Michael J Halaska

European Society of Gynaecological Oncology expanded quality indicators and accreditation for cervical cancer management

Vulvar and vaginal cancer during pregnancy: A pooled analysis of 15 cases from the International Network on Cancer, Infertility and Pregnancy and review of the literature

Abstract Introduction Vulvovaginal cancer in pregnancy is rare. Limited data complicate decision‐making and patient counseling. Our review, coupled with new case data, fills a current gap in the literature and provides practical insights. Material and Methods Oncological and obstetric data of these pregnancies were examined by a case collection from the International Network on Cancer, Infertility and Pregnancy (INCIP) registry (vulvar n  = 10, vaginal n  = 5) and a literature review (vulvar n  = 46, vaginal n  = 37). Results Although preoperative imaging of inguinofemoral lymph nodes is feasible, only 16.1% of vulvar cancer patients underwent ultrasound or MRI. Treatment was initiated during pregnancy for 69.1% of vulvar cancer and 28.4% of vaginal cancer patients. Surgical lymph node staging of vulvar cancer was postponed until after delivery in 10 cases, although uni‐ or bilateral lymphadenectomy during pregnancy was not associated with more complications. Delivery outcomes included a live birth rate of 96.4% for vulvar cancer and 50% for vaginal cancer due to the high rate of pregnancy terminations, with most births preterm. The overall 5‐year survival rates for vulvar (81.3%) and vaginal (66.4%) cancer during pregnancy are comparable to nonpregnant populations, indicating that pregnancy does not adversely impact maternal prognosis. Conclusions This study underscores the feasibility of adapting standard oncological care for pregnant patients, emphasizing multidisciplinary teams to optimize maternal and fetal outcomes.

Postoperative quality of life in patients with early-stage cervical cancer: A prospective 10-year follow-up study

The substantial improvement in early-stage cervical cancer survival rates has given rise to the significance of subsequent quality of life. This study aims to assess the quality of life in patients subjected to radical and conservative surgeries for cervical cancer. One hundred patients diagnosed with early-stage cervical cancer (stages IA2-IIA1) undergoing surgical treatment were enrolled in our study between 2007 and 2011. Patients completed quality of life questionnaires EORTC QLQ-C30 and QLQ-CX24, distributed before the surgery, 6, 12, and 120 months after the procedure. At the final 120-month follow-up, 54 patients remained eligible for inclusion. 23 patients ("CONS group") underwent laparoscopic lymphadenectomy combined with hysterectomy or simple trachelectomy. The remaining 31 patients ("RAD group") underwent abdominal radical hysterectomy type C1. At the 6-month post-surgery assessment, the RAD group reported a significantly higher incidence of menopausal symptoms, decline in physical functioning and concern regarding their sexual well-being. CONS group patients reported notable exacerbation of lymphedema and neuropathy-related symptoms but only a slight decline in physical functioning. Additionally, their role functioning, emotional well-being, and social functioning significantly improved compared to their preoperative baseline. At the 120-month postoperative assessment the RAD group showed a significant decline in several parameters, including lymphedema, peripheral neuropathy, postmenopausal symptoms, fatigue, pain, and physical functioning. Cervical cancer treatment is invariably associated with a negative long-term impact on quality of life, RAD group demonstrated poorer outcomes than the CONS group across multiple parameters but even the CONS group exhibited long-term effects of the surgery.

New staging of endometrial carcinoma – FIGO 2023

Aim: To review the changes in the new version of the FIGO 2023 staging system for endometrial cancer. Methods and results: The new FIGO 2023 endometrial cancer staging system provides key updates for the diagnosis and treatment of endometrial cancer. An important step in diagnosis is molecular classification, which allows more accurate risk stratification for recurrence and the identification of targeted therapies. The new staging system, based on the recommendations of the international societies ESGO, ESTRO and ESP, incorporates not only the description of the pathological and anatomical extent of the disease, but also the histopathological characteristics of the tumour, including the histological type and the presence of lymphovascular space invasion. In addition, the staging system uses molecular testing to classify endometrial cancers into four prognostic groups: POLEmut, MMRd, NSMP and p53abn. Each group has its own specific characteristics and prognosis. The most significant changes have occurred in stages I and II, in which the sub-staging better reflects the biological behaviour of the tumour. This update increases the accuracy of prognosis and improves individualized treatment options for patients with endometrial cancer. Conclusion: The updated FIGO staging of endometrial cancer for 2023 incorporates different histologic types, tumour features, and molecular classifications to better reflect the current improved understanding of the complex nature of several endometrial cancer types and their underlying bio logic behaviour. The aim of the new endometrial cancer staging system is to better define stages with similar prognosis, allowing for more precise indication of individualised adjuvant radiation or systemic treatment, including the use of immunotherapy. Key words: endometrial cancer – FIGO – staging – molecular classification – update

Preoperative and postoperative staging in endometrial cancer – a prospective study

Objective: The aim of this study was to determine how often changes the stage of the tumour in definitive histology against preoperative clinical stage in patient cohort with diagnosed endometrial cancer. Methods: We evaluated prospectively a cohort of 166 patients with endometrial cancer. They all underwent abdominal hysterectomy, bilateral salpingo-oophorectomy, sentinel lymph node biopsy. Patients with high-risk tumours also pelvic lymfadenectomy. We collected data of preoperative diagnostic biopsy and postoperative definitive histology. The data were statistically processed. Results: Detection of sentinel lymph node was successful in 71.1%, bilateral successful detection was in 40.6%. Discrepancy of tumour grade between preoperative biopsy and definitive histology was generally 31.4%. Upgrading of the tumour was in 22 (14.4%) cases, downgrading in 26 (17%) cases. Upgrade from low-risk to high-risk group of tumours was noticed in eight cases. Histopathological tumour type changed in 6.6%, 4.6% moved to histopathologic high-risk group. The tumour stage changed in definite histology in 57.3%, in 19.2% of cases moved from stage low/intermediate-risk group to intermediate-high/high-risk disease group. Conclusion: Correct assessment of preoperative clinical stage and histological grade of endometrial cancer is burdened with a high inaccuracy rate. A lot of cases is up-staged after surgical staging and moved to intermediate-high/high-risk disease group. Results confirm the importance of oncogynaecologic centre II. evaluation of histopathology findings from diagnostic biopsies made in referring hospitals. Sentinel lymph node biopsy should be performed even in clinically low/intermediate-risk disease group. Key words: endometrial cancer – tumour stage – tumour grade – sentinel lymph node detection