Uterine Leiomyoma or Sarcoma?

Uterine leiomyomas are benign neoplasms derived from the smooth muscle cells of the myometrium. In contrast, uterine sarcomas are rare tumors, with a prevalence of 3-7 per 100,000 women, originating from myometrial cells or endometrial connective tissue. Uterine sarcomas and especially leiomyosarcomas are more aggressive than uterine epithelial neoplasms. The differential diagnosis between leiomyoma and uterine sarcoma preoperatively remains challenging for the clinical practitioner in order to determine optimal treatment. The chapter aims to summarize current evidence regarding differential diagnosis and optimal management of these two challenging clinical entities.

Surgical Prevention in Ovarian Cancer

Ovarian cancer is the second most common malignant disease of the female genital tract, but the first in mortality because it is usually diagnosed at an advanced stage. Options for early detection, diagnosis, and treatment are limited. Prevention of ovarian cancer relates to primary prevention by avoiding factors that are epidemiologically associated with an increased incidence of ovarian cancer and the adoption of protective habits. These include interventions to exclude the fallopian tubes and ovaries. Secondary prevention is related to early diagnosis. The chapter aims to summarize current evidence on prevention of ovarian cancer as well as role of surgery to prevent advanced-stage disease.

Cervical and Vulvar Cancer in Early Stages

Cervical and vulvar cancer represent two clinical entities whose diagnosis and management are often challenging. They are frequently diagnosed in the early stages, therefore leaving chances for optimal treatment and prognosis. The aim of this chapter is to answer two oncological issues concerning early stage cervical and vulvar cancer. First, is still room for surgical treatment for early stage cervical cancer or should we suggest chemoradiotherapy instead? Second, when is a limited surgical intervention sufficient for early stage vulvar cancer?

Early-Stage Cervical Cancer

Recent advances in screening and early diagnosis have decreased cervical cancer incidence and mortality rate in high-resource settings. The postponement of childbearing and the young age of women at diagnosis produced new challenges in the management of this disease. In recent years, attention has been directed to assessing more conservative procedures that can reduce treatment-related morbidity, without compromising oncologic safety and reproductive potential. Fertility sparing surgery (FSS) procedures, including cervical conization, simple or radical trachelectomy with pelvic nodes dissection or sentinel lymph node assessment, and neoadjuvant chemotherapy followed by conization, have shown encouraging results. In this chapter, the authors discuss the role of conservative surgery in the management of early-stage cervical cancer focusing on obstetrical and oncological outcomes.

Chemoprevention in Breast Cancer

Chemoprevention in breast cancer represents one of the most important therapeutic regimens in an effort to optimize survival and prevent breast cancer recurrence. The chapter aims to analyze below all potential medical regimens used in breast cancer chemoprevention, along with explaining the reasons why those are the ones selected: their characteristics, their mechanism of action, and their side effects. Among these, we may report tamoxifen, raloxifen, aromatase inhibitors, and new therapeutic regimens such as polyphenoles.

vNotes (Vaginal Natural Office Transluminal Endoscopic Surgery)

vNOTES or vaginal Natural Orifice Transluminal Endoscopic surgery is a new paradigm shift in gynaecological surgery. A first paradigm shift from conventional surgery into laparoscopic surgery was firstly observed in the 1980s and 1990s. vNOTES may represent a shift from 90° to parallel surgery. Almost all benign gynaecological operations can be performed via vNOTES. The chapter presents the technique of vNOTES along with results of various benign and mainly malignant cases. In parallel, the clinical approach of endometrial cancer is widely discussed.

Cystic Masses During Pregnancy

The prevalence of cystic masses in pregnancy varies from 0.1 to 2.4% and approximately 1 to 6% of these masses are malignant. The clinical presentation of cystic masses in pregnancy varies widely. The majority of cystic masses identified in pregnancy are benign simple cysts less than 5mm in diameter. Malignant neoplasms may be developed, and it is of paramount importance for the attending physician to be able to identify them. Ultrasonography is an excellent tool for the detection of cystic masses and for the discrimination between benign and malignant masses. IOTA group has proposed simple ultrasound rules in order to distinguish between benign and malignant cystic masses. In some cases where there is uncertainty about the type of mass, the MRI has high diagnostic value. Tumor markers that used in epithelial and nonepithelial cancers in nonpregnant women are difficult to interpret in pregnancy, because they are involved in biological functions associated with fetal development, differentiation, and maturation.

Borderline Ovarian Tumors

Borderline ovarian tumors (BOTs) are a specific subgroup of ovarian tumors and are characterized by cell proliferation and nuclear atypia without invasion or stromal invasion. They are usually more present in younger people than the invasive ovarian cancer and are diagnosed at an early stage and thus have a better prognosis. Histologically, borderline tumors are divided into serous (50%), mucosal (46%), and mixed (4%). The serous tumors are bilateral in 30% of the cases and are accompanied by infiltrations outside the ovary in 35% of the cases. These infiltrations may be non-invasive or invasive depending on their microscopic appearance and may affect treatment. Surgery is the approach of choice, and laparoscopic surgery, with the undeniable advantages it offers today, is the “gold standard.” All the surgical steps required to properly treat borderline tumors, at both diagnostic and therapeutic levels, can be safely and successfully be applied laparoscopically. Manipulations during surgery should be limited, and biopsies for rapid biopsy should be done within an endoscopic bag.

Is mRNA indeed Useful in Clinical Management of Cervical Pathology?

Personalised medicine and precision medicine are being applied in more medical fields in the last years. The need for personalisation is especially pronounced in cervical pathology, since in the majority of cases an abnormal screening test does not necessarily imply high-grade lesion, regardless of whether the screening test is cytology or HPV testing. The chapter aims to summarize the exact added value that mRNA presents for management in clinical practice as well as highlight comparative advantages and disadvantages with other triage strategies.

Endometrial Polyps in Reproductive Age

Endometrial polyps are endometrial masses that consist of glands, stroma, and vessels. They can be single or multiple, sessile or pedunculated, and range in size from some millimeters up to several centimeters. Despite the fact they rarely cause symptoms, they are usually found on a routine examination. Therefore, they are a common problem on daily clinical practice. The question of potential malignancy risk as well as the necessity of further treatment are often posed. The present chapter summarizes current evidence regarding risk of malignant transformation as well as indications and methods of appropriate treatment.