Spotlight on… gynaecological cancer

In the last Spotlight highlighting cancer-related publications in The Obstetrician & Gynaecologist (TOG), Jo Morrison brought the attention of the readers to articles in oncology relating to a range of topics including pregnancy, hormonal consumption and prevention (TOG 2022;24:88–9). Over the past few years, the TOG editorial board has commissioned and accepted an eclectic mixture of articles in relation to gynaecological cancer. In this highlight, I review the articles featured in TOG alongside selected publications from BJOG. Amongst the sustainable developmental goals of 2030, cancer features prominently, since an estimated 70% of cancer deaths occur in low- and middle-income countries. The burden and disparity in managing cancer-related health impact around the globe reflect the disparity between and within societies at large. Illah and colleagues scope the spectrum of factors associated with global disparities in gynaecological cancer management and highlight some of the opportunities for intervention (TOG 2025;27:29–36). In a recent quantitative analysis of the global burden of breast and gynaecological cancers, Cheng and colleagues have utilised data from the Global Burden of Disease Study 2019 (BJOG 2025;132:55–63). This article illustrates divergent trends over the past three decades within breast and gynaecological cancer burden, but what is clear is that the inequality between countries has continued to grow. Personalised cancer therapy is an umbrella term which encompasses tailored prehabilitation, choice of surgical intervention as well as utilising targeted therapy based on molecular disease characteristics to name a few. In a recent publication, Darwish and colleagues review molecular testing and targeted therapy with regards to ovarian cancer (TOG 2023;25:220–8). They highlight the genomics of ovarian cancer, therapeutic strategies as well as underline the ethical challenges. As a consequence of molecular testing, family members with BRCA 1 or 2 germline mutations may be identified. Following an informed risk reduction salpingo-oophorectomy (RRSO), one short-term outcome is the identification of serous tubal intraepithelial carcinoma lesions. This is of course a precursor lesion of high-grade serous pelvic cancer spectrum and its management is yet to be fully defined. In a focus group study of international experts, Negri and colleagues (BJOG 2024;131:1851–61) scope the current status and suggest a management algorithm and additionally outline research themes. A longer-term sequela of RRSO is in relation to metabolic syndromes. In an international consensus paper, Nebgen and colleagues (BJOG 2023;130:1437–50) recommend evidence-based items to be discussed prior to RRSO surgery and post-operative measures to optimise longer-term health. These suggestions could enhance daily clinical practice and improve clinical governance. With regard to lower genital tract dysplasia, Henderson and colleagues (TOG 2024;26:18–26) review the diagnosis and management of vulval intraepithelial neoplasia (VIN). The article explores both medical and surgical management of VIN. Among the barriers to implementing a successful cervical screening programme are cultural and logistical factors in developed and developing countries. A self-directed technique such as urine collection for human papillomavirus screening broadens our armamentarium. In a randomised study of two sampling techniques, Davies and colleagues (BJOG 2024;131:1456–64) report a validation study with very encouraging performance indices. In adequately resourced settings, for patients who meet the relevant criteria, sentinel node mapping and biopsy only has become the standard in determining the lymph node status and disease stage. This applies to endometrial, cervical and vulval cancers. The journey from initial investigations of the sentinel lymph node (SLN) concept to incorporation into the guidelines has taken approximately two decades. Collins and Phillips describe the role of sentinel node navigation in gynaecological oncology (TOG 2023;25:210–9). This review encompasses all the aspects from concept, mechanics of SLN navigation to governance matters associated with the implementation and maintenance of this strategy. The authors also highlight the oncological and clinical benefits as well as the cost effectiveness of this concept. The role of SLN mapping in ovarian cancer remains under investigation. Hyperthermic intraperitoneal chemotherapy (HIPEC) in the setting of interval cytoreductive surgery is currently offered in a number of cancer centres with appropriate resources. Graham and colleagues offer a summary of HIPEC including the mechanisms, rationale, practicalities of treatment delivery and the evidence base at the time of submission (TOG 2024;26:76–83). This is an area where the evidence base is rapidly shifting. And finally, I can't conclude without a note on the evolving roles of artificial intelligence (AI). In an introductory article, Athavale and co-authors (TOG 2024;26:177–82) sketch out the scope of AI in gynaecoloy. This could be a succinct read for all my colleagues. Specifically in relation to cancer care, an interesting feasibility study by Levine and colleagues (BJOG 2025;132:99–101) confirms that weekly multidisciplinary team meetings (or tumour boards) will remain a core element of patient care for the moment! Open access funding provided by Medizinische Universitat Wien/KEMÖ.