Search Results (314)

Ovarian cancer remains a leading cause of gynaecological cancer mortality, and ultrasound-based deep learning systems for its diagnosis are typically built as separate post hoc processes for classification, segmentation, and interpretability, which introduces workflow inefficiencies and may produce inconsistent predictions. This work addresses that limitation. We propose UM-TOTA (Unified Multi-Task Ovarian Tumour Architecture), a Vision Transformer (ViT)-based architecture that performs eight-class tumour classification, three-class malignancy detection, tumour segmentation, and clinical concept interpretability within a single unified framework. We integrate a concept bottleneck guided by the IOTA and O-RADS clinical guidelines to enable transparent decision-making through medical concepts that clinicians can understand, and we employ combined adaptive t-vMF Dice and boundary-enhanced segmentation losses with progressive task weighting to stabilise multi-task optimisation. We evaluated the model on the Multi-Modality Ovarian Tumor Ultrasound (MMOTU) 2D dataset under two protocols: image-level 5-fold stratified cross-validation, and the patient-disjoint partition released with the dataset. Under cross-validation, UM-TOTA achieved 80.26% ± 1.10% accuracy (97.06% one-vs-rest macro specificity) for eight-class classification, 90.88% ± 1.14% accuracy (90.41% specificity) for malignancy detection, and 77.29% ± 1.29% Dice for segmentation. Under the patient-disjoint partition, which excludes any overlap of patients between training and testing, the corresponding values were 78.46%, 89.13%, and 75.41%, a reduction of under 2.2 percentage points on every metric. The UM-TOTA reduced the computational parameter load by approximately 65.1% relative to sequential single-task pipelines. The learned concepts aligned with established malignancy criteria, identifying vascularisation, solid components, and papillary projections as key predictors. This unified approach offers an efficient and interpretable framework for clinical ovarian ultrasound workflows. Full article

Endometrial cancer is one of the most rapidly increasing gynaecological malignancies worldwide. The clinically adapted molecular classification of endometrial carcinoma, derived from The Cancer Genome Atlas, comprises four major subtypes: POLE-mutated, mismatch repair-deficient, p53-abnormal expression, and no specific molecular profile. Its clinical implementation has improved prognostic stratification, risk assessment, and treatment decision-making in patients with endometrial carcinoma. However, current workflows rely on immunohistochemistry and targeted sequencing, which increase costs, turnaround times, and infrastructure requirements, thereby limiting their universal adoption in routine clinical practice. Recent advances in artificial intelligence (AI), particularly deep learning models capable of predicting molecular features directly from H&E-stained whole-slide images, have emerged as promising tools for precision oncology. In addition to reproducing established molecular classification, these approaches may reveal previously unrecognised biomarker-defined histologic patterns that are difficult to detect using conventional methods. This article synthesises the current evidence on AI-based molecular classification in endometrial carcinoma from a pathologist-centred perspective, emphasising the biological rationale, methodological limitations, and future directions for clinical translation. Full article

Background/Objectives: Women with breast cancer (BC) and gynaecological cancer (GC) often undergo extensive oncological treatment, which can lead to pelvic floor disorders (PFD). However, there is still limited evidence regarding their real-world treatment practices, patient counselling, and prevalence. This study aims to systematically evaluate the prevalence of PFD and current treatment approaches, identify unmet needs, and improve future care. Methods: This observational multicentre survey was conducted at four university hospitals and one gynaecological oncology outpatient clinic in Germany. Women with BC and GC, who had undergone at least one oncological treatment, completed anonymously a study-specific questionnaire and the validated German Pelvic Floor Questionnaire. Recruitment was undertaken over a period of nine months, reflecting real-world daily care. Results: A total of 246 patients were included (median age 57 years, range 30–88); 74% were postmenopausal, and 52% had at least one vaginal delivery. BC was the most common diagnosis (63.8%). The most common symptoms were urinary incontinence (22.3% in BC, 38.1% in GC) and urgency (32.5% in BC, 35.7% in GC). Pelvic radiotherapy was significantly associated with increased urgency symptoms (p = 0.017), pelvic surgery with urgency symptoms (p = 0.048) and dyspareunia (p = 0.045), and antihormonal therapy with vaginal dryness (p = 0.028). The combination of chemotherapy and antihormonal therapy was associated with significantly higher rates of vaginal dryness in women with GC, whereas no such association was observed in women with BC (p = 0.036). Among the 108 patients classified as having new-onset symptoms, 51 (47.2%) reported symptom onset within one year of the cancer diagnosis. Overall, 34.1% of patients reported impairment in more than one patient-reported domain, including daily life, social life, sexual well-being, and psychological well-being. The median study-specific impact rating for the most bothersome pelvic floor symptom was 5/10. Only 28.0% of patients received prior counselling on PFD, and 19.9% were actively asked about symptoms. In total, 26.0% received urogynaecological treatment, whereas 15.4% reported unmet treatment needs. Conclusions: PFD is highly prevalent in women with BC and GC. Symptoms are clinically relevant but underestimated in routine care. Despite the availability of effective treatment options, significant gaps exist in patient counselling, early detection, and access to specialised care. Full article

Mismatch repair deficiency (MMRd) is a critical biomarker in endometrial cancer (EC) for prognostication, Lynch syndrome screening, and immunotherapy eligibility. This study aimed to determine the prevalence of MMRd and its correlation with clinicopathological characteristics in EC. This prospective observational cohort included 93 patients with EC undergoing primary surgical treatment, managed as per the European Society of Gynaecological Oncology (ESGO) guidelines. MLH1, PMS2, MSH2, and MSH6 expression was assessed through immunohistochemistry (IHC) on formalin-fixed, paraffin-embedded hysterectomy specimens. Associations between mismatch repair (MMR) status and histology, grade, lymphovascular space invasion (LVSI), myometrial invasion, FIGO 2023 stage, nodal status, recurrence, and survival were analyzed. The median age was 66 years. Most tumors were endometrioid (86%), 29% were grade 3, 45.2% showed deep myometrial invasion, and 23.7% had substantial LVSI. MMRd was identified in 41.9% of cases, with MLH1 and PMS2 loss being most frequent, and was significantly associated with endometrioid histology (p = 0.027) and deep myometrial invasion (p = 0.011). No significant correlations were found with grade, LVSI, FIGO stage, nodal involvement, recurrence, or overall survival. Routine MMR assessment may refine risk stratification and guide individualized treatment decisions. Full article

Objective: Fertility-preserving therapies are a potential option for selected patients with early-stage endometrial cancer and atypical endometrial hyperplasia/endometrial intraepithelial neoplasia. This systematic review aims to evaluate the impact of fertility-preserving strategies according to molecular subtype. Methods: A comprehensive search was conducted in PubMed, Cochrane Library, EMBASE, and Web of Science for English-language studies published until June 2024, investigating fertility-sparing treatments using endocrine therapy in early-stage endometrial cancer, considering molecular classification. The PRISMA checklist was followed, and the protocol was registered in PROSPERO (CRD42025649342). Data on body mass index (BMI), age, and molecular classification (POLE-mutant, non-specific molecular profile [NSMP], p53-abnormal, and mismatch repair deficient [dMMR]) were extracted. The study assessed objective response rates (ORR), pregnancy outcomes, and survival outcomes. Statistical analyses were performed using R software. Results: The search identified 941 articles, and 10 studies with 457 patients were selected for final analysis. Pregnancy outcomes were reported in three studies, whilst all reported ORR data. Baseline median age (dMMR 35 years, POLE-mutant 38.2 years, p53-abnormal 33.9 years, and NSMP 31.6 years) and BMI (dMMR 24.3, POLE-mutant 27.9, p53-abnormal 26.2, and NSMP 29.8) differed by molecular subtype. Aggregated full-term delivery rates from the three studies reporting pregnancy outcomes were 36.4% (4/11) for POLE-mutant, 22.1% (27/122) for NSMP, 14.3% (1/7) for p53-abnormal, and 4.0% (1/25) for dMMR tumours, but statistical comparison was not feasible due to small sample size. Overall response rate was highest in NSMP (87.4%) and POLE-mutant tumours (84.6%), while dMMR (59.3%) and p53-abnormal (58.8%) had significantly lower ORR (compared to NSMP, p < 0.001 and p = 0.03, respectively). Conclusions: These findings support the potential role of molecular classification in refining patient selection for fertility-sparing treatment in early-stage endometrial cancer. Pregnancy-related outcomes should be interpreted with caution given the limited available evidence. Full article

Background: India accounts for one-fifth of global cervical cancer deaths, yet Human Papillomavirus (HPV) vaccination coverage remains low despite the World Health Organization (WHO) recommendations to initiate vaccination at age 9. With the national HPV vaccination campaign in 2026 and its approval for integration into India’s Universal Immunization Programme (UIP), strengthening physician knowledge, beliefs, and confidence in recommending the vaccine is critical. Methods: In 2023, the American Cancer Society and Cancer Foundation of India catalyzed two national medical societies, the Federation of Obstetric and Gynaecological Societies of India and the Indian Academy of Pediatrics, to educate physicians on HPV vaccination using a train-the-trainer (ToT) model. A mixed-methods evaluation, using the RE-AIM Framework, included pre- and post-training surveys assessing changes in knowledge, beliefs, confidence, and intent, as well as monthly engagement surveys and project reports analyzed using descriptive and inferential statistics. A fidelity assessment evaluated consistency of training delivery. Twenty in-depth interviews explored physician reactions and implementation of learnings, analyzed using a rapid approach. Results: A total of 18,206 physicians were trained. The post-training respondent group demonstrated higher HPV vaccination knowledge scores and more favorable responses in confidence, beliefs, and intent than the pre-training respondent group. The fidelity assessment demonstrated consistent delivery overall, with some variability in role play facilitation. Interviews highlighted increased physician confidence, peer knowledge sharing, and community engagement following the training. Medical societies reported strong program adoption and plans for continued efforts. Conclusions: A ToT physician training cascaded through medical societies is a feasible strategy to prepare physicians to recommend the HPV vaccine and address parental concerns at scale. Full article

Background: The COVID-19 pandemic substantially disrupted healthcare systems worldwide, raising concerns regarding delays in diagnosis, alterations in treatment pathways, and oncological outcomes for women with advanced ovarian cancer (AOC). This study evaluated the impact of the pandemic on the management and survival of patients with AOC treated at a high-volume ESGO-accredited tertiary gynaecological oncology centre. Methods: A retrospective cohort study was conducted using a prospectively maintained database of consecutive women diagnosed with FIGO stage III–IV epithelial ovarian, fallopian tube or primary peritoneal cancer between January 2017 and December 2022. Patients were divided into pre-pandemic and pandemic cohorts. Demographic characteristics, FIGO stage, treatment pathways, surgical outcomes, and overall survival were compared. Survival was analysed using Kaplan–Meier methodology and multivariable Cox proportional hazards regression was performed to evaluate the independent association between the pandemic period and overall survival after adjustment for age, FIGO stage, ECOG performance status and treatment modality. Results: A total of 700 patients were included, 406 patients treated before the pandemic and 294 during the pandemic. Patients diagnosed during the pandemic had a better ECOG performance status, but 51.3% presented with FIGO stage IV disease. Overall treatment rates were maintained (84.4% vs. 87.4% pre-pandemic), although treatment strategies shifted towards increased use of neoadjuvant chemotherapy (55% vs. 42.4%, p < 001), with a greater proportion of patients subsequently undergoing interval debulking surgery. Complete cytoreduction following interval debulking surgery was preserved throughout the study period, despite more advanced disease at presentation. One-year overall survival was similar between cohorts (69% vs. 72.2% pre-pandemic), whereas three-year overall survival was significantly lower among patients treated during the pandemic (36.1% vs. 45.1%). On multivariable Cox regression analysis, treatment during the pandemic remained independently associated with poorer overall survival after adjustment for clinically relevant baseline factors. Conclusions: Despite unprecedented disruption to healthcare services, specialist gynaecological oncology care has maintained access to multimodality treatment and preserved maximal effort cytoreductive surgery. Nevertheless, patients diagnosed during the pandemic experienced inferior long-term survival independent of baseline disease characteristics and treatment allocation, highlighting the broader indirect consequences of the pandemic on cancer outcomes. These findings emphasise the importance of protecting diagnostic pathways, multidisciplinary cancer services and surgical capacity during future healthcare crises. Full article

Background: Although cervical cancer is a highly preventable malignancy, Romania continues to report critical mortality rates. This paradox is largely attributable to the suboptimal implementation of clinical guidelines and a passive, “opt-in” administrative framework. This cross-sectional study investigates the cognitive and behavioural determinants—specifically, human papillomavirus (HPV) knowledge, institutional trust in healthcare systems, and digital misinformation exposure—that modulate female attitudes toward HPV immunisation. Methods: An observational cross-sectional study was conducted between December 2025 and March 2026 across four obstetrics and gynaecology clinics. Data were collected via digital questionnaires administered to adult female patients aged 18 to 65 years. The assessment tool evaluated four primary domains: HPV knowledge, perceived vaccine safety, immunisation intention, and the degree of exposure to social media misinformation. Results: The cohort demonstrated a substantially low vaccination rate (28.6%). Statistical analysis elucidated significant positive correlations between HPV knowledge, trust in health authorities, and vaccination intention. Furthermore, reliance on official information sources strongly correlated with perceived vaccine safety. Conversely, exposure to negative online content exhibited a weak negative association with knowledge levels, yet it did not directly influence vaccination intention. Conclusions: Health literacy and institutional trust emerge as fundamental pillars for HPV vaccine acceptance. To overcome patient vaccine hesitancy, the national healthcare system must initiate a strategic paradigm shift, prioritising the neutralization of digital misinformation and transitioning from a passive model to a proactive, “opt-out” infrastructure. Full article

Background/Objectives: The levonorgestrel-releasing intrauterine device (LNG-IUD) is widely used as a long-acting reversible contraceptive and as a therapeutic option for heavy menstrual bleeding, endometriosis, adenomyosis, and endometrial hyperplasia. Although its predominant effect is local, systemic levonorgestrel exposure has raised questions regarding its potential influence on cancer risk. This review aims to summarise and critically appraise the available evidence on the association between LNG-IUD use and gynaecologic, breast, and selected non-gynaecologic malignancies (including colorectal, lung, pancreatic, gastric, thyroid, skin [melanoma], and haematological cancers). Methods: A structured narrative review was developed by a multidisciplinary expert group affiliated with the European Society of Gynaecological Oncology (ESGO) and the European Society for Gynaecological Endoscopy (ESGE). PubMed/MEDLINE, Embase, and Scopus were searched in December 2024 without publication-date restrictions. We critically appraised epidemiological and clinical evidence on LNG-IUD use and breast, endometrial, ovarian, cervical, and selected non-gynaecologic cancer risks, prioritising population-based cohorts, registry-based studies, case–control studies, systematic reviews, and meta-analyses. Results: The strongest and most consistent evidence supports a substantial reduction in endometrial cancer risk among LNG-IUD users, with a possible protective association also suggested for ovarian cancer. Available data do not indicate a clear increase in cervical cancer, CIN3+, or invasive cervical disease. In contrast, evidence for breast cancer remains heterogeneous, with some registry-based studies suggesting a modest relative increase and other cohort or case–control studies showing no significant association. Evidence regarding non-gynaecologic cancers remains limited and inconclusive. Conclusions: Overall, current evidence suggests that the LNG-IUD has a favourable oncological safety profile, with the strongest evidence supporting a significant reduction in endometrial cancer risk and a potential protective effect against ovarian cancer. There is no evidence pointing to increased risk of cervical cancer. However, results related to breast cancer are mixed, and a slight risk increase cannot be ruled out; thus, counselling should be personalised based on the indication, menopausal status, duration of use, and individual breast cancer risk. Full article

Obesity is a chronic, relapsing disease and a significant oncological risk factor. The correlation is most pronounced and consistent for endometrial cancer. Conversely, evidence linking obesity to ovarian cancer is less robust and varies by histotype, while the association with cervical cancer is influenced by factors related to screening, diagnosis, treatment, and survival. This review examines obesity, particularly class III (morbid) obesity, in relation to the risk of gynaecological cancer, diagnostic approaches, and management strategies. A structured narrative review of PubMed/MEDLINE, Cochrane Library, Scopus and Web of Science Core Collection was conducted for literature published between January 2000 and December 2025. Eligible evidence included systematic reviews, meta-analyses, cohort and case–control studies, mechanistic studies and clinical guidance relevant to obesity and endometrial, ovarian or cervical cancer. Title/abstract screening and full-text selection were conducted using predefined criteria for conceptual relevance and clinical applicability. Excess adiposity contributes to endometrial carcinogenesis through hormonal dysregulation, insulin resistance and hyperinsulinaemia, adipokine imbalance, chronic inflammation, and oxidative stress. In ovarian cancer, associations are generally weaker but appear more relevant for selected histological subtypes and cumulative adiposity exposure. In cervical cancer, obesity should not be interpreted as replacing HPV-driven pathogenesis; rather, it may affect screening adequacy, treatment selection, perioperative risk, and disease-specific survival in morbidly obese patients. Current evidence does not support morbid obesity as an independent driver of all gynaecological cancers. It supports obesity as a major modifiable risk factor and clinical modifier, particularly for endometrial cancer, and highlights the need for pragmatic risk stratification based on BMI class, adiposity distribution, metabolic comorbidity, functional status and cancer-site-specific pathways. Biomarker evidence remains hypothesis-generating, and obesity-integrated oncological pathways require prospective validation in patients with a BMI ≥ 40 kg/m². Full article

Background/Objectives: To evaluate clinical and dosimetric predictors of vaginal toxicity in patients treated with vaginal-cuff brachytherapy (VCB), with or without external beam radiotherapy (EBRT), and assess the impact of different prescription and optimization strategies on dose–volume parameters. Methods: We retrospectively analyzed 217 patients treated with EBRT combined with VCB (n = 120) or VCB alone (n = 97). In VCB three prescription and optimization strategies (volume-based, graphical optimization, and 5 mm distance-based prescription) were compared to determine differences in dose–volume parameters. In patients who developed late vaginal side effects, the dosimetric parameters were evaluated using descriptive statistics and Cox regression modeling. Kaplan–Meier analysis was performed to assess time to toxicity. Results: In the EBRT+VCB cohort, 34/120 patients (28.3%) developed grade 1–2 vaginal toxicity compared to 35/97 (36%) in the VCB alone cohort. In the EBRT+VCB group, patients with toxicity received a higher D90 per fraction and higher vaginal D_2cc. In multivariable analysis, vaginal D_2cc (HR = 1.60, 95% CI = 1.01–2.54, p = 0.045) and CTV-DVH (HR = 0.77, 95% CI = 0.61–0.97, p = 0.027) were independently associated with toxicity. No significant dose–toxicity associations were observed in the VCB-alone cohort. Most events occurred within 48 months in both groups. Comparison of prescription strategies showed systematic differences in target and organ-at-risk dose–volume parameters, including vaginal D_2cc. The 5 mm distance-based prescription consistently resulted in higher D90, D100, EQD2, and vaginal D_2cc values. Conclusions: In patients receiving EBRT combined with VCB, both vaginal D_2cc and target dose distribution were associated with vaginal toxicity. The prescription and optimization strategy significantly influenced dose–volume parameters. Planning methodology and dosimetric aspects should be considered when interpreting dose–toxicity relationships in vaginal brachytherapy. Full article

The study aims to investigate the Health-Related Quality of Life (HRQOL) in lung cancer survivors, comparing it with the HRQOL of survivors of other types of cancer, analyzing its association with clinically significant distress, and exploring the modulating role of sociodemographic, clinical, and psychosocial variables. A total of 141 lung cancer survivors who had completed treatment with curative intent and were disease-free completed the Quality of Life in Adult Cancer Survivors questionnaire (QLACS), the Brief Symptom Inventory-18 (BSI-18), the Medical Outcomes Study–Social Support Survey (MOS-SSS), and the Utrecht Proactive Coping Competence scale (UPCC). Several multivariate analyses of variance (MANOVA) were performed to address the study objectives. Statistical analysis was performed using IBM SPSS Statistics 22.0. The overall HRQOL of lung cancer survivors did not differ from the HRQOL of hematologic, breast, and gynaecologic cancer survivors and was lower than that of colorectal, head/neck, prostate, and melanoma cancer survivors. HRQOL was associated with clinically significant distress. Younger age, female sex, lower levels of proactive coping, and less positive social interaction were independently associated with worse HRQOL in lung cancer survivors. The overall HRQOL of lung cancer survivors is among those with the poorest HRQOL compared with other cancer survivors’ groups. The modifiable nature of the psychosocial variables that characterize the risk profile (with the exception of sociodemographic ones) allows for the establishment of more ambitious goals than the simple establishment of subgroups on which to prioritize care. The team of professionals involved in the care of lung cancer survivors should also provide intervention strategies that improve their well-being. Full article

Background: Endometrial carcinoma (EC) is one of the most common gynaecological malignancies, with a steadily increasing incidence worldwide. In 2013, a novel molecular classification of ECs enabled patient stratification into four groups with important clinical management implications: (1) DNA Polymerase Epsilon (POLE)-mutated, (2) microsatellite instability-high (MSI-H/dMMR) hypermutated, (3) tumours with low somatic copy number alteration (low-SCNA), and (4) tumours with high SCNA and p53 deficiency. This molecular classification should also be used as a tool to identify hereditary cancer syndromes, as MSI-ECs can be associated with Lynch Syndrome (LS, ORPHA:144) while somatic POLE mutations may reflect polymerase proofreading-associated polyposis (PPAP syndrome, ORPHA:447877). Methods: From 2022 to 2024, molecular classification of ECs was routinely performed on 188 consecutive cases. The results were correlated with family history and constitutional genetic testing. Results: Somatic testing revealed that 45 ECs were dMMR and 23 carried POLE variants. Five POLE-mutated ECs also displayed concomitant MSI. For all 68 patients, cancer genetic counselling was proposed, but only 41 accepted, and of these, 26 patients were eligible for the genetic test. None of the POLE somatic variants were proven to be constitutive, whereas LS was diagnosed in seven patients with dMMR-EC; interestingly, two of these patients displayed a POLE-mutated EC. Conclusions: Our data strongly suggest that molecular classification of ECs is important to improve the identification of LS and highlight the relevance of investigating all molecular markers at once in order to identify overlaps between POLE mutations and MMR defects. Full article

Background: High-risk human papillomavirus (HPV) is a leading cause of cervical cancer, particularly in settings with high-risk sexual behaviours and limited preventive care. HPV prevalence peaks in adolescence and early adulthood due to early sexual initiation, multiple partners, inconsistent condom use, anal intercourse, and oral–genital contact. To assess the prevalence and associated risk factors for high-risk HPV infections among female students in Benin City, Nigeria. A faith-based college in Benin City, Nigeria. Methods: A cross-sectional study was conducted among 133 female nursing students. Self-collected genital swabs were analysed using real-time fluorescence quantitative PCR to detect 14 high-risk HPV types. Participants completed a structured questionnaire on sexual behaviour, contraceptive use, and HPV knowledge. Results: The overall high-risk HPV prevalence was 45/133 (33.8%), with 39 (29.3%) presenting multiple infections. HPV66, 58, and 56 were the most common types detected. Significant associations were observed with oral contraceptive use (OR = 3.2, 95% CI = 1.01–9.97) and abnormal vaginal discharge (p = 0.028). Conclusions: The predominance of HPV66, HPV58, and HPV56 highlights the increasing importance of non-vaccine HPV genotypes and shows the need for targeted screening and vaccination. Associations with abnormal vaginal discharge and oral contraceptive use emphasize the importance of sexual health education and routine gynaecological care among young women. This study underscores the need for targeted HPV screening, vaccination, and sexual health education to reduce cervical cancer risk among young women in Nigeria. Full article