Current Opinion in Obstetrics & Gynecology

Reducing health disparities in endometrial cancer care in 2024

Purpose of review To summarize the most recent publications explaining disparities among patients diagnosed with endometrial cancer and identify areas of improvement. Recent findings Racial disparities in endometrial cancer care have been identified along the cancer continuum including risk, diagnosis, access to treatment, and overall survival. The mortality gap in endometrial cancer is one of the top five widest Black–White mortality gaps among all cancer diagnoses in the United States. Many publications have demonstrated that the disparities exist, the aim of this review is to identify actionable areas of improvement. To mitigate racial disparities, we must acknowledge that Black patients are at higher risk of high-risk subtypes of endometrial cancer, and their presentation can vary from what is considered typical for the most common type of endometrial cancer. We must address that practice recommendations for diagnosis may not be generalizable to all races and ethnicities, and that racism has an impact on how providers approach a work-up for Black vs. White patients. Finally, we must improve access to appropriate treatment by steadfastly adhering to recommended practice guidelines regardless of race/ethnicity and improving efforts to enroll a diverse patient population to clinical trials. Summary In this review, we sought to identify specific and actionable areas of improvement to reduce racial disparities in endometrial cancer care.

Fertility preserving treatment for gynecologic malignancies: a review of recent literature

Purpose of review A significant number of women diagnosed with a gynecologic malignancy meet criteria for fertility-sparing treatment. Women are continuing to delay childbearing; the importance of fertility-sparing therapy is, therefore, increasing. It is imperative that physicians understand the options for, and limitations of, these treatments. Recent findings Recent research has demonstrated improved outcomes for endometrial cancer by adding targeted hysteroscopic resection to progestin therapy. Cervical cancer research has focused on oncologic and pregnancy outcomes following management with radical trachelectomy, confirming its safety. Given the high rates of preterm birth following trachelectomy, studies have evaluated the adequacy of fertility counseling prior to treatment, and have looked for predictive factors for preterm birth. Additionally, research has shown a rise in the percentage of women receiving conservative treatment for both endometrial and cervical cancer. Summary With an increasing number of women seeking conservative treatment, physicians must understand the safety and implications of such therapy. Retrospective studies have demonstrated the safety of fertility-sparing treatment for both endometrial and cervical cancer; prospective research is currently underway to provide better guidance for future directions of fertility-sparing treatment for gynecologic malignancies.

Molecular characterization of endometrial cancer and therapeutic implications

Purpose of review The present article reviews molecular subtyping and genomic characterization of endometrial carcinoma, and the associated therapeutic and prognostic implications. Recent findings Endometrial cancer has historically been classified through histology into endometrioid and nonendometrioid subtypes with poor prognostic predictability. Molecular classification through genomic analysis now allows for a major advance in characterization. Four distinct subgroups have been identified: polymerase (POLE) ultramutated, microsatellite unstable, copy number-low--microsatellite stable, and copy number-high—‘serous-like’. These subtypes have prognostic implications and may aid in the identification of early-stage patients who are at high risk for recurrence. Through analysis of surrogate markers (POLE, MSI, and p53) and other validated molecular alterations (L1CAM), it is possible to obtain an integrated molecular risk profile that relates to prognosis. Studies utilizing this risk profile in order to identify patients who may benefit from adjuvant treatment for early-stage disease are on-going. Summary Molecular characterization of endometrial cancer into subgroups has enhanced prognostic and therapeutic implications, contrary to traditional risk stratification. Further development of an integrated molecular risk profile may identify patients who could most benefit from adjuvant treatment following surgery and tailor treatment decisions in the recurrent setting.

Endometrial cancer in the morbidly obese: a review

Purpose of review With a worldwide increase in obesity, there has been an increase in obesity-related diseases. Endometrial cancer is a common cause of cancer for women worldwide. Incidence of endometrial cancer has risen worldwide. Accompanying these patients are risk factors and challenges that may prevent standard of care from being delivered. Recent findings The current article describes recent literature describing surgical approaches to the obese patient and special considerations in this population. This article also reviews bariatric surgery and endometrial cancer as well as new updates in radiation, chemotherapy and hormonal therapy research in the obese population. Summary The current article reviews therapeutics and surgery in the morbidly obese for the treatment of endometrial cancer.

Optimizing immunotherapy for gynecologic cancers

Purpose of review This review will provide an update on the most recent clinical developments in immuno-oncology in advanced gynecologic cancers and will also highlight ongoing studies in this field. Recent findings Although immune checkpoint blockade (ICB) therapy is rapidly altering the treatment landscape in a myriad of solid tumors, the efficacy of ICB therapy with antibodies directed against CTLA-4, PD-1, and PD-L1 in advanced gynecologic cancers has been limited. The exception has been the PD-1 inhibitor pembrolizumab in microsatellite instability high (MSI-H) or mismatch repair-deficient (dMMR) advanced endometrial cancers, highlighted by the recent conditional approval of pembrolizumab in recurrent/metastatic PD-L1-positive cervical cancers and the accelerated approval of pembrolizumab and lenvatinib in microsatellite stable (MSS) or mismatch repair-proficient (pMMR) advanced endometrial cancer. The discovery of novel, rational ICB combinatorial approaches in advanced gynecologic cancers is highly warranted. Summary Recent advances in the genomic characterization of gynecologic malignancies have informed clinical trial design. However, improved molecular and immunophenotypic biomarkers to more accurately identify patients who will most benefit from immunotherapeutic approaches are urgently needed. This is especially critical as we attempt to integrate immune-oncology agents, chemotherapy, targeted therapy, and radiation therapy in the management of gynecologic cancers.

Don’t be STUMPed: description and management of uncommon pathologies encountered on specimens from benign gynecologic surgery

Purpose of review In this review, we aim to describe uncommon pathologies that gynecologic surgeons may reasonably encounter on surgical specimens following benign gynecologic surgery. Recent findings Herein, we describe uncommon pathologic findings of the uterus (e.g. squamous morular metaplasia, fibroid variants, stromal tumor of uncertain malignant potential), peritoneum and adnexa (e.g. endosalpingiosis, serous tubal intraepithelial carcinoma), endometriosis (e.g. stromal endometriosis, atypical endometriosis), and findings of particular interest in postmenopausal women (e.g. ovarian cortical stromal hyperplasia, tubal metaplasia). The majority of pathologic findings presented in this article are inherently benign, although they can present diagnostic challenges. If properly classified, additional treatment and/or extended follow-up is often not required; exceptions are highlighted. Summary The gynecologic surgeon may encounter uncommon pathologies during a career. Inherent diagnostic difficulties, as well as nonstandardized or outdated terminology, can introduce further uncertainty. Whenever such a situation arises, the surgeon and pathologist should discuss the diagnosis to ensure appropriate treatment options.

Eradicating cervical cancer in the poorest regions of the world

Introduction Cervical cancer is the fourth most common type of cancer found in women and the most common type of gynecologic cancer globally. Despite adequate prevention through the human papillomavirus vaccine, screening methods, and treatment strategies, cervical cancer remains one of the leading causes of morbidity and mortality. There are alarming disparities and geographical variations that exist among incidence rates and mortality of women with cervical cancer around the world. Findings The burden of this disease shows marked disproportions among incidence, mortality, and survival rates among high-income countries and low-income and middle-income countries. There are notable barriers to screening and prevention to include health literacy, education, and public awareness, societal and cultural factors, poverty and economic inequality, limited professional workforce capacity, and overall health infrastructure. These inequities emphasize a major global health concern. Conclusion Globally, there is a need for international participation to help in the fight to eradicate cervical cancer. The three regions with the highest rates of cervical cancer include Southeast Asia (including India), Latin America and the Caribbean, and Sub-Saharan Africa. This review article highlights the current methods of screening and prevention within these regions to combat the rising global epidemic that is cervical cancer.

New developments in the treatment of cervical cancer in 2026

Purpose of review Cervical cancer remains the fourth most common cancer among women worldwide, predominantly affecting low- and middle-income countries because of limited access to human papillomavirus vaccination and screening. While early-stage disease can often be cured with surgery or chemoradiotherapy, the advanced or recurrent cervical cancer continues to have a poor prognosis. Recent findings Significant advances are transforming its treatment landscape. The addition of bevacizumab to chemotherapy has improved survival, and immune checkpoint inhibitors such as pembrolizumab and cemiplimab have shown significant benefits in both first- and later-line settings. In locally advanced disease, pembrolizumab combined with chemoradiotherapy (KEYNOTE-018) demonstrated unprecedented survival outcomes, leading to regulatory approval. Antibody–drug conjugates, particularly tisotumab vedotin, have also emerged as promising options for recurrent or metastatic cervical cancer, with ongoing studies exploring targets such as Human epidermal growth factor receptor 2 (HER2), trophoblast cellsurface antigen 2 (TROP-2), mesothelin, and nectin-4. Summary These developments reflect a shift toward precision medicine that integrates immunotherapy, antiangiogenic, and targeted agents; however, challenges persist in optimizing treatment sequences, overcoming resistance, and identifying biomarkers to personalize care. Addressing global disparities in prevention and treatment access remains essential to achieving the WHO’s goal of eliminating cervical cancer by 2030.

Alarming trends and disparities in high-risk endometrial cancer

Purpose of review To summarize the most recent publications highlighting the trends and disparities among patients diagnosed with high-risk endometrial cancer. Recent findings Endometrial cancer mortality continues to rise, driven by the increasing incidence of high-risk histologic subtypes that accounts for a disproportionate number of endometrial cancer deaths. The lack of progress made in endometrial cancer treatment, particularly of high-risk histologic subtypes, disproportionately affects black women who are more likely to be diagnosed with these aggressive tumor types. Even when accounting for high-risk histology, various factors across the spectrum of care may influence the survival disparities between black and white women, including timely access to guideline-concordant care, clinical trial enrollment, and systemic racism that impacts cancer outcomes. Summary In this review, we highlight the disproportionate impact of worsening endometrial cancer mortality and healthcare inequalities contributing to the endometrial cancer survival disparity between black and white women.

Prevention of gynecological cancers: cervical cancer screening in Turkey: a role model for the world

Purpose of review This review examines Turkey's cervical cancer screening programme, highlighting its evolution from a cytology-based approach to a more effective HPV-based strategy. The review is timely given the global push to reduce cervical cancer incidence through improved screening practices, and it positions Turkey's programme as a potential model for other countries facing similar public health challenges. Recent findings Recent advances in cervical cancer screening in Turkey include the nationwide introduction of HPV DNA testing, centralized laboratory systems and innovative management software. The programme has significantly improved screening coverage and early detection rates, particularly in underserved communities. However, challenges remain in areas such as training healthcare workers, raising awareness of HPV vaccination, and integrating self-sampling methods into the screening process. Summary The Turkish experience demonstrates that a well organized HPV-based cervical cancer screening programme can overcome significant cultural and logistical barriers and lead to improved public health outcomes. Future efforts should focus on refining triage strategies, exploring new molecular tests, and expanding the use of self-sampling to further improve the effectiveness of cervical cancer prevention efforts worldwide.

Advancements in the application of uterine ultrasound elastography

Purpose of review This article reviews recent advances in ultrasound elastography in diagnosing and evaluating the normal nongravid uterus and the infertile uterus in the gynecologic patient. Recent findings Focusing on the most recent primary literature, studies have demonstrated new findings among a breadth of gynecologic clinical settings. Studies in the nongravid uterus have found that menopausal status, age, and menstrual phase have not been associated with changes in uterine tissue stiffness. Focusing on myometrial disease, there have been conflicting data regarding the ability to distinguish uterine fibroids from adenomyosis. One area of expanding research surrounding uterine elastography includes the infertile population, where ongoing studies attempt to provide a predictive model using shear wave elastography (SWE) in patients undergoing in-vitro fertilization. Summary Ultrasound elastography has become an increasingly studied and utilized tool in assessing physiologic and pathologic processes in the field of gynecology. Evaluating tissue stiffness through strain and SWE can serve to improve diagnosis of various uterine and cervical lesions, as well as prognosticate outcomes after fertility treatments. This growing area of research will continue to establish the role and application of ultrasound elastography into clinical practice.

Beyond uterine artery embolization for fibroids: what can interventional radiology do for you?

Purpose of review This review highlights important advances in image-guided therapies for patients with benign complex gynecological conditions, beyond uterine artery embolization for leiomyomata (fibroids). Recent findings A comprehensive search was conducted in PubMed (NLM), Embase (Ovid), and Web of Science Core Collection (Clarivate) to find English-written articles on interventional radiology gynecologic procedures, including cryotherapy for abdominal wall endometriosis, uterine artery embolization for adenomyosis, embolization for pelvic venous disorder, and ultrasound-guided biopsies for uterine myometrial tumors, focusing on articles published in the previous 18 months. Summary The role of interventional radiology has been expanding in complex benign gynecologic conditions with recent advances and new applications.

Current opinions: updates on the changing landscape in the management of cervical cancer

Purpose of review To review the recent updates in the management of cervical cancer across all stages of the disease. Recent findings After decades of minor advances, the landscape in cervical cancer is now rapidly changing. Recent studies have reported across the cervical cancer spectrum and on different therapeutic modalities. First, less radical surgery in the assessment and management of patients with early-stage, low-risk disease has been shown to be a safe option with reduced morbidity. The role of checkpoint inhibitor therapy in combination with chemotherapy and radiation has demonstrated improved survival outcomes, moving immunotherapy to earlier lines of therapy. The options for systemic therapy continue to include checkpoint inhibitors as well as treatment with antibody drug conjugates (ADCs) in the recurrent setting. Additional research continues to focus on targeting biomarkers in this disease. Summary In this paper, we will review the practice-changing trials impacting early stage, locally advanced, and recurrent cervical cancer patients. Despite advances, the limited survival for these patients continues to highlight the need for access to preventive healthcare (vaccine/cytology) and clinical trials to continue to make advances.

Impact of fibroids on fertility, pregnancy loss, and preconception management

Purpose of review Although fibroids are understood to be a predominantly benign and common pathology, they can have significant impacts on patients’ quality of life and reproductive health. This review summarizes the impact of uterine fibroids on fertility and spontaneous abortion, while also addressing how the treatment for fibroids can affect fertility. Lastly, the review will address strategies for preconception management of fibroids to optimize patients’ reproductive health. Recent findings The data regarding the impact of fibroids on fertility and pregnancy loss is evolving. However, it is agreed that the impact of fibroids is predominantly determined by their location in the uterus. Fibroids located in the submucosal layer or otherwise disrupting the endometrial cavity can impede the implantation of an embryo or potentially increase the risk of spontaneous abortion. When treating fibroids for the purpose of fertility, surgical management is preferred over medication management. There is limited data supporting procedures such as uterine artery embolization or radiofrequency ablation for the management of fibroids to improve fertility. Surgical management of fibroids not impacting the uterine cavity remains controversial. Summary Uterine fibroids can have a detrimental impact on fertility and therefore require purposeful attention to both the diagnosis and management of the condition in reproductive-aged women. The treatment of fibroids for the purpose of fertility alone remains controversial. Regardless, fibroid size and location should be cataloged, and surgical management should be offered to patients experiencing difficulties with conception.

Enhancing equity in cervical screening – initiatives to increase screening participation

Purpose of review Cervical cancer can be eliminated as a public health problem through a three-pillar approach including high coverage of human papillomavirus (HPV) vaccination and HPV-based cervical screening, and treatment of precancers and invasive cancers. However, access inequities prevent many women and people with a cervix benefitting from these life-saving advances. This review focuses on evidence-based interventions that can improve equity and scale-up of cervical screening. Recent findings The transition from conventional cytology to HPV screening provides multiple opportunities to address equity and a multipronged approach can be used to identify priority groups, understand barriers and develop tailored solutions. There are proven financing mechanisms, tools, technologies and screening delivery methods to overcome screening barriers in different settings. This includes self-sampling interventions, point-of-care testing, health service integration, consumer-led co-design processes and digital screening registries. Summary To achieve cervical cancer elimination globally, cervical screening must be delivered in an inclusive, culturally safe and context-appropriate manner. There are multiple tools and strategies that can be implemented to improve participation of never- and under-screened groups, and to enhance equity in cervical screening.

Take it or leave it: oophorectomy at the time of benign hysterectomy

Purpose of review Previous modeling data suggest ovarian conservation up to age 65 for women without adnexal disease and at average risk of ovarian cancer because of an increase in mortality associated with ovarian removal. Recent modeling data challenges this practice. This review of recent literature will update providers regarding consideration for oophorectomy at time of benign hysterectomy. Recent findings Oophorectomy at time of hysterectomy for women less than 50 years with estrogen supplementation and greater than 50 years without estrogen supplementation is not associated with increased mortality. Summary Although not associated with increased mortality, the decision to remove the ovaries at time of hysterectomy in women older than 50 years is nuanced and requires careful shared decision-making, considering unique patient factors.

A review of the state of cervical cancer: updates from prevention to recurrent disease

Purpose of review To summarize the recent updates in cervical cancer from prevention and early detection to the management of early stage and recurrent disease as well as future areas of exploration. Recent findings The importance of the human papilloma virus vaccine and screening continue to make an impact in reducing the global burden of cervical cancer. In early-stage, low risk disease, new studies have demonstrated the role of less radical surgery with similar disease related outcomes. Efforts to improve outcomes in locally advanced cervical cancer have been reported. The incorporation of adjuvant chemotherapy, novel agents and checkpoint inhibitors, with the latter impacting disease free survival. In advanced/recurrent disease, the role of immunotherapy continues to make an impact and, in addition to recurrent disease, has now moved to the frontline for patients with programmed cell death ligand 1 expression. Tisotumab vedotin, an antibody drug conjugate, and other novel agents continue to be studied in this setting. Summary In this review, we discuss prevention measures and the outcomes of recent trials in all stages of cervical cancer. As therapies continue to evolve, ongoing trials and new areas of exploration will continue to identify opportunities to improve survival in cervical cancer.

Is there a role for hyperthermic intraperitoneal chemotherapy in ovarian cancer?

Purpose of review Our objective is to provide a history, rationale, and review of the use of hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of ovarian cancer. Recent findings In the last decade, there has been an increase in the literature regarding HIPEC in the treatment of ovarian cancer. The rationale for HIPEC extends from earlier trials demonstrating improved survival using intraperitoneal chemotherapy. HIPEC provides a one-time opportunity for intraperitoneal chemotherapy at the time of cytoreduction and with the addition of hyperthermia. Cisplatin HIPEC has been demonstrated to have a survival benefit when used in the interval cytoreductive setting. In terms of safety, nephroprotection remains a key concern when administering HIPEC. Sodium thiosulfate provides nephroprotection and should be considered when performing HIPEC. Various institutions have created multidisciplinary protocols for administering HIPEC, which include operating room staff, nursing, anesthesia, pharmacy, and surgical teams. Summary HIPEC has a role in the treatment paradigm of ovarian cancer. Currently, HIPEC is approved in the interval cytoreductive surgery setting. Further trials are needed to understand the appropriate timing, chemotherapeutic agents, and protocolization of HIPEC.

New treatment standards for vulvar cancer 2020

Purpose of review To highlight the recent advances regarding molecular mechanisms and therapeutic strategies in vulvar squamous cell carcinoma (VSCC), a rare but continuously rising disease. Recent findings Clinical research focuses on deescalation especially with regard to surgery. Recurrence patterns have been analyzed to further understand the course of disease showing a persistent risk for local recurrence even several years after the initial diagnosis. The main focuses of recent translational research are the distinct molecular mechanisms behind human papillomavirus (HPV)-positive and -negative VSCC. Next-generation sequencing analyses have highlighted TP53 as central driver mutation in HPV-negative disease. For HPV-independent VSCC, an impaired prognosis with limited disease-free and overall survival has been reported from a large multicenter analysis. Although no targeted agent has been granted approval, the impact of immunotherapy in vulvar cancer has been investigated in basket trials. Therapy response, however, was limited. Summary Further clinical research should focus on deciphering the molecular mechanisms of tumor development further. Detailed understanding of the molecular landscape will help to find novel therapy targets, fight the disease in advanced stages and thereby improve the quality of life for affected patients.

Latest clinical evidence of maintenance therapy in ovarian cancer

Purpose of review To summarize the data supporting the use of maintenance therapy in ovarian cancer treatment. Recent findings Since December 2016, the United States Food and Drug Administration has approved four drugs for six different ovarian cancer maintenance indications based on the results of clinical trials demonstrating efficacy and tolerability. These include antiangiogenesis and poly (adenosine diphosphate-ribose) inhibitors (PARP inhibitors). Four drugs are approved for use in maintenance therapy for recurrent ovarian cancer, including bevacizumab (GOG-0213 and OCEANS), niraparib (NOVA), olaparib (Study 19 and SOLO2) and rucaparib (ARIEL3). Two drugs are approved for use in maintenance therapy in newly diagnosed ovarian cancer, including bevacizumab (GOG-0218) and olaparib (SOLO1). New data were reported at the European Society for Medical Oncology Congress in October 2019 that may lead to the approval of additional strategies in front-line maintenance, including the use of niraparib (PRIMA), veliparib (VELIA) and bevacizumab + olaparib (PAOLA). Summary The landscape of maintenance treatment options for ovarian cancer has been rapidly expanding and continues to evolve as new data emerge. Currently approved strategies include antiangiogenesis and PARP inhibitor treatments.

Mechanisms of PARP inhibitor resistance in ovarian cancer

Purpose of review To summarize recently discovered PARP inhibitor resistance mechanisms and highlight the clinical relevance of these findings to date. Recent findings A predominant mechanism of acquired PARP inhibitor resistance in homologous recombination-deficient cancers is the acquisition of homologous recombination proficiency as a consequence of secondary genetic or epigenetic events, such as secondary mutations in BRCA1 or BRCA2, or reversal of BRCA1 promoter methylation that restores homologous recombination and leads to PARP inhibitor resistance. Multiple other potential mechanisms of acquired resistance to PARP inhibitors including loss of DNA end resection inhibition (53BP1/REV7/RIF1/Sheldin) or DNA replication fork protection (PTIP/EZH2), but also increased drug efflux or induction of a reversible senescent or mesenchymal cell state have been described in ovarian cancer models. However, only few of these mechanisms have been identified in clinical samples. Summary Multiple adaptive responses following PARP inhibitor treatment have been identified. Further research is needed to better understand what role these mechanisms play for clinical PARP inhibitor resistance and how these mechanisms may render ovarian cancer cells susceptible to subsequent novel combination therapies.

Biomarkers that may predict response to immunotherapy in ovarian malignancies

Purpose of reviewImmune checkpoint blockade (ICB) is a promising area of cancer therapeutic research. Therapies targeting the programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) mechanism of tumor immune evasion have resulted in durable responses in many difficult-to-treat tumor types. While these inhibitors are being actively investigated in clinical trials for ovarian cancer, most patients fail to respond to initial treatment with immune therapy. This review focuses on biomarkers for predicting response to treatment, and discusses clinical trials using ICB for recurrent ovarian cancer.Recent findingsWhile PD-L1 detection by immunohistochemistry (IHC) is approved as a companion or complementary diagnostic in some cancers, there are many limitations with its use as a predictive marker. Recent research has explored biomarkers beyond PD-L1 that assess for somatic mutations, immune cell infiltrate, and gene signatures.SummaryWith improved understanding of the tumor microenvironment and genomic classifications of ovarian tumors, new diagnostics and biomarkers that supplement conventional IHC may help predict response to therapy.

Updates in palliative care of patients with gynecologic malignancies in 2026: early integration, resource models, and emerging therapies

Purpose of review This review summarizes recent evidence in palliative care for patients with gynecologic malignancies, focusing on early integration, models of care delivery, and updates in symptom management and palliative procedures. Recent findings Early palliative care involvement, particularly more than 3 months before death, is associated with less aggressive end-of-life care and better alignment with patient preferences. Resource-adapted models, such as stepped approaches and telehealth, expand access to specialist palliative care while preserving quality. Advances in symptom management include olanzapine for cancer anorexia cachexia syndrome, nonopioid analgesics, and cell-free and concentrated ascites reinfusion. Procedural interventions near the end-of-life, such as palliative colostomy for malignant bowel obstruction, highlight the importance of shared decision-making and aligning treatments with patient values, goals, and preferences. Interdisciplinary care models, including nurse-led models such as the BOLSTER trial, further demonstrate benefit in supporting patients and caregivers, and the challenges with illness uncertainty in matching treatments to goals. Summary Evidence highlights strategies to integrate palliative care earlier, optimize resource use, expand symptom management options, and support patient-centered decision-making in gynecologic oncology.

Updates in palliative care of gynecologic oncology patients

Purpose of review This review assesses the impact of early integration of palliative care and the disparities that exist among patients with gynecologic malignancies. It also highlights the recent advances in symptom management, goals of care communication, and end of life care. Recent findings Although palliative care has been utilized earlier, there are still barriers to its integration both nationally and worldwide, manifesting as predominantly late hospice referrals and aggressive care at the end of life. However, there are increasing efforts to promote earlier integration and discussion around goals of care through multidisciplinary approaches. Apart from symptom burdens, patients with gynecologic malignancies experience financial toxicity that impact various aspects of their lives, leading to potentially harmful choices to mitigate costs. A growing area of interest in palliative care is the realm of psychedelic-assisted therapy, which has shown benefits in treating advanced cancer patients with depression. Summary While significant strides have been made in incorporating palliative care earlier, continued research in palliative care is needed to address symptomatic and psychosocial suffering worldwide.

PARP inhibitors in the treatment of ovarian cancer: a review

Purpose of review This article will review recent changes in the standard of care for olaparib, niraparib, and rucaparib, as well as ongoing trials evaluating this class of drugs in combination with antiangiogenic agents and PD-1/PD-L1 inhibitors. Recent findings Niraparib received FDA approval for use in patients with complete response or partial response to first-line platinum-based chemotherapy regardless of BRCAm or HRD status that was received in April 2020. FDA approval was received for olaparib in combination with bevacizamab for epithelial ovarian cancer patients with complete response/partial response to first-line chemotherapy and bevacizumab and g/sBRCA and/or genomic instability by Myriad myChoice CDx in May 2020. Summary In the last year, treatment with PARPi has extended to not only include BRCAm and HRD-deficient patients but also have shown improvement in outcomes in HRD-proficient patients. With these advancements, more patients can access these agents and receive benefit. In the upcoming years, it will be exciting to see the potential benefit when PARPs are added to other angiogenic antagonists and immunotherapy agents.

Current and future landscape of poly (ADP-ribose) polymerase inhibition resistance

Purpose of review To highlight relevant strategies to overcome poly(ADP-ribose) polymerase (PARP) inhibitor resistance and present key clinical trials. Recent findings The use of PARP inhibition (PARPi) for frontline maintenance offers substantial clinical benefit in patients with homologous recombination-deficient tumors. However, expanding PARPi from recurrent therapy to frontline maintenance may potentially result in more PARPi resistant tumors earlier in the treatment continuum and data for the use of PARPi after PARPi remain limited. Clinical evidence demonstrates tumors may develop resistance to PARPi through demethylation of the BRCA promoter or BRCA reversion mutations. Multiple clinical trials investigating therapeutic strategies to overcome resistance, such as combinations of PARPi with antiangiogenic drugs, PI3K/AKT/mTOR, or MEK inhibitors have already been reported and more are ongoing. Furthermore, increasing the amount of DNA damage in the tumor using chemotherapy or cell cycle inhibitors such as ATM, ATR/CHK1/WEE1 is also under exploration. Summary There is increasing clinical interest to identify options to enhance PARPi efficacy and overcome adaptive resistance. PARPi represent a class of drugs that have significantly impacted the treatment and maintenance of ovarian cancer; as the use of PARPi increases, better understanding of resistance mechanisms is essential.

Advances in antibody-drug conjugates for gynecologic malignancies

Purpose of review Antibody-drug conjugates (ADCs) represent a new class of drugs that combine a surface receptor-targeting antibody linked to a cytotoxic molecule delivering the potent cytotoxic payload directly to tumor cells. This review summarizes the current literature demonstrating their use in the treatment of gynecologic malignancies. Recent findings Tisotumab vedotin is the first U.S. Food and Drug Administration (FDA) approved ADC for the treatment of gynecologic cancers. While in the phase 3 randomized controlled trial in platinum resistant ovarian cancer patients, FORWARD 1, mirvetuximab did not meet its primary endpoint of progression-free survival. But we await more recent data from the two ongoing phase 3 trials of mirvetuximab in recurrent ovarian cancer patients. HER2/neu, Napi2b, mesothelin, and human trophoblast cell-surface marker (Trop-2) overexpression have also been exploited as excellent targets by novel ADCs in multiple tumors including ovarian, endometrial, and cervical cancers. Summary Current evidence strongly supports the use of ADCs and ongoing clinical trials will provide further information into the potential of making these drugs part of current standard practice allowing patients to be treated with a higher level of personalized cancer care.

Trastuzumab deruxtecan and the evolving role of human epidermal growth factor receptor 2–targeted antibody–drug conjugates in breast and ovarian cancer

Purpose of review Breast cancer remains a leading cause of cancer-related morbidity and mortality worldwide. One of the most significant advances in treatment has been the evolution of human epidermal growth factor receptor 2 (HER2)–targeted therapies. This review summarizes recent clinical progress in HER2-directed antibody–drug conjugates (ADCs), with specific focus on trastuzumab deruxtecan (T-DXd) in breast and ovarian cancer, and highlights emerging ADCs shaping the next generation of HER2-targeted therapy. Recent findings T-DXd has demonstrated superior efficacy to trastuzumab emtansine (T-DM1) in breast cancer across the metastatic and adjuvant settings, and has also shown significant activity in HER2-low and ultralow disease. Mechanistic innovations, including a cleavable linker, a high drug-to-antibody ratio, and a membrane-permeable topoisomerase I inhibitor payload, enhance its potency. In ovarian cancer, T-DXd has shown promising early efficacy in heavily pretreated patients; however, additional real-world data are needed to better define its clinical benefit and optimize patient selection. Emerging HER2-directed ADCs such as disitamab vedotin aim to overcome resistance and broaden therapeutic options for patients. Summary The efficacy of T-DXd represents a major advance in HER2-targeted therapy, expanding treatment beyond HER2-positive disease into a wider continuum of HER2 expression. Ongoing clinical development of next-generation ADCs aims to improve efficacy, safety, and access to precision-guided cytotoxic therapy across solid tumors.

The advent of immune checkpoint inhibition for the treatment of patients with primary advanced or recurrent dMMR/MSI high endometrial cancer in 2025

Purpose of review The Cancer Genome Atlas identified four distinct molecular subtypes of endometrial cancer (EC): POLE mutated, mismatch repair deficient (dMMR), copy number low, and copy number high. The goal of this review is to summarize the profound clinical implications of molecular subtyping, particularly in guiding treatment decisions for dMMR and microsatellite instability high (MSI-H) EC. Recent findings Clinical trials have demonstrated the remarkable efficacy of immunotherapy in dMMR/MSI-H EC tumors. Trials including GARNET, KEYNOTE-158, NRG GY-018, and RUBY have shown significant improvements in clinical outcomes for patients with advanced and recurrent disease, leading to FDA approvals for immunotherapy in both frontline and recurrent EC treatment settings. Building on these successes, recent studies, including DUO-E, are exploring combination therapies to enhance the efficacy of immunotherapy in EC. Simultaneously, trials including NRG GY-020, are investigating the potential benefits of immunotherapy in early-stage disease. Summary Immunotherapy therapy has revolutionized the treatment of endometrial cancer in both upfront and recurrent settings, with molecular subtyping identifying patients most likely to benefit, especially those with dMMR/MSI-H tumors.

A review of racial disparities in ovarian cancer and clinical trials

Purpose of review Ovarian cancer ranks fifth in mortality among women with cancer and accounts for more death compared to any other gynecological cancers. This review summarizes the most recent literature on disparities in ovarian cancer as well as within recent clinical trials. Recent findings Recent studies have identified a notable disparity in genetic testing utilization, disease stage at the time of diagnosis, and adherence to treatment guidelines between Black women and their White counterparts, ultimately leading to increased mortality rates among Black women from ovarian cancer. Additionally, there is an underreporting of race in clinical trials and those that do report race demonstrate significant racial disparities within trial participants with the majority of participants being White. Summary It is imperative that we address the significant racial disparities within ovarian cancer and clinical trials to establish a framework of equitable healthcare provision. Multiple determinants, such as implicit bias, provider mistrust, accessibility hurdles, and socioeconomic influences, appear to contribute to the current disparities faced by women of color. Further investigation is warranted, encompassing a deeper understanding of diverse patient perspectives and identifying barriers to receiving optimal care and participating in clinical trials.

Risk factors for cervical cancer among distinct populations in low-resource countries: feasibility of cervical cancer screen-and-treat program on ukerewe island of lake victoria, Tanzania

Purpose of review A mass cervical cancer screening using World Health Organization-endorsed visual inspection with acetic acid (VIA) and cryotherapy triage was conducted over 5 days at Nansio District Hospital on Ukerewe Island, Tanzania in Lake Victoria. The aim was to evaluate the feasibility of a pilot screen-and-treat on a lower resource island and compare the results to previously held screen-and-treats in higher resource mainland settings. Recent findings Two hundred and eight-two women underwent VIA on Ukerewe Island during July 2017. The frequency of abnormal VIA screens was nearly twice that observed on the mainland in 2016 (18.4% vs 10.7%, respectively; P = 0.0091). Island women had lower rates of grand multiparity (19.8% vs 26.8%, P = 0.02) and more island women did not know their HIV status (80% vs 50%, P < 0.0001). Overall, 31% of abnormal VIA screens occurred among women under 30 years between the two sites. Due to the cost of transporting CO2 tanks, cryotherapy was nearly twice as expensive on the island as compared to the mainland. Summary Although transfer of an entire pilot screen-and-treat program to Ukerewe Island is feasible and well-received, expenses associated with ferrying equipment may be prohibitive to long-term sustainability. Higher VIA positivity rates were observed on the island.

Precision medicine for cervical cancer

Purpose of review To summarize the data on precision medicine for cervical cancer including the use of potential biomarkers. We also review ongoing areas of research in cervical cancer therapeutics. Recent findings In the current clinical practice, programmed death ligand 1 (PD-L1) expression is used to select patients with cervical cancer for treatment with checkpoint inhibitors. However, more recently presented data suggest that PD-L1 may not be a fully accurate biomarker for selection and further analysis is warranted. With the publication of the molecular landscape of cervical cancer, tumor profile-based therapy selection is of greater interest (i.e. targeting PI3K and HER2). Summary In this review, we discuss the role of potential biomarkers for cervical cancer that may assist with the selection of precision therapies. Enrolling patients on active clinical trials will help clarify the role of targeting specific mutations.

Atypical endometriosis and the progression to endometriosis-associated ovarian cancer: an updated review

Purpose of review Atypical endometriosis is a distinct subtype of endometriosis, characterized by specific histopathologic findings. It is thought to be a precursor lesion to endometriosis-associated ovarian cancers, particularly clear-cell and endometrioid subtypes, analogous to endometrial intraepithelial neoplasia as a precursor lesion to endometrial cancer. This review summarizes recent evidence regarding the pathogenesis of atypical endometriosis and progression to endometriosis-associated ovarian cancer and the diagnosis and management of atypical endometriosis. Recent findings (a) Pathogenesis: Deep infiltrating endometriosis and ovarian endometriomas are associated with an increased risk of ovarian cancer. Genomic alterations in endometriosis potentiate progression from benign to malignant disease. Dysregulation in the mechanistic target of the rapamycin pathway is noted throughout endometriosis and endometriosis-associated ovarian cancer. (b) Diagnosis: Glandular crowding is emphasized as an important pathologic characteristic in atypical endometriosis and appears to increase the risk of development of ovarian cancer. (c) Management: Management strategies for atypical endometriosis are guided by clinical history and imaging characteristics. Summary A strong association exists between ovarian endometriomas and deep infiltrating endometriosis and ovarian cancer. While new genomic alterations have been implicated in the progression from endometriosis to endometriosis-associated ovarian cancer, there remains no established molecular mechanism to predict cancer progression. Accurate pathologic diagnosis of atypical endometriosis is critical to characterizing ovarian cancer risk. Appropriate patient selection for salpingo-oophorectomy is the foundation of management for atypical endometriosis.

Mesothelin in solid tumors: biology, biomarker utility, and therapeutic targeting

Purpose of review Mesothelin (MSLN) is a CA125-binding surface glycoprotein that mediates cell adhesion and peritoneal metastasis development in mesothelioma, high-grade serous ovarian cancer (HGSOC), pancreatic ductal adenocarcinoma, and cholangiocarcinoma. Recent findings Because of its tumor-restricted expression and functional role in dissemination, MSLN is represents an attractive molecule to target in solid tumors. Several antibody-based therapeutic agents, vaccine and chimeric antigen receptor therapy directed against MSLN are object of clinical evaluation. MSLN-targeted therapies are limited by antigen shedding and on-target/off-target effects. Summary MSLN is expressed in solid tumor patients, with no differences in expression among histologies. MSLN expression is associated with Fédération Internationale de Gynécologie et d’Obstétrique (FIGO) stage and platinum sensitivity. Higher MSLN expression is detected among primary ovarian cancer patients and correlates with better survival data in HGSOC patients only. According to our data, treatment strategies targeting MSLN should be offered in first line setting rather than in relapse.

Recent advances and future directions in gynecologic radiation oncology

Purpose of review Radiotherapy remains crucial to the management of gynecologic cancers. This review highlights recent advances in radiation delivery, integration with systemic therapies, and the evolving role of radiotherapy across definitive, adjuvant, recurrent, and palliative settings. Recent findings Trials in cervical cancer have established survival gains with novel systemic combinations, while adaptive and standardized radiation protocols continue to improve precision and outcomes. In endometrial cancer, molecular classification is informing adjuvant therapy selection and driving subtype-specific clinical trials. Expanding use of stereotactic body radiotherapy and proton therapy in ovarian and recurrent disease demonstrates feasibility and durable control. Efforts in reirradiation, palliative care, and survivorship underscore the need for safe dose escalation, symptom management, and long-term quality of life research. Persistent disparities and rising costs emphasize the importance of value-based and equitable care delivery. Summary Emerging imaging and adaptive techniques are making radiation for gynecologic cancers more precise and individualized. Advances in brachytherapy, stereotactic approaches, and proton therapy are refining delivery, while integration with systemic and molecularly guided strategies is broadening therapeutic impact. Ongoing priorities include reducing disparities, improving survivorship, and translating technological progress into accessible, patient-centered care.

Contraception in the setting of gynecologic and breast dysplasia

Purpose of review There is limited data on contraceptive options in the setting of gynecologic and breast dysplasia. Despite this, many patients who report a history of these precancers retain their reproductive organs and seek contraception to avoid pregnancy. These patients require evidence-based counseling to guide their contraceptive choices, particularly in the setting of hormonally driven pathology. Recent findings In this review article, we outline known data on contraceptive options for patients with borderline ovarian tumors, endometrial hyperplasia, cervical/vulvar dysplasia, and atypical lobular and ductal hyperplasia. We also identify gaps in knowledge and opportunities for further research. Summary Patients with gynecologic and breast dysplasia benefit from comprehensive contraception counseling. More research is needed on contraceptive options for patients with dysplasia.

Fertility counseling for patients with hereditary breast and ovarian cancer syndrome

Purpose of the review Among patients with hereditary breast and ovarian cancer, risk reduction strategies have a direct impact on fertility. In this review, we highlight the importance of early referral of those patients to fertility specialists for fertility planning, as the consideration for these risk-reducing procedures is overlaid with thoughts on childbearing. Recent findings Increased utilization of genetic testing has identified individuals with inherited pathogenic variants increasing risks of breast and ovarian cancer. For those patients, studies have identified potential areas for improvement including counseling on reproductive potential, fertility preservation, and the option for preimplantation genetic testing. Recent guidelines have emphasized the importance of consultation with a reproductive endocrinologist in the care of those patients. Summary Early referral to fertility specialists would ensure that reproductive concerns are met in a timely fashion and would facilitate future fertility planning, reviewing options for IVF, oocyte and embryo cryopreservation, and consideration of preimplantation genetic testing.

Deep endometriosis demystified: Natural progression, hormonal treatment, and malignant transformation

Purpose of review We present a review of the natural progression, response to hormonal therapy, and risk of malignancy associated with deep endometriosis (DE) to guide evidence-based discussion of conservative treatment. Recent findings Advanced imaging protocols have enhanced nonsurgical detection of DE, allowing noninvasive diagnosis, treatment, and surveillance. While some DE is progressive, 50% of disease appears stable over time, and progression is reduced by half with hormonal treatments (21 versus 12%). Hormonal treatment can reduce the size of DE lesions by 1 cm³, with reductions occurring after 6 months and remaining stable up to 3 years. Most hormonal therapies improve symptoms and quality of life, regardless of changes in DE size, with combined contraceptives and progestins being the most studied. DE may present a higher risk of ovarian and extraovarian cancer than previously hypothesized, though further research is needed to confirm findings. Limitations of DE research include differing imaging strategies, definitions of disease and progression, short follow-up, focus on rectosigmoid DE only, and lack of randomized trials. Summary DE is a subtype of endometriosis that is increasingly diagnosed and treated with noninvasive strategies. Hormonal treatments improve symptoms and reduce progression of DE. Further research on optimal conservative management and risk of malignancy is warranted.

Changing treatments paradigms and role of immunotherapy in recurrent endometrial cancer

Purpose of review Over the past decade, the treatment of patients diagnosed with endometrial cancer (EC) shifted away from the use of chemotherapy to more novel targeted therapy and immunotherapy approaches. Recent findings The Cancer Genome Atlas data demonstrated different subgroups within ECs, more specifically, it facilitated the identification of predictive biomarkers. In particular, immunotherapies (immuno-oncology (IO)) are active either as monotherapy or in combination with other agents, depending on the biomarker profile of the tumor. Summary In May 2017, pembrolizumab was approved for patients with microsatellite instability high (MSI-H) EC. More recently, this approval was extended for patients harvesting tumors with a high tumor mutational burden status. Furthermore, in July 2021, the combination of pembrolizumab and lenvatinib was approved for patients who do not exhibit MSI-H disease. Given the wealth of targets in EC and different targetable mutations, the challenge will be to choose the proper treatment and the proper sequencing to derive the best outcome in the first-line setting and improve outcomes in subsequent settings. This review summarizes the current indications of immunotherapy for the treatment of advanced and recurrent EC. We outline the role of testing for uterine cancer and its implication in therapy management. Finally, we address new concepts for immunotherapy combinations with other therapies.

Role of sentinel lymph node biopsy for gynecologic cancers

Purpose of review To provide an overview of the current knowledge and recent advances of sentinel lymph node (SLN) assessment in uterine, cervical, vulvar, and ovarian cancers. Recent findings In endometrial cancer, SLN evaluation has become increasingly utilized as part of the treatment of early-stage disease, with data showing improved detection of pelvic lymph node metastasis. In cervical cancer, SLN biopsy has also gained increasing traction with studies demonstrating the feasibility and accuracy of SLN detection. Evaluation with frozen section, however, remains limited in the detection of metastases. The prognostic significance of positive SLN in vulvar cancer is currently being investigated, with preliminary data showing lower recurrence rates in patients receiving adjuvant radiation. Summary SLN evaluation remains standard of care to detect lymph node metastasis in early-staged endometrial cancer. In cervical cancer, SLN biopsy has been shown to be reliable, while decreasing morbidity without impacting disease-free survival in select patients. The technique and high sensitivity of SLN biopsy in vulvar cancer has been demonstrated in large prospective trials. There are no randomized controlled trials in ovarian cancer that evaluate the role of SLN biopsy on treatment and outcome; current SLN evaluation remains investigational.

Update on new treatments for rare ovarian tumours

Purpose of review In spite of their rarity when considered individually, the sum of all rare ovarian tumours (ROT) represent almost half of all ovarian malignancies. As such, their appropriate inclusion within dedicated clinical trials is essential for enhanced management. Recent findings Supported by institutional expert national (e.g. TMRG) and international (e.g. ESGO) networks and owing to national (e.g. ARCAGY-GINECO) and international (e.g. ENGOT) collaborations dedicated to clinical research, the last few years have shown increased number of clinical trials dedicated to ROT. These either were based on specific molecular features of ROT (e.g. expression of oestrogen receptors for low-grade serous ovarian carcinomas and anastrazole evaluation in the PARAGON trial) or on the evaluation of innovative therapies (e.g. pembrolizumab within the ROT cohort from the AcSé Pembrolizumab multicentric basket trial). Furthermore, recent years have also shown the advent of randomized clinical trials. For instance, the ALIENOR trial positioned weekly paclitaxel as a new option for relapsed sex cord-stromal tumours, while the GOG281/LOGS trial raised trametinib as a new standard-of-care option for recurrent low-grade serous carcinomas. Summary The last few years have exhibited a paradigm shift towards the possibility to develop dedicated trials for ROT, owing to international collaborations supported by institutional networks. Current trials, molecular-driven and based on innovative designs, are highly promising, as they may bring ROT management towards more personalized medicine.

Opportunistic salpingectomy for prevention of ovarian cancer among the general population

Purpose of review Ovarian cancer remains the most lethal gynaecological cancer. Early detection and treatment options are limited, so prevention is key. This article reviews the current opinion on opportunistic salpingectomy for ovarian cancer prevention within the general population. Recent findings Salpingectomy (the removal of the fimbriated ends of the fallopian tubes) reduces ovarian cancer risk without inducing early menopause or depleting ovarian reserves. The International Federation of Gynecology and Obstetrics firmly supports the use of salpingectomy opportunistically (in addition to planned abdominal surgery) for ovarian cancer risk reduction. When salpingectomy should be provided as an elective surgery, and what nongynecological surgeries can be used as opportunities for salpingectomy, is an ongoing discussion. Summary As understanding of the safety and efficacy of opportunistic salpingectomy has solidified into guidelines, its use for ovarian cancer risk reduction has increased. However, the uptake of opportunistic salpingectomy has varied between geographic regions and across institutions. In the US, roughly a third of women undergo a hysterectomy during their lifetime, each of these women should have a chance to consider opportunistic salpingectomy for ovarian cancer prevention. Education about the benefits and harms of opportunistic salpingectomy is both necessary and effective in reducing inequities in access to this risk-reducing surgery.

Is there a role for secondary debulking in ovarian cancer? A review of the current literature

Purpose of review Until recently, no data was available from randomized, controlled trials (RCT) to assess the role of secondary cytoreductive surgery (CRS) in the management of recurrent epithelial ovarian cancer. This review highlights results from the three completed RCTs, and other recent literature on this topic. Recent findings Both the AGO and iMODEL criteria predict high rates of complete gross resection at the time of secondary CRS. Overall survival (OS) was improved in the surgical arms in both DESKTOP 3 and SOC-1. In contrast, surgery did not improve OS in GOG 213, but greater than 80% of patients received bevacizumab with chemotherapy in GOG 213. Summary Secondary cytoreduction for recurrent ovarian cancer can be considered in patients who meet specific criteria. Available data supports improvement in OS for patients not receiving bevacizumab, who achieve complete gross resection. Surgery is harmful to patients with gross residual disease.

Changing treatment landscape for early cervical cancer: outcomes reported with minimally invasive surgery compared with an open approach

Purpose of review The aim of the article is to review recent studies that compare the oncologic efficacy of minimally invasive radical hysterectomy with that of open radical hysterectomy. Recent findings The Laparoscopic Approach to Cervical Cancer (LACC) trial, a randomized study design to test the hypothesis that minimally invasive radical hysterectomy is not inferior to open radical hysterectomy, was stopped early by the data and safety monitoring committee after enrolling 631 of a planned 740 patients. The disease-free survival rate at 4.5 years was 86% among women assigned to minimally invasive surgery and 96.5% in those who underwent open surgery (hazard ratio [HR] 3.74; 95% confidence interval [CI] 1.63–8.58). Minimally invasive surgery was also associated with inferior overall survival (HR 6.00; 95% CI 1.44–12.7). Recent well designed, adequately powered observational studies mostly corroborate the findings of the LACC trial. Summary After a decade of widespread acceptance and increasing popularity, the preponderance of evidence now suggests that minimally invasive radical hysterectomy for cervical cancer confers an excess risk of recurrence and death compared with open abdominal radical hysterectomy.

Multimodality screening and prevention of cervical cancer in sub-Saharan Africa: a collaborative model

Purpose of review Although cervical cancer continues to decrease in incidence throughout the developed world because of rigorous screening and vaccination campaigns, the disease remains a major cause of cancer-related morbidity and mortality in resource-limited regions including sub-Saharan Africa. This review summarizes current efforts to implement cost-effective and widespread cervical cancer education, screening, and community-based interventions in Africa and the challenges faced by local healthcare workers. Recent findings Effective screening with cytology (with or without high-risk human papillomavirus [HPV] DNA testing) as well as HPV self-sampling remains problematic in African countries because of a paucity of cytopathologists and resources. Accordingly, visual inspection of the cervix with acetic acid (VIA) with cryotherapy triage has gained traction in mass-screening campaigns because of low-cost supplies. Summary Public education to facilitate screening is essential. VIA remains a strong community-based approach. The involvement of technology in teaching local providers, advertising screenings to the community, and helping improve follow-up may also improve screening efforts. Ultimately, the best form of prevention is through HPV vaccination, which also requires implementation of ongoing public education programs.

Diagnosis and management of vulval lesions

Purpose of review The vulva is part of the skin. A wide spectrum of dermatological diseases affects the vulva, including infections, dermatoses, manifestations of hormonal and systemic conditions, and neoplasia. Vulval diseases are typically associated with significant delay in diagnosis due to limited healthcare practitioner knowledge amongst primary care physicians and specialists alike. This review article provides an update on the diagnosis and management of common vulval lesions. Recent findings This article reviews the literature on vulval lesions and vulval dermatoses and was conducted through searching PubMed. Common causes of vulval lesions are presented, including vulval cancer, vulval squamous intraepithelial lesions, dermatitis, psoriasis, lichen simplex chronicus, acute and chronic candida vulvovaginitis, lichen sclerosus, lichen planus, and nonsexually acquired genital ulceration. Summary Vulval complaints are common. It is important to not only be able to differentiate between benign findings and potentially premalignant or malignant lesions but also recognise and manage common causes of vulval lesions such as dermatitis, psoriasis, lichen sclerosus, infectious causes of disease, and nonsexually acquired genital ulceration.

The evolving landscape of antibody-drug conjugates in ovarian cancer: new drugs for a new era

Purpose of review This review addresses the emerging role of antibody-drug conjugates (ADCs) in the treatment of ovarian cancer, a field marked by a high need for more effective and targeted therapies. Given the recent advancements in ADC technology and the ongoing challenges in treating ovarian cancer, particularly in late-stage and recurrent cases, this review is both timely and relevant. It synthesizes current research findings and clinical trial data, highlighting the potential of ADCs to revolutionize ovarian cancer treatment. Recent findings The review covers key themes including the mechanism of action of ADCs, their specificity in targeting ovarian cancer cells, recent clinical trial outcomes, advancements in ADC design for improved efficacy and reduced toxicity, and strategies to overcome drug resistance in ovarian cancer. It also addresses the heterogeneity of ovarian cancer and the implications for personalized ADC therapies. Summary The review underscores the potential of ADCs to significantly impact clinical practice, offering a more effective and personalized treatment approach for ovarian cancer patients. The review suggests a paradigm shift in the treatment of this malignancy, emphasizing the need for further research and development in this area.

Maintenance therapy for newly and recurrent epithelial ovarian cancer: current therapies and future perspectives

Purpose of review Epithelial ovarian cancer (EOC) is the fifth cause of cancer death among women, and 70–80% of patients relapse within 2 years from the last cycle of first-line chemotherapy despite a complete response to chemotherapy and optimal debulking surgery. In this context, the goal of the maintenance treatment strategy is to prolong the time to recurrence. The recent development of targeted molecular therapies resulted in a broader spectrum of maintenance therapeutic options with consequent higher clinical benefit but less toxicity. This review summarizes the currently available maintenance strategies for newly and recurrent EOC, focusing on the decision-making process to personalize treatment and future perspectives. Recent findings Over the past 10 years, several studies have demonstrated the clear benefit in terms of survival with the addition of a maintenance treatment strategy over the ‘watchful waiting’ approach both in the first line and recurrent setting. Since December 2016, the United States Food and Drug Administration and European Medicines Agency have approved four drugs for ovarian cancer maintenance based on the results of several clinical trials demonstrating efficacy and tolerability. These include the antiangiogenic drug Bevacizumab and three polyadenosine diphosphate-ribose polymerase (PARP) inhibitors: olaparib, niraparib, and rucaparib. Summary These data led American and European Treatment guidelines to include bevacizumab, olaparib, niraparib, rucaparib, and combination bevacizumab-olaparib as maintenance treatment options in first-line and recurrent ovarian cancer therapy. However, with the availability of different maintenance options, identifying the best treatment choice for each patient can be challenging, and several clinical and molecular aspects have to be taken into account in the decision-making process.

Sentinel lymphatic mapping for gynecologic malignancies

Purpose of review To summarize the latest data in Gynecologic Oncology for the use of sentinel lymphatic mapping in vulvar, uterine, and cervical cancers. Recent findings To decrease morbidity and improve detection of lymphatic metastasis, lymphatic mapping with sentinel lymph node biopsy is emerging as standard of care over conventional systemic lymphadenectomy in the surgical management of gynecologic malignancies. Summary Sentinel lymph node mapping with biopsy is one of the most significant advances in cancer surgery. The presence of nodal metastasis is not only a prognostic factor for recurrence and survival in patients with gynecologic malignancies, but also guides assessment for adjuvant treatment. This review article discusses the most recent clinical updates in sentinel lymph node mapping, dissection, and management in vulvar cancer, endometrial cancer, and cervical cancer.

The current status of immunotherapy in the treatment of primary advanced and recurrent endometrial cancer

Purpose of review Despite the recent upward trends in incidence and mortality of endometrial cancer, there are still limited FDA-approved therapies for patients with primary advanced and recurrent endometrial cancer. This disparity presents the opportunity for further investigation of targeted therapies in this patient population. Recent findings One such area of adjuvant therapy is immunotherapy, which has shown improved progression-free survival in patients with several solid tumors, including endometrial, leading to the FDA approval of two immune checkpoint inhibitors. Additionally, with further study of precision medicine, the current adjuvant treatment paradigms that exist based on histopathologic subtype alone may be shifting towards a new genomic-based approach. Summary This article is a snapshot of the origins of immunotherapy use in this patient population as well as a guide to its future use. The author's hope with this article is to describe the patient population as well as the history of the integration of immunotherapy use into the adjuvant treatment of endometrial cancer leading up to FDA approval of Pembrolizumab and Dostarlimab. This article also consolidates the current literature as well as ongoing clinical trials that will hopefully lead to FDA approval of more immunotherapeutic agents in the near future.

Endometrial cancer therapy in 2026

Purpose of review Endometrial cancer is one of the few cancers that has continued to rise in incidence over the past decade, necessitating novel diagnostic and treatment approaches. Recent findings A revised staging system for endometrial cancer has been implemented in the last 5 years as growing attention has also been directed toward identifying biomarkers and other factors that offer deeper insights into tumor biology and therapeutic responses. Fertility-preserving therapy can be an option for younger patients when certain criteria are met. The use of immunotherapy for advanced stages (III or IV) or recurrent endometrial cancer has been studied extensively over the last 5 years, with new treatment options including checkpoint inhibitors. Recurrent cases have a particularly poor prognosis, and there have been limited options for patients. New treatments have been approved by the United States Food and Drug Administration (FDA) for recurrent endometrial cancer, leading to improved outcomes for patients. Summary There have been improvements in endometrial cancer therapy, leading to increased survival and improved outcomes; however, there are unmet needs that need to be addressed in 2026 and beyond.

Role of sentinel node mapping in endometrial cancer in 2025

Purpose of review The aim is to summarize the role of sentinel lymph node biopsy (SLN) in surgical staging for endometrial cancer (EC). Recent findings The value of SLN in EC staging continues to be demonstrated in all clinically uterine-confined disease, as SLN matches or improves the diagnostic accuracy of pelvic±para-aortic lymphadenectomy (PLD ± PALD) while reducing recovery time, surgical complications, and risk of lower extremity lymphedema. High diagnostic accuracy allows recommendation of appropriate adjuvant therapy, and recent studies have shown that even patients with high-risk histology may undergo SLN as opposed to PLD ± PALD provided this is combined with appropriate imaging. Debate about the necessity of any lymph node assessment in patients with certain low-risk features continues, with a preponderance of evidence pointing toward universal SLN in patients undergoing surgical staging for EC. In patients with negative SLN and intermediate risk uterine factors, molecular profiling is recommended to augment information gained through surgical assessment. Summary EC surgical staging with SLN is considered standard practice in clinically uterine-confined disease. This approach allows precise treatment recommendations without PLD ± PALD related side effects. The integration of molecular profiling with EC surgical staging will accelerate the benefits of therapeutic advances in EC.

State of the art endocrine treatments for patients diagnosed with endometrial cancer in 2025

Purpose of review Endometrial cancer (EC) is rising in incidence, particularly in younger, premenopausal women, due to increasing rates of obesity and delayed childbearing. This review evaluates current and emerging endocrine therapies, with a focus on fertility-preserving approaches for early-stage EC and treatment options for advanced or recurrent disease. Recent findings Fertility-sparing endocrine therapies, such as medroxyprogesterone acetate, megestrol acetate, and levonorgestrel-releasing intrauterine devices, achieve high response rates but carry recurrence risks. Biomarkers, including progesterone receptor status and molecular subtyping, are improving patient selection and outcomes. In advanced EC, single-agent and combination endocrine therapies with agents like selective estrogen receptor modulators, selective estrogen receptor down-regulators (SERDs), and aromatase inhibitors show efficacy, especially in hormone receptor-positive disease. Newer agents, including next-generation SERDs and proteolysis-targeting chimeras, hold potential for treating resistant cases. Summary Endocrine therapy offers a well tolerated alternative to chemotherapy in selected EC patients, particularly those with hormone-sensitive tumors. Advances in molecular profiling and the development of novel endocrine agents are refining treatment strategies, supporting endocrine therapy’s continued role in managing EC across various stages.

Latest advances in immuno-oncology for endometrial cancer: single-agent and combination regimens

Purpose of review The scope of immuno-oncology in endometrial cancer has changed rapidly in the last several years, requiring up-to-date knowledge for those who treat these patients. Recent findings This article will focus on molecular profiling, recent trials, and FDA approvals of targeted immuno-oncology medications in endometrial cancer. These include immune checkpoint inhibitors alone or with combination treatment. Summary The publication of the TCGA has led to significant focus on molecular subgroupings into POLEm, MMRd, NSMP, and p53m groups. For those patients with MMRd vs. MMRp tumors, there are indications for single agent immune checkpoint inhibitors with dostarlimab or pembrolizumab. For those with MMRp tumors, the addition of lenvatinib to pembrolizumab has proven clinical benefit. The recent publication of the RUBY and NRG-GY018 trials have shown clinical benefit in both subgroups with addition of immune checkpoint inhibitor to platinum-based chemotherapy. Now there is approval for use of dostarlimab in frontline chemotherapy and maintenance for advanced stage or recurrent endometrial cancer. Several upcoming trials investigating molecular subgroups from the TCGA are eagerly anticipated.

Treatment options for molecular subtypes of endometrial cancer in 2023

Purpose of review This article reviews treatment strategies in endometrial cancer by molecular subtype. Recent findings The Cancer Genome Atlas (TCGA) classifies four molecular subtypes of endometrial cancer – mismatch repair-deficient (dMMR)/microsatellite instability-high (MSI-H), copy number high (CNH)/p53abn, copy number low (CNL)/no specific molecular profile (NSMP), and POLEmut – which are validated and highly prognostic. Treatment consideration by subtype is now recommended. FDA-approved immune checkpoint inhibitors (ICIs) include pembrolizumab and dostarlimab for previously treated dMMR/MSI-H EC, and pembrolizumab/lenvatinib for mismatch repair-proficient/microsatellite-stable endometrial cancer, including CNH/p53abn and CNL/NSMP. ICIs are being studied as first-line therapy in advanced/recurrent endometrial cancer by MMR status, as well as in combination with other targeted agents. Trastuzumab is NCCN compendium listed for HER2-positive serous endometrial cancer, which are primarily p53-abnormal. Antibody–drug conjugates targeting low and high HER2 levels show promise in breast cancer, and are beginning to be studied in endometrial cancer. In addition to hormonal therapy, maintenance therapy with selinexor (XPO1-inhibitor) showed potential benefit in p53-wildtype endometrial cancer and is being investigated prospectively. Multiple prospective trials are evaluating de-escalation of care for POLEmut endometrial cancer given favorable survival regardless of adjuvant therapy. Summary Molecular subtyping has important prognostic and therapeutic implications and should be guiding patient management and clinical trial design in endometrial cancer.

Minimally invasive and ablative therapies for symptomatic uterine fibroids: a narrative review

Purpose of review Uterine fibroids are benign smooth muscle growths that can cause abnormal uterine bleeding, bulk symptoms, and infertility. Traditional treatments include medical therapy and surgical interventions such as hysterectomy and myomectomy. In the past three decades, minimally invasive, uterus-sparing alternatives – namely, high-intensity focused ultrasound (HIFU), uterine artery embolization (UAE), and radiofrequency ablation (RFA) – have revolutionized the management of symptomatic fibroids. Although early studies suggest these modalities are effective, high-quality data on their long-term efficacy, safety profiles, and reproductive outcomes are limited. Recent findings This paper presents a literature review on HIFU, UAE, and RFA for the treatment of symptomatic uterine fibroids. Studies report improvements in symptom severity and quality of life, with low complication rates. Optimal outcomes depend on careful patient selection, as certain factors increase the risk of treatment failure and the need for reintervention. Furthermore, little is known about pregnancy outcomes following these interventions, as studies are sparse and heterogenous. Summary HIFU, UAE, and RFA are safe and effective options for the treatment of symptomatic uterine fibroids. Further research is needed to evaluate long-term effectiveness, fertility and pregnancy outcomes, and comparisons between treatment modalities.