The lymphatic pathway is an important route of metastasis in gynecological malignancy. Therefore, the examination of lymph nodes is an essential part of the ultrasound evaluation in patients with known or suspected gynecological malignancy. The lymph nodes most frequently involved in gynecological malignancy (apart from vulvar cancer) are parietal (retroperitoneal) and visceral abdominopelvic lymph nodes. In advanced disease, more distant lymph-node regions, such as the inguinal, axillary and supraclavicular lymph nodes, can also be involved. The standardized description of lymph nodes has been published previously by the Vulvar International Tumor Analysis (VITA) collaborative group. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for ultrasonographic lymph-node assessment performed as part of the locoregional and distant work-up to assess the extent of gynecological malignancy. The aim of this consensus opinion is also to describe the anatomical classification and drainage pathways of the lymphatic system as relevant to the gynecological organs. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

• MeSH
• Consensus * MeSH
• Humans MeSH
• Lymphatic Metastasis * diagnostic imaging   MeSH
• Lymph Nodes * diagnostic imaging   pathology   MeSH
• Genital Neoplasms, Female * diagnostic imaging   pathology   MeSH
• Neoplasm Staging * MeSH
• Terminology as Topic MeSH
• Ultrasonography * methods   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

A standardized methodology for the ultrasound evaluation of the pelvic sidewall has not been proposed to date. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for the ultrasonographic evaluation of structures within the pelvic sidewall. Five categories of anatomical structures are described (muscles, vessels, lymph nodes, nerves and ureters). A step-by-step transvaginal ultrasound (or, when this is not feasible, transrectal ultrasound) approach is outlined for the evaluation of each anatomical landmark within these categories. Accurate assessment of the pelvic sidewall using a standardized approach improves the detection and diagnosis of non-gynecological pathologies that may mimic gynecological tumors, reducing the risk of unnecessary and even harmful intervention. Furthermore, it plays an important role in completing the staging of malignant gynecological conditions. Transvaginal or transrectal ultrasound therefore represents a viable alternative to magnetic resonance imaging in the preoperative evaluation of lesions affecting the pelvic sidewall, if performed by an expert sonographer. A series of videoclips showing normal and abnormal findings within each respective category illustrates how establishing a universally applicable approach for evaluating this crucial region will be helpful for assessing both benign and malignant conditions affecting the pelvic sidewall. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

• MeSH
• Consensus * MeSH
• Humans MeSH
• Lymph Nodes diagnostic imaging   MeSH
• Pelvis * diagnostic imaging   MeSH
• Ultrasonography * methods   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Karcinom endometria patří mezi nejčastější gynekologické malignity ve vyspělých zemích a jeho incidence dlouhodobě roste. S rozvojem molekulárního porozumění biologii nádoru se otevřela cesta k cílené a imunoterapeutické léčbě, zejména u podtypů s defektním mechanismem oprav chybného párování DNA (deficient mismatch repair, dMMR) nebo s mikrosatelitovou instabilitou (microsateUite instability-high, MSI-H). Článek uvádí přehled současných možností imunoterapie v léčbě pokročilého nebo recidivujícího karcinomu endometria, včetně kombinací s chemoterapií a cílenými léky, na základě aktuálních dat z klinických studií. Imunoterapie se stala novým standardem v léčbě určité části pacientek s karcinomem endometria. Klíčovou roli hraje molekulární stratifikace, bez níž nelze imunoterapii účinně a bezpečně nasadit.

Endometrial cancer is one of the most common gynecological malignancies in developed countries, and its incidence has been increasing for a long time. With the development of molecular understanding of tumor biology, the way to targeted and immunotherapeutic treatment has been opened, especially for subtypes with deficient mismatch repair (dMMR) or microsateUite instability-high (MSI-H). The article provides an overview of current immunotherapy options for the treatment of advanced or recurrent endometrial cancer, including combinations with chemotherapy and targeted drugs, based on current clinical trial data. Immunotherapy has become the new standard of care for some patients with endometrial cancer. Molecular stratification plays a key role, without which immunotherapy cannot be used effectively and safely.

INTRODUCTION: In developed countries, urologic fistulas arise mainly from malignancies, radiotherapy, or surgical trauma. Hysterectomy and radiation therapy are both critical components of the treatment of women with cancers. Urologic fistulas significantly reduce the quality of life of cancer patients, and may result in delays or even refusal of adjuvant treatment by these patients, thereby negatively impacting both short- and long-term cancer survival. MATERIALS AND METHODS: A 10-year retrospective study of urologic fistulas associated with gynaecologic malignancies at the University hospital Hradec Kralove, Czech Republic was conducted. Descriptive statistics of the fistula and treatment characteristics of women with malignant fistulas were conducted using the NCSS 22 statistical software program (NCSS, Keysville, Utah). RESULTS: Cervical cancer was mostly commonly associated with urologic fistulas (36, 76.8%). Most of the malignant fistulas were complex (41, 87.2%) vesicovaginal (23, 48.9%) fistulas (VVFs). More than two-thirds (33, 70.2%) of the fistulas were diagnosed following radiotherapy, with a time interval from radiotherapy to fistula diagnosis of between 3.00 and 14.50 years. Primary fistuloraphy was performed for all the six cases with simple VVFs and seven (41.2%) of the 17 patients with complex VVFs. Treatment success rate was 83.33% and 14.3% for simple and complex fistulas, respectively. All the failed complex fistula repairs recurred. CONCLUSION: Malignant fistulas predominantly follow radiotherapy for cervical cancers, and are usually detected up to 15 years post-radiotherapy. Most are complex VVFs, which are difficult to treat, with a high rate of recurrence.

• MeSH
• Adult MeSH
• Hysterectomy adverse effects   MeSH
• Quality of Life MeSH
• Middle Aged MeSH
• Humans MeSH
• Urinary Fistula * etiology   epidemiology   MeSH
• Uterine Cervical Neoplasms * complications   MeSH
• Genital Neoplasms, Female * complications   therapy   pathology   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Vesicovaginal Fistula * etiology   epidemiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

Cíl: Přehled možností využití nelékařského zdravotnického oboru ergoterapie v onkogynekologii, popis role ergoterapeuta v prehabilitaci, zhodnocení dat z pilotní studie. Soubor a metodika: Do studie probíhající od listopadu 2023 do října 2024 bylo zařazeno celkem 18 pacientek, prospektivní studie probíhala po dobu 9 měsíců. Jednalo se o pacientky přijaté k 3týdenní intenzivní multimodální prehabilitaci v režimu 4/7 před plánovaným operačním výkonem pro primární nebo recidivující maligní nádor ovaria, endometria nebo děložního hrdla. Pacientkám se v rámci prehabilitace věnoval kromě lékařů i fyzioterapeut, psycholog, nutriční specialista a ergoterapeut. Klinická práce ergoterapeuta byla změřena na vyšetření a následnou terapii v oblasti kognitivních funkcí, jemné motoriky horních končetin, soběstačnosti a kvality života. Ergoterapeut aplikoval vybrané funkční testy a dotazníky (MKF klasifikace, Hand grip test, MoCA test, 5× Sit-to-Stand test, WHODAS 2.0) pro zjištění efektu rehabilitační intervence. Výsledky a závěry: Důležitými sledovanými ukazateli byly vybrané funkční schopnosti, které mají významný dopad na kvalitu života pacientek. Výsledky funkčních testů prokázaly významné zlepšení klíčových parametrů vlivem intenzivní prehabilitace, což potvrzuje zásadní roli intervence ergoterapeuta v onkogynekologické prehabilitaci.

Objective: Overview of the possibilities of using non-medical occupational therapy in oncogynecology, description of the role of an occupational therapist in prehabilitation, and evaluation of data from a pilot study. Methods: The study cohort consisted of 18 patients enrolled between November 2023 and October 2024. The prospective study was conducted over a period of nine months. Patients were admitted for a 3-week intensive multimodal prehabilitation program scheduled on a 4/7 basis prior to elective surgery for primary or recurrent malignant ovarian, endometrial, or cervical cancer. In addition to the physicians, patients received prehabilitation by a physiotherapist, psychologist, nutritionist, and occupational therapist. Clinical work of the occupational therapist was measured upon examination and subsequent therapy in the areas of cognitive function, fine motor skills of the upper limbs, self-sufficiency, and quality of life. The occupational therapist applied selected functional tests and questionnaires (MKF classification, Hand grip test, MoCA test, 5× Sit-to-Stand test, WHODAS 2.0) to determine the effect of the rehabilitation intervention. Results and conclusions: Important indicators were selected functional abilities that have a significant impact on the quality of life of patients. The results of functional tests showed a significant improvement of key parameters due to intensive prehabilitation, confirming the essential role of occupational therapist intervention in oncogynecological prehabilitation.

• MeSH
• Occupational Therapy * methods   statistics & numerical data   MeSH
• Preoperative Exercise MeSH
• Patient Reported Outcome Measures MeSH
• Quality of Life MeSH
• Humans MeSH
• Genital Neoplasms, Female * rehabilitation   MeSH
• Pilot Projects MeSH
• Prospective Studies MeSH
• Surveys and Questionnaires MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVE: Pelvic exenteration is a radical surgery for advanced or recurrent pelvic tumors, requiring careful patient selection and a multi-disciplinary approach. Despite advancements, it remains high-risk, with limited data on outcomes. The present meta-analysis evaluates survival, mortality, and trends to clarify its role in gynecologic oncology. METHODS: A systematic search was conducted in January 2025 to identify studies on pelvic exenteration outcomes for gynecologic malignancies. Studies with at least 10 patients reporting 5-year overall survival or 30-day mortality were included. Data extracted included patient and surgical characteristics, and a scoring system based on study design, sample size, and center volume was used to include high-quality studies (score ≥3). Poisson regression models were used to analyze the associations between predictors and outcomes, with results expressed as incidence rate ratios and a 95% CI. RESULTS: A total of 46 studies involving 4417 patients met the inclusion criteria. Most patients underwent pelvic exenteration for cervical cancer (N = 3183). Positive pelvic and aortic nodal involvement were key predictors of reduced 5-year overall survival, decreasing by 3.9% and 5.9% per 1% increase in nodal positivity, respectively. Pelvic wall involvement also significantly reduced survival by 15.9%. The 30-day mortality rate was 5.1%, with sepsis (27.2%) being the leading cause of death. Peri-operative mortality decreased significantly over time, with each year of publication associated with a 2.6% decrease in incidence rate. However, pelvic sidewall involvement and total exenteration increased 30-day mortality by 11.5% and 0.7%, respectively. CONCLUSIONS: Pelvic exenteration remains a viable but high-risk option for select patients with advanced gynecologic malignancies. Pre-operative assessment and multi-disciplinary planning are essential for optimizing outcomes.

• MeSH
• Pelvic Exenteration * mortality   methods   MeSH
• Humans MeSH
• Genital Neoplasms, Female * surgery   mortality   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Systematic Review MeSH

Imunoterapie představuje novou naději pro pacientky s pokročilými gynekologickými malignitami, kde tradiční léčba selhává. Kombinace imunoterapie s chemoterapií a dalšími modalitami již vykazuje pozitivní výsledky u karcinomu děložního hrdla a endometria. Výsledky klinických studií demonstrují prodloužení celkového přežití i přežití bez progrese. Další slibné možnosti nabízejí konjugované protilátky a nové imunoterapeutické přípravky, které se ukazují jako účinné u pacientek s refrakterními či rekurentními nádory. Imunoterapie tak rozšiřuje možnosti léčby gynekologických nádorů.

Immunotherapy represents a new hope for patients with advanced gynecological malignancies, where traditional treatments fail. The combination of immunotherapy with chemotherapy and other modalities has already shown promising results in cervical and endometrial cancer. Clinical trials demonstrate prolonged overall survival and progression free survival. Other promising options include conjugated antibodies and novel immunotherapeutic agents, which are proving effective in patients with refractory or recurrent tumors. Immunotherapy thus broadens treatment possibilities for tumors where other therapies have failed.

• MeSH
• Immunotherapy methods   MeSH
• Humans MeSH
• Genital Neoplasms, Female * drug therapy   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Review MeSH

Karcinóm endometria predstavuje významnú gynekologickú malignitu s celosvetovo stúpajúcou sa incidenciou. Pomocou sekvenovania RNA v tejto pilotnej štúdii sme v nádorových tkanivách v porovnaní so zdravým tkanivom identifikovali 2 483 rozdielne exprimovaných génov, zahrňujúcich proteín kódujúce gény, gény pre nekódujúce RNA a pseudogény. V našej štúdii sme sa zamerali na porovnanie proteín kódujúce gény. Analýza hlavných zložiek odhalila zhlukovanie na základe histologického stupňa. Analýza molekulárnej dráhy zdôraznila downreguláciu signalizácie Wnt a AGE-RAGE spolu so zvýšenou reguláciou dráh regulácie bunkového cyklu. Tieto zistenia poskytujú molekulárny náhľad na endometriálny karcinóm a identifikujú potenciálne biomarkery a terapeutické ciele pre zlepšenie stratégie klinického manažmentu.

Uterine endometrioid cancer represents a significant gynecological malignancy with a rising global incidence. Using RNA sequencing,in our pilot study we identified 2,483 differentially expressed genes, comprising protein-coding genes, genes for non-coding RNAs, and pseudogenes, in tumor tissues compared to healthy counterparts. In our study we focused on comparism of proteing-coding genes. Principal Component Analysis revealed clustering based on histological grade. Pathway analysis highlighted the downregulation of Wnt and AGE-RAGE signaling, alongside the upregulation of cell cycle regulation pathways. These findings provide molecular insights into endometrioid cancer and suggest potential biomarkers and therapeutic targets for improved management strategies.

Národní program screeningu kolorektálního karcinomu (KRK) probíhá v České republice od roku 2000 a je příkladem mezioborové spolupráce. Podílí se na něm specialisté z oboru gastroenterologie, praktického lékařství, gynekologie a klinické biochemie. Program je založen na dvou základních metodách – screeningovém imunochemickém testu na okultní krvácení do stolice (iTOKS, FIT) a preventivní koloskopii (TOKS-pozitivní a screeningová koloskopie). O jeho efektivitě vypovídají vysoké počty zachycených kolorektálních prekancerózních a maligních lézí. V letech 2006–2023 bylo v rámci programu provedeno 531 362 preventivních koloskopií, diagnostikováno 202 575 pacientů s adenomy (38,1 %) a 14 473 s karcinomy (2,7 %). Kvalita programu je monitorována na základě indikátorů kvality, které jsou zaměřeny na organizaci (pokrytí cílové populace) i jednotlivé metody. Pokrytí screeningovými testy ve standardním dvouletém sledování se dlouhodobě pohybuje okolo 30 %, v roce 2023 činilo 30,0 % (s výjimkou let 2020 a 2021, kdy došlo k přechodnému poklesu pokrytí na 27 % z důvodu pandemie onemocnění covidem-19). Epidemiologické ukazatele ovlivňují i nescreeningové testy, pokrytí všemi relevantními metodami ve dvouletém intervalu činilo 37,5 % v roce 2023. Koloskopie je hodnocena šesti parametry (počet vyšetření, střevní očista, totální koloskopie, záchyt adenomů celkově, u žen a u mužů). Všechny tyto indikátory splňovalo v roce 2023 celkem 72 % center pro screeningovou koloskopii. Přístroje analyzující TOKS musejí nově procházet pravidelným externím hodnocením kvality (EHK). To by mělo vést také k optimalizaci pozitivity testů, která v roce 2023 dosahovala hodnoty 9,1 %. I díky programu screeningu KRK lze pozorovat příznivé epidemiologické trendy KRK, kdy v letech 2000–2022 došlo k poklesu incidence o 32,3 % a mortality o 47,8 %. Budoucnost programu spočívá v jeho dalším zefektivňování. Cílem je navýšení pokrytí cílové populace při udržení a dalším zvyšování kvality tak, aby byl program realizovatelný a průchodný.

The National Colorectal Cancer Screening Program has been conducted in the Czech Republic since 2000 and serves as an example of interdisciplinary collaboration. Specialists from gastroenterology, general practice, gynecology, and clinical biochemistry are involved in the program. It is based on two primary methods: the screening fecal immunochemical test for occult bleeding (iFOBT, FIT) and preventive colonoscopy (FOBT-positive colonoscopy and screening colonoscopy). The program‘s effectiveness is evidenced by the high number of detected colorectal precancerous and malignant lesions. Between 2006 and 2023, a total of 531,362 preventive colonoscopies were performed, diagnosing 202,575 patients with adenomas (38.1%) and 14,473 patients with cancers (2.7%). Program quality is monitored by indicators focused on both organization (target population coverage) and screening methods. Coverage with screening tests in a 2-year interval has consistently ranged around 30%, except between 2020 and 2021 during the COVID-19 pandemic (27%), reaching 30.0% in 2023. Non-screening tests also affect epidemiological indicators, with total coverage by all relevant methods in a 2-year interval in 2023 amounting to 37.5%. Colonoscopies are evaluated using six parameters (number of examinations, bowel preparation quality, total colonoscopies, and adenoma detection rate in total, in both women and men). In 2023, 72% of screening colonoscopy centers met all of these indicators. FOBT analyzers now must have the regular external quality assessment (EQA), which should help stabilize test positivity, standing at 9.1% in 2023. Thanks to the National Colorectal Cancer Screening Program, favorable epidemiological trends have been observed, with a 32.3% decrease in incidence and a 47.8% decrease in mortality between 2000 and 2022. The future of the program lies in its further optimization, with a goal of both increasing coverage of the target population by examination and quality improvement, ensuring the program’s feasibility and efficiency.

• MeSH
• Incidence MeSH
• Colonoscopy MeSH
• Colorectal Neoplasms * diagnosis   mortality   prevention & control   MeSH
• Humans MeSH
• Occult Blood MeSH
• Mass Screening methods   MeSH
• Primary Prevention MeSH
• Quality Control MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH
• Geographicals
• Czech Republic MeSH

Karcinom děložního čípku je jednou z nejčastějších malignit zjištěných v průběhu těhotenství. Většina případů je zjištěna v časném stadiu onemocnění. Časná diagnostika se opírá o screeningové vyšetření v I. trimestru těhotenství. Vzhledem k těhotenským změnám na děložním hrdle jsou nálezy obtížně hodnotitelné, s tendencí k falešné pozitivitě. Péče o pacientku a plod by měla být v rukách multidisciplinárního týmu s individualizovanou léčbou a s respektováním přání pacientky. Placenta accreta je nejčastějším typem abnormálně invazivní placenty (AIP). Ultrazvukové vyšetření má své nezastupitelné místo zejména v časné diagnostice abnormální invaze trofoblastu. Mezi hlavní rizikové faktory abnormální nidace patří císařský řez v anamnéze (nebo jiné předchozí operace na děloze, kyretáž) a vyšší věk matky.

Carcinoma of the uterine cervix is the most frequent malignant disease diagnosed in pregnant women. Most cases are early carcinomas due to cervical screening methods (PAPP smear, HPV DNA testation and colposcopy). However sometimes the results of the examination are unclear due to the physiological pregnancy associated changes of the cervical epithelium (squamous of the vaginal portion and columnar of the cervical canal). Cervical cancer complicating pregnancy is a specific clinical situation, that requires individual approach, multidisciplinary experienced team of specialists in gynaecological oncology and in obstetrics, respecting the opinion of the pregnant woman. Placenta accreta represents the most frequent type of abnormally adherent placenta, where placental villi are attached to the myometrium. Placenta accreta may be ultrasonically diagnosed antepartum. The main etiological factors are previous caesarean section scar (or other previous uterine incisions, uterine curettage) and older age of pregnant women.

• MeSH
• Adenocarcinoma diagnosis   pathology   therapy   MeSH
• Early Detection of Cancer MeSH
• Cesarean Section adverse effects   MeSH
• Adult MeSH
• Gynecologic Surgical Procedures MeSH
• Obstetric Labor Complications etiology   MeSH
• Humans MeSH
• Human Papillomavirus Viruses MeSH
• Pregnancy Complications, Neoplastic diagnosis   therapy   MeSH
• Uterine Cervical Neoplasms * diagnosis   pathology   prevention & control   therapy   MeSH
• Placenta Accreta surgery   MeSH
• Postpartum Hemorrhage surgery   diagnosis   MeSH
• Antineoplastic Protocols MeSH
• Neoplasm Staging MeSH
• Pregnancy MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Case Reports MeSH