Search Results (679)

Background and Clinical Significance: Melanoma is predominantly a cutaneous malignancy, whereas metastatic involvement of the endometrium is exceptionally rare. Melanoma of unknown primary (MUP) accounts for a small portion of such cases. Patients typically present with abnormal uterine bleeding, and diagnosis can be challenging because metastatic melanoma can mimic other uterine malignancies. We report a rare case of MUP presenting with synchronous endometrial and subcutaneous metastases, a combination not previously reported in the literature. Case Presentation: A multiparous woman in her seventies presented with persistent postmenopausal bleeding. Transvaginal ultrasonography demonstrated endometrial thickening, and endometrial biopsy revealed metastatic melanoma confirmed by immunohistochemical positivity for S100, SOX10, HMB-45, and Melan-A. Positron emission tomography–computed tomography identified fluorodeoxyglucose uptake in the uterine corpus and a metabolically active subcutaneous lesion in the right anterolateral abdominal wall. Surgical excision of the abdominal lesion confirmed metastatic melanoma. Despite extensive investigations, including dermatological examination, ophthalmological assessment, and imaging studies, no primary tumor was identified. The patient underwent hysterectomy followed by adjuvant nivolumab. At 24-month follow-up, no evidence of disease recurrence was detected. Conclusions: Endometrial metastasis of melanoma may occur in the absence of an identifiable primary lesion and should be considered in patients presenting with abnormal uterine bleeding, particularly those with a history of melanoma or unexplained metastatic disease. Because these lesions frequently present as polypoid, nodular, or infiltrative endometrial masses, prompt hysteroscopy and endometrial sampling are essential for diagnosis. This case highlights the importance of comprehensive histopathological evaluation and multidisciplinary management in rare presentations of metastatic melanoma. Full article

Lymphedema is usually approached as a survivorship complication; yet, many of the injuries that produce lymphatic failure begin during cancer treatment planning. Regional nodal irradiation, chemoradiation, lymph-node surgery, systemic therapy, obesity, infection history, and baseline lymphatic reserve can converge to produce chronic swelling, fibrosis, cellulitis risk, functional limitation, and an impaired quality of life. Despite this, lymphatic drainage pathways are rarely contoured, constrained, or prospectively monitored as organs at risk in radiotherapy practice. This commentary argues that the lymphatic system should enter radiotherapy-planning discussions as a candidate toxicity structure, while cautioning against premature universal dose constraints. Evidence signals are clinically meaningful but not yet protocol-defining: in the MA.20 breast cancer trial, regional nodal irradiation increased lymphedema from 4.5% to 8.4%; in nasopharyngeal carcinoma, mean doses of approximately 58.7 Gy to level IV and 58.6 Gy to levels I–VII were proposed as thresholds associated with moderate/severe facial lymphedema; and gynecological cancer studies report wide lower-limb lymphedema incidence ranges, with radiotherapy, lymphadenectomy, number of nodes removed, and body mass index repeatedly implicated as risk factors. The immediate priority is not mandatory lymphatic sparing, but lymphatic-aware planning: a baseline risk assessment, reproducible candidate contours, dose–volume reporting, selective sparing where oncologically safe, and prospective toxicity monitoring. The author proposed a framework to reflect this argument. Making lymphatic toxicity visible, measurable, and modelled may help shift lymphedema from an accepted late effect to a potentially preventable planning endpoint. Full article

Interventional radiology (IR) has reshaped contemporary management strategies for selected gynecological and obstetric disorders by introducing minimally invasive, organ-sparing therapeutic alternatives to conventional surgical approaches. This review examines the current applications of IR in the treatment of symptomatic uterine fibroids, pelvic congestion syndrome, placenta accreta spectrum, cesarean scar pregnancy, and selected gynecological malignancies requiring palliative or preoperative embolization. In addition, selected vascular conditions in pregnancy, including visceral and cerebral aneurysms, are discussed due to their high-risk clinical profile and growing relevance for endovascular management. These entities were chosen because of their substantial clinical relevance, risk of severe complications, and the expanding body of evidence supporting endovascular management. Techniques such as uterine artery embolization and ovarian vein embolization are associated with high technical success and meaningful symptom reduction, while simultaneously decreasing hospitalization time, perioperative morbidity, and convalescence compared with traditional surgery. In complex obstetric scenarios—including placenta accreta spectrum and splenic artery aneurysm—prophylactic balloon occlusion and endovascular embolization may significantly limit life-threatening hemorrhage and improve maternal prognosis in appropriately selected patients when implemented within a multidisciplinary setting; for splenic artery aneurysm in particular, this evidence currently derives from case reports and small case series rather than comparative trials. Imaging modalities, including ultrasonography, computed tomography, magnetic resonance imaging, and angiography, are integral to diagnosis, patient qualification, procedural planning, and post-intervention monitoring. Although existing data generally confirm the safety and efficacy of interventional techniques, important limitations persist, including heterogeneous study populations, relatively small cohorts, and insufficient long-term reproductive follow-up. Greater standardization of clinical indications and procedural protocols, ongoing technological advancement, and well-designed multicenter trials are required to consolidate the evidence base. In gynecologic oncology, embolization techniques may provide effective hemorrhage control and facilitate surgical treatment in selected patients. In addition, uterine artery embolization has emerged as an important uterus-preserving adjunct in the management of cesarean scar pregnancy, although long-term reproductive (fertility) outcome data remain limited. IR is becoming an increasingly important component of modern gynecological care, supporting individualized, uterus-preserving, and less invasive therapeutic strategies; fertility preservation specifically is an important goal that, for several of the indications discussed, remains incompletely proven by long-term reproductive-outcome data. Full article

Background/Objectives: Management of locally advanced cervical cancer (LACC) and other gynecological malignancies aims to achieve locoregional control while avoiding morbid surgical salvage. This exploratory, hypothesis-generating study described the treatment pathways of three protocol groups and examined whether clinical, sociodemographic, and treatment-deviation variables are associated with any oncological surgery. Methods: Sixty-nine adult patients with gynecological or urogenital cancers (89.9% cervical carcinoma) treated with platinum-based chemotherapy at a Romanian tertiary center between April 2024 and April 2025 were stratified into INTERLACE-type dose-dense induction chemotherapy followed by chemoradiotherapy (Group A, n = 27), classic three-weekly neoadjuvant chemotherapy followed by chemoradiotherapy (Group B, n = 7), and no induction chemotherapy (Group C, n = 35). Associations with any oncological surgery (upfront, completion, or salvage) were explored by multivariable logistic regression with bootstrap internal validation, Firth penalized regression, and restricted sensitivity analyses. Results: Twenty-five patients (36.2%) underwent surgery (14 upfront, 8 completion, 3 salvage), and none of them were from Group A, whose median follow-up was only 8.6 months and whose allocation was confounded by diagnosis and stage. The model showed an apparent area under the curve of 0.717 (optimism-corrected 0.672), accuracy of 73.9% against a no-information rate of 63.8% (p = 0.049), sensitivity of 0.480, and specificity of 0.886. Urban provenience (OR 0.343, 95% CI 0.113–1.039, p = 0.059), Delta Target Dose (OR 1.109 per Gy, p = 0.076), and number of chemotherapy cycles (OR 1.298 per cycle, p = 0.076) showed non-significant trends whose direction was unchanged in all sensitivity analyses. Conclusions: The absence of surgery after induction chemotherapy is hypothesis-generating rather than confirmatory, and the exploratory model is not a clinical prediction tool. Geographic provenience and planning-to-delivery treatment deviation are candidate variables for prospective evaluation in a homogeneous LACC population with standardized radiotherapy parameters and mature oncological endpoints. Full article

Objective: Ovarian, fallopian tube, and primary peritoneal cancers remain among the deadliest gynecological malignancies, largely because most cases are diagnosed at an advanced stage and no effective screening strategy is currently available. Increasing evidence suggests that many high-grade serous ovarian carcinomas originate from the fallopian tube. We aimed to explore the diagnostic performance of ex vivo fallopian tube cytology and the CytoSaLPs score for detecting tubal and adnexal malignancies in women undergoing salpingectomy or salpingo-oophorectomy. Methods: We conducted a prospective single-center observational study including 304 women undergoing salpingectomy or salpingo-oophorectomy for benign, premalignant or malignant gynecological indications between 2020 and 2023. Ex vivo cytological brushing of the distal fallopian tube was performed before fixation, followed by histopathological examination using the SEE-FIM protocol where appropriate. The primary analysis was performed at the specimen level. Of 544 paired specimens initially available for cytology–histology correlation, 53 non-diagnostic cytological specimens were excluded from the primary diagnostic performance analysis, leaving 491 evaluable paired specimens. Fallopian tube cytological findings were compared with histopathology as the reference standard. The discriminatory ability of the CytoSaLPs score was explored using receiver operating characteristic analysis. Results: Fallopian tube cytology demonstrated high sensitivity for histologically confirmed tubal malignancy, although specificity was moderate. Based on the primary specimen-level analysis, sensitivity was 94.4% and specificity was 71.0%. When fallopian tube cytology was compared with ovarian histology, sensitivity was 72.9% and specificity was 72.4%. For the adnexa considered as a single anatomical entity, sensitivity was 76.5% and specificity was 70.7%. The CytoSaLPs score showed good discriminatory ability for fallopian tube malignancy (AUC 0.8534), moderate discrimination for ovarian malignancy (AUC 0.6790), and fair discrimination for adnexal malignancy (AUC 0.730). The optimal score thresholds were derived from the same dataset and should therefore be considered provisional. Three serous tubal intraepithelial carcinoma lesions were identified histologically; two showed cytological abnormalities and elevated CytoSaLPs scores, whereas one specimen was non-diagnostic. Conclusions: This exploratory proof-of-concept study suggests that ex vivo fallopian tube and the CytoSaLPs score may provide a structured approach for detecting cytological abnormalities associated with tubal and adnexal malignancy. However, the findings were obtained in a tertiary gynecologic oncology population under ex vivo conditions, non-diagnostic specimens occurred in approximately 10% of samples, and the scoring system was developed and evaluated within the same cohort. Independent external validation and evaluation using clinically applicable in vivo sampling methods are required before any clinical implementation can be considered. Full article

Background: Borderline ovarian tumors (BOTs) represent a distinct group of rare epithelial ovarian neoplasms with excellent prognosis, but persistent uncertainty in patient understanding and clinical management. This study evaluated disease awareness, perceptions, and treatment patterns among affected women in Germany. Methods: The national multicenter Expression VIII survey was conducted across 34 centers by the North-Eastern German Society of Gynecologic Oncology (NOGGO). Using a standardized 46-item questionnaire, 286 patients with BOTs provided data on symptoms, treatment, fertility, follow-up, and illness perception. Descriptive analyses were performed. Results: Most participants (mean age 51 years) underwent surgery (94%), while systemic therapy was infrequent (chemotherapy 9%, bevacizumab 4%). Fertility-sparing surgery was performed in 14% overall, corresponding to 71% of those desiring future childbearing. Although 81% identified their physician as their main information source and rated information quality highly (mean 8.6/10), 29% believed they had ovarian cancer and 64% were unaware of their tumor stage. Nearly all patients (97%) received regular follow-up, though 18% were uncertain about the procedures performed. Disease severity was rated moderately high (mean 5.4/10), and recurrence risk and mortality were often overestimated. Conclusions: Despite good overall physician communication, substantial misconceptions persist among patients with BOTs, including the mistaken belief that they have been diagnosed with cancer, suggesting a need for clearer, structured education about its favorable prognosis and management of the disease. Improved guideline adherence and treatment centralization in specialized centers may reduce overtreatment and optimize fertility-preserving approaches. Full article

Background: Secondary cytoreductive surgery (SCS) followed by postoperative chemotherapy is a recognized option for select patients with platinum-sensitive first recurrent epithelial ovarian cancer (EOC), supported by the DESKTOP-III and SOC-1 trials. Neither trial reported chemotherapy rates stratified by lesion number or resection status. As a result, the added value of postoperative chemotherapy after complete resection of a unifocal recurrence remains unclear. This study aimed to evaluate current clinical practice and factors influencing this decision. Methods: A cross-sectional survey was conducted among gynecological and medical oncologists from international expert oncological centers, assessing definitions of unifocal recurrence, current postoperative chemotherapy practice after complete SCS, perceived clinical value and strength of the supporting evidence, and factors influencing decision-making. Results: Twenty of 48 invited experts responded (41.7%). Respondents applied different definitions of unifocal recurrence, leading to variable estimates of the annual number of patients undergoing SCS. Respondents perceived postoperative chemotherapy to have meaningful clinical value, despite rating the supporting evidence as weak. A proportion did not routinely administer postoperative chemotherapy after complete SCS, managing patients with observation alone. Decisions to omit chemotherapy were influenced by institutional, clinical, and patient-related factors. Overall, 82% of respondents considered a randomized trial comparing chemotherapy with observation clinically valuable. Conclusions: Clinical practice regarding postoperative chemotherapy after complete SCS for a first unifocal recurrence of EOC varies among international expert oncological centers. The absence of a uniform definition of unifocal recurrence and lack of direct evidence regarding postoperative chemotherapy omission highlight the need for standardized definitions and prospective randomized evaluation of chemotherapy versus observation. Full article

Background: Assessment of lymph node involvement was incorporated into the 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system as a critical determinant of patient management and prognostication. This study aims to validate the prognostic significance of metastatic lymph node characteristics and their correlation with molecular classification. Methods: We conducted a retrospective analysis of 131 patients with stage IIIC endometrial carcinoma who underwent surgical intervention at the Tianjin Medical University Cancer Institute and Hospital from 2010 to 2025. The patients were stratified based on various characteristics of metastatic lymph nodes. Progression-free survival (PFS) was estimated using Kaplan–Meier curves, and group comparisons were performed using the log-rank test. Univariate Cox proportional hazards regression was conducted to identify independent prognostic factors for PFS. Results: In accordance with the 2023 FIGO staging system, within the stage IIIC cohort, patients with concurrent pelvic and para-aortic lymph node metastases and those in the stage IIIC1 cohort with macrometastasis demonstrated decreased PFS (HR = 2.748; 95% CI = 1.227–6.151; p = 0.011, and HR = 4.039; 95% CI = 1.232–13.240; p = 0.021, respectively). Furthermore, patients with lymph nodes showing extracapsular extension had significantly reduced PFS in the stage IIIC, stage IIIC1, and stage IIIC1ii cohorts (HR = 10.12; 95% CI = 2.38–42.99; p < 0.001; HR = 3.58; 95% CI = 1.242–10.31; p = 0.011; and HR = 2.32; 95% CI = 0.83–6.71; p = 0.037, respectively). The number of involved lymph nodes, the largest diameter of metastatic foci in lymph nodes, and the presence or absence of extracapsular extension of metastatic lymph nodes were significantly different among the NSMP, MMRd, and p53abn molecular classifications (p = 0.033, p < 0.001, and p = 0.002, respectively). Patients with extracapsular extension of metastatic lymph nodes had worse PFS than those without in the MMRd group (p = 0.018). Conclusions: Extracapsular extension (ECE) of metastatic lymph nodes is the strongest predictor of worse progression-free survival in stage IIIC endometrial carcinoma, especially in the IIIC1 and MMRd subgroups, supporting its value for risk stratification and prognostic assessment. Full article

Background/Objectives: Metabolic syndrome (MetS) and low socioeconomic status (SES) are each established drivers of coronary artery disease (CAD), a leading cause of acute cardiovascular presentations to emergency and acute care services. Whether SES modifies the long-term association between MetS and CAD in a universal health coverage setting is unclear. We examined the independent and joint associations of MetS and income-based SES with 20-year incident CAD. Methods: In this nationwide retrospective cohort study using the Korean National Health Insurance Service database, 489,521 adults aged 40–79 years who underwent a national health examination in 2005 and were free of CAD at baseline were followed through 31 December 2024 (up to 20 years). At baseline, the mean age was 54.1 ± 9.2 years, and 252,818 participants (51.6%) were men. MetS was defined by modified harmonized criteria, with body mass index (BMI) ≥ 25 kg/m² substituted for waist circumference. SES was measured by health insurance premium deciles and classified as high (deciles 8–10), middle (4–7), low income (1–3), and Medical Aid (decile 0). The outcome was incident CAD (myocardial infarction or angina pectoris). Multivariable Cox proportional hazards models were adjusted for age, sex, smoking, alcohol consumption, regular exercise, BMI, chronic kidney disease, alternate exposure, and estimated adjusted hazard ratios (aHRs); joint exposure and additive interaction (relative excess risk due to interaction, RERI) were assessed. Results: MetS prevalence was 30.6%. During follow-up, 48,428 participants (9.9%) developed CAD. MetS was independently associated with CAD (aHR 1.84; 95% CI 1.78–1.91), as was a graded socioeconomic gradient (Medical Aid vs. high SES aHR 1.62; 1.54–1.70). Incidence rates ranged from 3.13 (high-SES without MetS) to 11.40 (Medical Aid with MetS) per 1000 person-years. In the joint analysis, Medical Aid beneficiaries with MetS had the highest risk (aHR 2.92; 2.78–3.08 vs. high-SES without MetS; p for interaction < 0.001), with positive additive interaction (RERI 0.68). Conclusions: Over two decades, low SES amplified the CAD burden associated with MetS. Adults living in the most severe material deprivation who also had MetS constituted the highest risk group, of direct relevance to risk stratification and disparities in emergency and acute cardiovascular care. Full article

Background and Objectives: Radical cystectomy (RC) is standard treatment for muscle-invasive bladder cancer, but the role of gynecologic organ preservation in women remains uncertain. We primarily evaluated the prevalence and predictors of pathological gynecologic organ involvement and secondarily assessed survival and developed a prediction model. Materials and Methods: This multicenter retrospective study included 232 women undergoing RC at 13 tertiary centers. Of the 232 women, 182 had clinical T2 disease and 50 had BCG-unresponsive or very-high-risk Ta/T1 non-muscle-invasive bladder cancer. Overall survival (OS) was the primary endpoint; CSS and RFS were secondary outcomes. Multivariable logistic regression was used to identify predictors and develop preoperative prediction models. Results: Pathological gynecologic organ involvement was identified in 26 patients (11.2%): uterine in 15 (6.5%), vaginal in 11 (4.7%), ovarian in five (2.2%), and adnexal in 21 (9.1%). The median OS was shorter in patients with involvement than in those without (19.0 vs. 48.0 months; p = 0.048). Vaginal and ovarian involvement were associated with shorter OS (both p < 0.001), whereas uterine and adnexal involvement were not. Pathological T stage was associated with organ involvement (p = 0.001), with the highest frequency in pT4 disease. Model 2 showed an AUC of 0.898 and an optimism-corrected AUC of 0.872. A risk score of 0 classified 31.0% as low risk, with an NPV of 97.2% and a sensitivity of 92.3%. Conclusions: Pathological gynecologic organ involvement was uncommon but associated with poorer survival. These findings may support preoperative risk stratification, although the oncologic safety of organ-preserving surgery cannot be established from pathological involvement data alone. Full article

A standardized extract of cultured Lentinula edodes mycelia (ECLM), commercially known as AHCC^®, shows anti-inflammatory, immunomodulatory, and organ-protective properties. Experimental studies have indicated that ECLM modulates innate and adaptive immunity, including natural killer (NK) cell activity, antigen-presenting cell function, T-cell responses, and cytokine balance. These effects are particularly relevant in oncology because surgical stress and ischemia–reperfusion injury (IRI) generate a transient perioperative environment characterized by immune suppression, inflammation, and conditions favorable for metastatic progression. Recent animal studies have demonstrated the protective effects of ECLM in intestinal and hepatic IRI models, providing a potential mechanistic rationale for improving the perioperative host microenvironment. Clinical studies on hepatocellular carcinoma, pancreatic cancer, and gynecological malignancies suggest that ECLM may offer potential benefits in immune preservation, nutritional support, symptom management, and recurrence prevention, although most studies are small and hypothesis-generating. Emerging evidence from patient-derived xenograft and spontaneous carcinogenesis models further suggests that ECLM may influence tumor biology beyond host immune activation, although the underlying mechanisms require elucidation. This review summarizes the mechanistic, preclinical, translational, and clinical evidence supporting the use of ECLM as a candidate for perioperative immunonutritional strategies. We propose the hypothesis that ECLM may function as a perioperative microenvironmental stabilizer that integrates immune preservation and intestinal barrier protection. Full article

Background: Postoperative admission to critical care facilities is frequently employed following complex abdominal and gynecologic oncology surgery; however, the clinical value of routine short-stay (≤24 h) high-acuity care remains uncertain as the existing evidence is limited, heterogeneous and derived primarily from non-randomized studies. Consequently, the present critical narrative review aims to discuss the rationale for planned short-duration postoperative high-acuity care, summarize the contemporary evidence, and identify priorities for future research. Methods: Relevant studies evaluating planned postoperative admission to critical care facilities for ≤24 h following major abdominal surgery were identified through a targeted review of contemporary literature using a structured search of MEDLINE, Scopus, Google Scholar, the Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Evidence from observational studies investigating intensive care units, high-dependency units, post-anesthesia care units, and advanced recovery pathways was critically synthesized, with particular attention to clinical outcomes, healthcare utilization, and current knowledge gaps. Results: Nine primary studies were included, predominantly observational in design, with the majority lacking a comparative study design, thereby limiting direct evaluation of the clinical effectiveness of planned short-stay postoperative high-acuity care. None of the studies were designed to evaluate a gynecologic oncology population, limiting the direct applicability of the available evidence to this setting. As such, the current evidence is better suited to critical clinical interpretation of the rationale, patient selection, and potential role of postoperative high-acuity care than to drawing definitive conclusions regarding intervention effectiveness. Overall, the available data suggest that planned short-stay high-acuity postoperative care is not consistently associated with reductions in postoperative mortality or overall morbidity but may decrease unplanned intensive care unit admissions in selected patient populations. Most studies reported little or no effect on overall hospital length of stay, whereas increased healthcare costs were primarily observed in capacity-driven or unplanned postoperative critical care pathways. Interpretation of the available literature remains limited by the predominance of observational studies, heterogeneous patient populations, variability in critical care models, and inconsistent outcome reporting. Conclusions: Current evidence does not support routine postoperative admission to critical care facilities following major abdominal surgery, while evidence specifically addressing gynecologic oncology remains insufficient to establish specialty-specific effectiveness. However, planned, time-limited high-acuity postoperative care was not associated with an observed increase in adverse clinical outcomes in the available observational studies and may offer clinical and system-level benefits in selected high-risk patients; these findings should be interpreted cautiously given the limitations of the available evidence. Prospective studies with standardized outcome reporting and clearly defined populations are needed to inform evidence-based perioperative care strategies. Full article

Cancer-associated thrombosis (CAT) is defined as venous or arterial thrombotic events occurring in patients with active malignancy or during anticancer treatment, most commonly presenting as venous thromboembolism and representing a leading cause of morbidity and mortality in oncology. Hormone-sensitive malignancies, including breast, ovarian, and endometrial cancers, are characterized by a complex interaction among tumor biology, endocrine signaling, inflammation, endothelial dysfunction, and coagulation activation. In these malignancies, venous thromboembolism (VTE) risk is influenced not only by intrinsic tumor-related mechanisms but also by patient-specific factors and anticancer therapies, particularly endocrine treatments, chemotherapy, targeted agents, and extensive surgical procedures. Breast cancer is generally associated with an intermediate thrombotic risk, although endocrine therapy—especially tamoxifen—significantly increases VTE incidence. Ovarian cancer represents one of the most thrombogenic solid tumors because of elevated tissue factor expression, inflammatory activation, advanced-stage presentation, and aggressive multimodal treatment strategies. Endometrial cancer exhibits a strong association with obesity, metabolic syndrome, prolonged estrogen exposure, and perioperative thrombotic complications. Emerging evidence highlights the role of immune-thrombosis, extracellular vesicles, inflammatory cytokines, and sex-specific coagulation pathways in cancer-associated hypercoagulability. Current guidelines increasingly support individualized thromboprophylaxis based on tumor biology, patient-specific risk factors, and bleeding risk assessment. This review summarizes the biological mechanisms linking hormones and thrombosis in breast and gynecologic cancers, discusses current evidence regarding VTE risk factors and treatment-related thrombotic complications, and explores modern approaches to biomarkers, risk stratification, and personalized thromboprophylaxis. Full article

Background/Objectives: The COVID-19 pandemic was a major challenge for healthcare systems and social life worldwide. During the pandemic, studies focused on examining structural changes in patient care and establishing new guidelines to manage COVID-19, but very few of them addressed patients’ perceptions and concerns regarding changes in cancer treatment during the pandemic. This study aimed to assess the changes in their therapy situation during three waves of the pandemic and the impact on their social life. Methods: This exploratory cross-sectional multicenter survey was conducted among patients with gynecological malignancies and breast cancer at gynecological oncology centers in Germany between October 2020 and February 2022. An anonymous paper-based 50-item questionnaire, available in German, assessed medical care, treatment modifications, mental health, and socioeconomic burden during the COVID-19 pandemic. Data were analyzed descriptively. Two subgroup analyses were conducted, comparing age groups ≤70 and >70 years, as well as patients with and without a migrant background. Results: Overall, 778 patients met the inclusion criteria of the survey (median age: 59; range: 24–93). In the majority of the patients (77.1%), the treatment schedules remained unchanged during COVID-19 pandemic. Treatment appointments were modified in a small number of patients (9.0%). Changes in therapy schedules were slightly more common among the second- and third-generation migrants and among patients ≤70 years. Despite the uncertainty of the COVID-19 pandemic, most patients (83.4%) kept their trust in the healthcare system. Acceptance of preventive measures was high, and 85.9% were willing to be vaccinated against COVID-19. Psychological symptoms such as worries and fear were reported by more than half of the participants during the last 2 weeks previous to the survey and more common among patients ≤70 years. Only 8.6% were more afraid of a COVID-19 infection than their cancer disease. Conclusions: Despite major challenges in cancer care due to the COVID-19 pandemic, access to cancer treatment and adequate management at gynecological oncology centers in Germany remained stable. The increased psychological burden in crises requires new infrastructure and should be addressed to improve patient care in future crises. The acceptance of taking preventive measures against COVID-19 was high among cancer patients. Full article

Backgroundand Objectives: Endometrial cancer ranks among the most prevalent gynecologic malignancies in high-income countries, with increasing incidence and mortality driven by the global obesity epidemic. Evidence suggests that women with early-stage disease face a greater risk of death from obesity-related comorbidities than from cancer recurrence and that weight reduction is associated with improvements in quality of life and in the long-term burden of obesity-related morbidity and mortality. Minimally invasive (MIS) metabolic/bariatric surgery is the most effective treatment for achieving significant, sustained weight loss and comorbidities resolution/improvement. Advances in MIS (laparoscopic, robotic, and endoscopic) techniques have reduced perioperative morbidity and mortality. Novel pharmacotherapies, including glucagon-like peptide-1 receptor agonists (GLP-1RAs), have recently received regulatory approval for weight management and ongoing studies are investigating their therapeutic impact on endometrial carcinogenesis and tumor biology. This review synthesizes and critically appraises evidence on metabolic interventions, including innovative bariatric techniques and pharmacologic agents, with the aim of informing their integration into multidisciplinary, risk-adapted management strategies for patients with severe obesity and endometrial cancer. Materials and Methods: A comprehensive review was conducted in accordance with SANRA (Scale for the Assessment of Narrative Review Articles) criteria. Results: Emerging evidence indicates that MIS metabolic/bariatric surgery combined with hysterectomy is feasible and may be integrated into the multidisciplinary management of selected patients with severe obesity and endometrial hyperplasia or carcinoma. GLP-1RAs may modulate both the obesogenic systemic milieu and selected tumor-associated pathways, although definitive clinical evidence of direct antitumor effect and oncologic benefit in endometrial cancer has not been established. Conclusions: Obesity is a modifiable risk factor for endometrial cancer. Metabolic/bariatric interventions represent a promising component of the comprehensive, patient-centered management of this disease. Prospective studies are essential to clarify the association between these interventions and longitudinal oncologic outcomes, the feasibility and potential benefits of combined approaches, and their differential impact according to the molecular classification of endometrial cancers. Although weight reduction is associated with a lower risk of endometrial cancer, a direct improvement in cancer-specific survival has not yet been demonstrated; weight-loss management therefore represents a promising component of care in the severely obese population, and its incorporation into formal guidelines requires confirmation in prospective studies. Full article