment strategy is necessary to facilitate the clearance of HPV and prevent the progression of preinvasive lesions without causing cervical tissue destruction. This study aimed to evaluate the effectiveness of a vaginal adsorbent gel composed of a hydroxyethyl cellulose matrix formulation containing dispersed silicon dioxide, antioxidant sodium selenite, deflamin, and citric acid in patients with HPV infection. Methods: The study was designed as a retrospective cohort study and involved 449 women infected with HPV. For the purposes of the study, the patients were divided into two groups: the treatment group (TG) comprised 207 patients who used the vaginal gel daily for a period of three months, while the control group (CG), consisting of 242 patients, received no treatment under an “active surveillance” protocol. The study’s endpoints encompassed the domains of cytology, histology, and HPV clearance. Results: The regression rate of smear pathologies was 24.8% in the control group and 29.0% in the group using the vaginal adsorbent gel. In the first year, the histological regression rate in cervical biopsies was 49.3% in the treatment group and 19.4% in the control group, with a significant difference between groups (p < 0.001). Moreover, the clearance rate of HPV types was found to be significantly higher in the group using the vaginal adsorbent gel. Conclusions: The findings of this study suggest that the outpatient treatment approach can effectively prevent the oncogenic progression of cervical dysplasia. This alternative method has been shown to be efficacious in preventing the progression of cervical dysplasia and promoting regression. Furthermore, the efficacy of this gel in eradicating HPV has been demonstrated within a 12-month period. Full article

Background: Following the results of the Laparoscopic Approach to Carcinoma of the Cervix (LACC) trial, doubts have arisen about the safety of laparoscopy in the treatment of endometrial cancer. Methods: A retrospective multicenter cohort study which included all endometrial cancer (EC) patients who underwent a hysterectomy in Emilia Romagna hospitals from 2000 to 2019. All cases were revised and classified according to the 2009 International Federation of Gynaecology and Obstetrics (FIGO) staging system. The different impacts of the surgical approach on survival were stratified according to the recurrence risk from the 2016 European Society for Medical Oncology (ESMO)–European Society of Gynaecological Oncology (ESGO) classification system. The clinical characteristics and oncological outcome of patients treated by laparoscopy were compared with those treated by laparotomy. Results: A total of 2402 EC patients were included in the study. The use of laparoscopy has increased over the years, reaching 81% of procedures in 2019. Laparoscopy reduced complications and hospital stay. Laparoscopy was preferred to treat low, intermediate, and intermediate/high-risk patients. Laparoscopy showed no adverse effects on overall survival (OS) in any recurrence risk class. Particularly in high-risk EC patients, laparoscopy was associated with an increased OS in comparison with women treated by laparotomy regardless of the use of adjuvant therapy. Conclusions: Laparoscopy should always be chosen to treat EC of any risk class. The goal is to ensure correct treatment and oncological safety regardless of the surgical approach. Full article

Precision prevention strategies for cervical cancer that integrate genetic biomarkers provide opportunities for personalized risk assessment and optimized preventive measures. An HPV infection–Precancerous–Cancer risk assessment model incorporating genetic polymorphisms and DNA methylation was developed to better understand the regression and progression of cervical lesions by HPV infection status. Utilizing a virtual cohort of 300,000 Taiwanese women aged 30 years and older, our model simulated the natural history of cervical cancer, capturing transitions from a healthy state through precancerous lesions (LSILs and HSILs) to invasive carcinoma and incorporating the possibility of regression between states. Genetic and epigenetic markers significantly influenced disease transitions, demonstrating heterogeneous risks among women with distinct molecular biomarker profiles. Guided by these individual risk profiles, tailored preventive strategies including varying intervals for Pap smear screening, HPV DNA testing, and HPV vaccination showed improved efficiency and effectiveness in reducing cervical cancer incidence compared to uniform approaches. The proposed dynamic transition model of cervical neoplasms incorporating genetic biomarkers can facilitate the development of an individualized risk-based approach for guiding precision prevention towards the goal of cervical cancer elimination. Full article

Cancer of the uterine cervix (cervical cancer) is a leading cancer among women worldwide, although its incidence has been reducing in many developing nations. In the majority of cervical cancer cases, the presence of high-risk human papillomavirus (HPV) is usually detected. However, a growing body of evidence currently considers that exclusive HPV infection may not be sufficient for cancer development. Apart from certain common risk factors for cervical cancer, like poor nutritional status and smoking, many studies documented an association with other viral infections, such as human immunodeficiency virus (HIV) and herpes simplex virus type 2 (HSV-2). Similarly, vaginal bacterial populations perhaps play a key role in cervical cancer. It may be worth mentioning that different bacterial species can immensely influence (either protecting or adversely) the biochemical characteristics of the cervicovaginal environment—for example, Lactobacillus crispatus, Gardnerella vaginalis, and Chlamydia trachomatis. As a result, chronic infections with unfavorable microorganisms (other than HPV) may affect the pathological processes of malignancy. On the other hand, the cervix is an estrogen-sensitive organ like the corpus uteri (i.e., the body of the uterus). Estrogen and different estrogen receptors are implicated in the development and promotion of various cancers, including endometrial cancer. A number of reports also suggest a close association between estrogen and HPV in the development of cervical cancer. Furthermore, estrogen is linked with the characteristics of the vaginal microenvironment including bacteria. Therefore, several of the abovementioned factors (some are preventable) could play an important role in the progression of cervical neoplastic lesions. Full article

The applicability of RHT in the treatment and supportive care of tumors has been discussed for years in many publications. There are hundreds of articles that have reported on the good acceptance and feasibility of HT, as well as its value in terms of controlling malignant diseases, enhancing response and, in some randomized controlled trials (RCTs), clear improvements in OS. Despite this, HT has never fully been accepted as a standard treatment among radiation and medical oncologists. The increased activity that HT offers in the context of chemotherapy (CHT), radiotherapy (RT), chemoradiotherapy (CRT), and immunotherapy, thus facilitating programmed cell death (PCD), has been documented in many studies. This aspect has been demonstrated in many tumors, including soft tissue sarcoma, cancers of the cervix, esophagus, stomach, colon/rectum, pancreas, breast, head and neck, and prostate, and bone metastases. HT improves cancer cell death through many modalities, targeting both the tumor microenvironment (TME) and the cancer cells directly. Targeted HT increases the temperature of the primary tumor and surrounding tissues to 39–43 °C, causing the tumor cells to become more immune-responsive. HT can also activate the immune response of the TME through inducing heat shock proteins (HSPs), which also promote an immunological response and PCD. HT can oxygenate hypoxic tumors, facilitating RT-induced DNA damage in cancer cells. At present, it seems that the combination of HT and RT, CHT, and immunotherapy might lead to immune enhancement effects in the TME, making cancer cells more responsive to immunotherapies. This narrative review presents the novel aspects of HT reported in recent years. Full article

Sex workers and formerly incarcerated people with a cervix face significant structural, interpersonal, and emotional barriers to cervical cancer screening, despite being at elevated risk for HPV infection. HPV self-sampling (HPV-SS) is a validated, user-directed method that has the potential to address these barriers, yet it remains excluded from Ontario’s organized screening program. This qualitative study explored the lived experiences of structurally marginalized individuals with a cervix who were offered HPV-SS as part of a mixed-methods pilot in the Greater Toronto Area. Five virtual focus groups were conducted with 34 participants, including both those who used the HPV-SS kit and those who declined it. Using inductive thematic analysis, we identified barriers to traditional screening including fear, stigma, mistrust of healthcare providers, logistical constraints, and a lack of accessible information. HPV-SS was widely described as more acceptable, empowering, and emotionally manageable, offering participants autonomy, privacy, and control over their care. Concerns included swab design, uncertainty about correct use, and unclear follow-up after positive results. Participants offered concrete, community-informed recommendations to improve HPV-SS implementation, including opt-in distribution models, gender-affirming language, and trauma-informed educational materials. The findings highlight the urgent need to integrate HPV-SS into organized screening programs to advance equitable access to cervical cancer prevention for marginalized populations. Full article

Cervical cancer ranks third among malignant diseases of the female reproductive system and progressively develops through a series of pathological changes known as cervical intraepithelial neoplasia (CIN). Despite being extremely aggressive and causing increased mortality, the main treatment options include surgery or a combination of chemotherapy and radiotherapy, often based on cisplatin-based chemotherapy and external beam radiotherapy or brachytherapy. Cervical dysplasia is an abnormal growth of cells on the surface of the cervix that could lead to cervical cancer. CIN most commonly occurs at the squamocolumnar junction of the cervix, a transitional zone between the squamous epithelium of the vagina and the columnar epithelium of the endocervix. The primary cause of CIN is chronic infection of the cervix with Human Papillomavirus (HPV). Oxidative stress (OS) and chronic inflammation are associated with HPV-induced cervical dysplasia. Reactive oxygen species (ROS) facilitate the progression of CIN through DNA damage, immune evasion, and cellular mutations. Thus, the inflammatory environment, characterized by increased expression of proinflammatory cytokines, contributes to epithelial transformation. Given these mechanisms, antioxidants, including vitamins A, C, D, E, polyphenols, and carotenoids, are being investigated for their potential as adjunctive therapies in CIN management. This review aims to provide a comprehensive analysis of the influence of oxidative stress, antioxidants, and inflammation on cervical cancer. Full article

To investigate the changes of ERα and PRs in the epithelium and stroma of normal and neoplastic uterine cervix. Two pathologists independently scored the expression levels of ERα, PR(A+B), and PRB in the stroma and epithelium of normal, cervical intraepithelial neoplasia grade 2 and 3 (CIN2/3), carcinoma in situ (CIS), and invasive cervical carcinoma (ICC) specimens. Sex hormone receptors were abundantly expressed in the stroma compared to the epithelium or carcinoma of the cervix. Stromal ERα was progressively upregulated during cervical carcinogenesis, with an immunoreactive score (IRS) of 1.3 ± 1.5, 2.1 ± 1.9, and 3.6 ± 3.3 in the CIN2/3, CIS, and ICC groups, respectively (p < 0.001). By contrast, epithelial PR(A+B) and PRB were downregulated, with IRS of 0.4 ± 0.7 and 0.5 ± 0.8, 0.1 ± 0.4 and 0.2 ± 0.6, and 0.1 ± 0.6 and 0.1 ± 0.4 in the CIN2/3, CIS, and ICC groups, respectively (p < 0.001). During the CIN2/3 transition, the coexpression relationship between ERα and PRs began to break down. Although epithelial PR(A+B) was downregulated, stromal PR(A+B) and PRB were upregulated with IRS of 2.0 ± 2.0 and 2.0 ± 1.9 as well as 2.1 ± 2.3 and 3.2 ± 3.2 in the CIS (p = 0.009) and ICC groups (p < 0.001), respectively. After complete transformation, the stromal PRB was significantly upregulated, and its loss was related to more distant metastasis and poorer prognosis. The results of this study highlight the carcinogenic role of stromal ERα, the tumor suppressor role of epithelial PRs, and the importance of stromal PRB in the development of cervical cancer; they can be used as a basis for developing prevention and treatment strategies for this disease. Full article

Whole-slide imaging (WSI) in cytopathology poses challenges related to segmentation accuracy, computational efficiency, and image acquisition artifacts. This study aims to evaluate the performance of deep-learning models for instance segmentation in cervical cytology, benchmarking them against state-of-the-art methods on both public and institutional datasets. We tested three architectures—U-Net, vision transformer (ViT), and Detectron2—and evaluated their performance on the ISBI 2014 and CNseg datasets using panoptic quality (PQ), dice similarity coefficient (DSC), and intersection over union (IoU). All models were trained on CNseg and tested on an independent institutional dataset. Data preprocessing involved manual annotation using QuPath, patch extraction guided by GeoJSON files, and exclusion of regions containing less than 60% cytologic material. Our models achieved superior segmentation performance on public datasets, reaching up to 98% PQ. Performance decreased on the institutional dataset, likely due to differences in image acquisition and the presence of blurred nuclei. Nevertheless, the models were able to detect blurred nuclei, highlighting their robustness in suboptimal imaging conditions. In conclusion, the proposed models offer an accurate and efficient solution for instance segmentation in cytology WSI. These results support the development of reliable AI-powered tools for digital cytology, with potential applications in automated screening and diagnostic workflows. Full article

Background and Objectives: To summarize the evidence on in vivo uterine pelvic lymphatic drainage. Materials and Methods: A literature search was performed in multiple electronic databases from inception to December 2024. We included all the studies that compared two different uterine injection sites in the mapping of pelvic sentinel lymph nodes by injecting two different tracers into two distinct injection sites. The primary outcomes included the concordance and discordance rates in the mapped pelvic sentinel lymph nodes between the pairs of injection sites. The secondary outcomes were the detection rates per injection site and tracer. Four reviewers independently reviewed the records for inclusion, assessed the risk of bias, and extracted the data. Pooled concordance, discordance, and detection rates with 95% confidence intervals (CIs) were estimated using the random effects model. Heterogeneity was quantified using the I² tests. Results: Out of 2512 records, we included 4 studies (172 patients and 344 hemipelves). Three studies injected the cervix with the technetium-99m and the uterine corpus with methylene blue; one study injected the cervix with indocyanine green and the utero-ovarian ligament with methylene blue. Both tracers/injection sites successfully identified a sentinel lymph node in 132 hemipelves (132/344; 38.4%), identifying the same sentinel lymph node in 116 cases (116/132; 87.9%). The pooled concordance rate per hemipelvis was 91.8% (95% CI 0.665–1.000; I² = 92%; chi² p-value < 0.01). Two different sentinel lymph nodes were identified in the remaining 16 hemipelves, with a pooled hemipelvis discordance rate of 8.2% (95% CI 0.000–0.335; I² = 92%; chi² p-value < 0.01). The cervix and technetium-99m were the injection site and tracer with the highest pooled detection rate. Conclusions: Different uterine injection sites appear to share a common pelvic lymphatic pathway and sentinel lymph node in most cases, consistent with the current practice in endometrial cancer. Future research will confirm whether cervical injections might be proposed for pelvic sentinel lymph node mapping in all gynecological cancers. Full article

Background: Predictive models like Residual Neural Networks (ResNets) can use Magnetic Resonance Imaging (MRI) data to identify cervix tumors likely to recur after radiotherapy (RT) with high accuracy. However, there persists a lack of insight into model selections (explainability). In this study, we explored whether model features could be used to generate simulated images as a method of model explainability. Methods: T2W MRI data were collected for twenty-seven women with cervix cancer who received RT from the TCGA-CESC database. Simulated images were generated as follows: [A] a ResNet model was trained to identify recurrent cervix cancer; [B] a model was evaluated on T2W MRI data for subjects to obtain corresponding feature maps; [C] most important feature maps were determined for each image; [D] feature maps were combined across all images to generate a simulated image; [E] the final image was reviewed by a radiation oncologist and an initial algorithm to identify the likelihood of recurrence. Results: Predictive feature maps from the ResNet model (93% accuracy) were used to generate simulated images. Simulated images passed through the model were identified as recurrent and non-recurrent cervix tumors after radiotherapy. A radiation oncologist identified the simulated images as cervix tumors with characteristics of aggressive Cervical Cancer. These images also contained multiple MRI features not considered clinically relevant. Conclusion: This simple method was able to generate simulated MRI data that mimicked recurrent and non-recurrent cervix cancer tumor images. These generated images could be useful for evaluating the explainability of predictive models and to assist radiologists with the identification of features likely to predict disease course. Full article

Objectives: The aim of the study was to analyze and compare the possible effect of cervical conization and the loop electrosurgical excision procedure (LEEP) on female sexual function up to one year after intervention, as existing studies provide incoherent results. Methods: This prospective cohort study enrolled patients who underwent either LEEP (n = 35) or surgical conization of the cervix (n = 44). Patients completed the questionnaire before the intervention and at three, six, and twelve months after the end of the postoperative period. The questionnaire included the Polish version of the Female Sexual Function Index (FSFI) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire of Cancer Patients with the module Cervix-24. Results: In the LEEP group, significant deterioration was observed in the FSFI orgasm subscale after three and six months in comparison to the baseline (3.98 ± 2.08 vs. 3.19 ± 2.29 vs. 3.09 ± 2.24; p < 0.02). The difference in the orgasm subscale compared to the baseline score was not reported after twelve months of follow-up. In the surgical conization group, significant deterioration was observed in the general FSFI score between the baseline and three months after (22.37 ± 12.38 vs. 20.82 ± 12.02; p < 0.003) and in the arousal subscale between the baseline and three months after (3.69 ± 2.14 vs. 3.01 ± 2.02; p < 0.001). In the orgasm subscale, there was a significant improvement between three and twelve months of observation (3.05 ± 2.22 vs. 3.63 ± 2.29; p < 0.003). A significant deterioration was observed in the sexual activity subscale of the EORTC QLQ-C30 + CX24 between baseline and after three months (49.42 ± 36.12 vs. 39.09 ± 36.81; p < 0.03). All reported deteriorations had a tendency to resolve within twelve months of observation. Conclusions: Both LEEP and surgical conization of the cervix seem to have a mild, transient negative impact on female sexual function, which normalizes one year after the procedure. Long-term consequences of both procedures are similar. Further research with larger sample sizes is necessary to confirm these findings. Full article