Molecular Approaches to Gynecological Cancers: Biomarkers and Targeted Therapeutic Pathways

Gynecological cancers, including ovarian, endometrial, and cervical malignancies, represent a heterogeneous group of tumors characterized by distinct clinical behaviors and complex molecular properties. Advances in molecular oncology have substantially reshaped the understanding of gynecological carcinogenesis, revealing that dysregulation of tumor suppressor genes, DNA damage repair pathways, oncogenic signaling cascades, and virus-driven mechanisms critically influence disease initiation, progression, and therapeutic response. In ovarian cancer, alterations in homologous recombination repair, TP53 mutations, and aberrant activation of MAPK and PI3K/AKT signaling pathways have enabled molecular stratification and the successful implementation of targeted therapies. Endometrial cancer exemplifies the transition toward molecular classification, with POLE exonuclease domain mutations, mismatch repair deficiency, and copy number alterations defining biologically and clinically distinct subgroups with divergent prognostic outcomes. Cervical cancer represents a unique virus associated malignancy in which persistent high risk human papillomavirus infection drives oncogenesis through disruption of cell cycle regulatory pathways, providing a robust biological basis for molecular diagnostics and prevention strategies.This review comprehensively summarizes the current knowledge of key molecular biomarkers and signaling pathways involved in gynecological cancers, including CA-125, mismatch repair deficiency, TP53, HER2, BRCA-associated DNA repair mechanisms, POLE mutations, WNT/β-catenin signaling, and HPV-related molecular alterations. Furthermore, the clinical implications of these molecular insights for diagnosis, prognosis, risk stratification, and personalized therapeutic approaches are discussed. In conclusion, integration of molecular profiling into clinical practice represents a critical step toward precision medicine in gynecological oncology, offering the potential to improve patient outcomes through biomarker-driven diagnosis and targeted treatment strategies.