Background: ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) has brought about the publication of the FIGO 2023 staging system with a significant impact in practice for endometrial cancer (EC). Methods: In this comparative study, we investigated the need for adjuvant treatment according to FIGO 2023, for each FIGO 2009 stage. We prospectively enrolled EC patients from June 2021 to June 2024, collected classical risk factors and classified according to FIGO 2009. Afterwards, we reclassified the same women according to FIGO 2023 and grouped them according to ESMO/ESTRO/ESGO risk factors. Results: We collected 211 eligible patients. We found 176 patients with FIGO 2009 I–II and 35 women with FIGO 2009 III–IV. Based on classic anatomopathological risk factors and FIGO 2009, adjuvant treatment was indicated in 124 (70.5%) patients with FIGO 2009 I–II (vaginal brachytherapy = 48; external beam radiotherapy with or without vaginal brachytherapy = 63; chemotherapy with external beam radiotherapy with or without vaginal brachytherapy = 13) and in 35 (100%) women with FIGO 2009 III–IV (all underwent chemotherapy). After FIGO 2023 re-staging, the women with early-stage EC, were more frequently candidates for no treatment, with a decreased relative risk (RR) for adjuvant treatment (RR 0.84; CI95% 0.74–0.95; p < 0.01) when compared to the previous FIGO classification. No significant risk (RR 1.01; CI95% 0.76–1.3; p = 0.08) for a more aggressive adjuvant treatment was noted after FIGO 2023 re-staging. In FIGO stage III–IV, no changes in the treatment modalities were observed. Conclusions: The re-staging according to FIGO 2023 of women previously staged to FIGO 2009 I–II, yields an RR of 0.84 to spare any type of adjuvant treatment.

Background: Endometrial cancer (EC) is the most common tumour of the female reproductive system, and low-grade EC is the histological type with the best prognosis for its less aggressiveness. Abnormal uterine bleeding is one of the first symptoms that appears and that allows an early diagnosis, while the disease is still confined into the uterus. The objective of this study was to identify risk factors associated with recurrence in low-grade EC across International Federation of Gynaecology and Obstetrics (FIGO) 2009 stages I to IV. Methods: This is a retrospective study that collected patients surgically treated at the Thames Valley Cancer Centre from March 2010 to January 2020 for low-grade EC. All cases were debated at the multidisciplinary team discussion, both prior to and following surgery, to decide the surgical approach and the need for adjuvant treatments. Clinical, surgical and histopathological data were gathered from electronic patient record and used for the statistical analysis. Results: A total of 238 patients were included. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were favourable, with follow-up nearing 10 years. However, 14 patients (5.88%) experienced recurrence, 11 of whom (78.5%) were initially diagnosed at stage I. The median time from surgery to relapse was 30 months. The vaginal vault was the most common site of recurrence (42%), followed by pelvic lymph nodes and distant metastases. Only myometrial invasion (P=0.049) and serosal involvement (P=0.01) were statistically significant predictors of recurrence in both univariate and multivariate analyses. Conclusions: This study confirms that deep myometrial invasion and serosal involvement are significant predictors of recurrence and poor outcomes in grade 1 EC. Other factors, such as lymphovascular space invasion and lymph node positivity, were not confirmed as significant. Before recommending adjuvant treatment for low-grade EC patients exhibiting these risk factors, further prospective trials are necessary.

Background and Objective: The field of Gynaecological Oncology (GO) has undergone a paradigm shift over recent decades, shaped by advancements in prevention, molecular therapeutics, and surgical innovation. We explore how the management of gynaecological malignancies has transformed in the past 25 years. Methods: A structured narrative review of landmark publications and guideline updates published between 2000 and 2025 was undertaken. Key developments in the management of cervical, ovarian, endometrial, vulvar, and vaginal cancers were critically analysed, with particular focus on prevention strategies, surgical evolution, and integration of targeted and immune therapies. Key Content and Findings: In cervical cancer, population-level human papillomavirus (HPV) vaccination has dramatically reduced incidence, while the LACC and SHAPE trials prompted a return to open and less radical surgery, respectively. Sentinel node biopsy is supplanting systematic lymphadenectomy, and combined chemoradiotherapy (CRT) with immunotherapy is improving survival in locally advanced disease. For ovarian cancer, optimal cytoreduction remains key, with TRUST highlighting surgical quality, while heated intraperitoneal chemotherapy (HIPEC) and poly-ADP ribose polymerase (PARP) inhibitors—alone or combined with immunotherapy—extend progression-free survival (PFS). Endometrial cancer management is now driven by molecular classification [The Cancer Genome Atlas (TCGA)/Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE)], with immunotherapy and targeted therapy transforming outcomes. In vulvar and vaginal cancers, GROINSS-V (Groin Sentinel Node Trial in Vulvar Cancer) and related studies underpin de-escalated and minimally invasive nodal surgery, while immunotherapy emerges for advanced disease. Conclusions: Modern GO is defined by prevention, precision, and personalisation. The contemporary Gynaecological Oncologist now integrates molecular insight, function-preserving surgery, and multidisciplinary collaboration to deliver optimised, patient-centred care.

Primary presacral clear cell carcinoma (CCC) of Müllerian origin is extremely rare. Malignant transformation of endometriosis is a known phenomenon, though typically involving the ovaries or pelvic peritoneum. Retroperitoneal presentation, especially decades after definitive surgery, is exceedingly uncommon. A 60‐year‐old woman presented with a large retroperitoneal/presacral pelvic mass leading to hydronephrosis, 20 years after total abdominal hysterectomy and bilateral salpingo‐oophorectomy for endometriosis. MRI showed a cystic‐solid mass with mural nodularity. Surgical exploration revealed dense retroperitoneal adhesions with involvement of the rectosigmoid and the appendix. En bloc resection was performed in posterior exenterative fashion. Histopathology confirmed clear cell carcinoma arising from endometriotic foci, fulfilling Sampson's criteria. Postoperative management included adjuvant paclitaxel‐carboplatin chemotherapy. The patient recovered uneventfully and was scheduled for ileostomy reversal. This case illustrates the potential late malignant transformation of endometriosis into Müllerian CCC even decades after hysterectomy and oophorectomy. Endometriosis‐associated carcinoma should be considered in the differential diagnosis of retroperitoneal pelvic masses, particularly in women with prior endometriosis.

Background/Objectives: Pelvic exenteration is a complex surgery considered for locally advanced or recurrent pelvic malignancies, entailing a radical en-block resection of multiple adjacent pelvic organs, followed by reconstructive surgery. Achieving R0 resection (complete removal of macroscopic and microscopic disease) is critical for improving survival outcomes. This study aimed to define patient, tumour, and surgical predictors of R0 resection in an irradiated field, thereby optimising patient selection and establishing a surgical roadmap for pelvic exenterations. Methods: Our retrospective observational cohort study includes consecutive patients undergoing exenteration post-radiotherapy for non-ovarian gynaecological malignancies at Oxford University Hospitals between 1 January 2011 and 31 December 2024. The primary outcome was margin status. Secondary outcomes were intraoperative and postoperative complications. Results: Twenty-seven patients were identified, with a median age of 63 years (range 41–81) and median BMI of 27 (range 17–45). Primary tumour sites included the vulva (11.1%), vagina (14.8%), cervix (40.7%), and uterus (33.3%). R0 was achieved in 77.8% (n = 21) of cases. Intraoperative complications occurred in 29.6%, and significant postoperative complications (Clavien-Dindo IIIA/IIIB) in 22.2% of patients. R0 resection was significantly associated with younger age (median 61 vs. 70 years, p = 0.035) and primary cervical tumours (p = 0.036). On univariable logistic regression, tumour size on imaging (p = 0.038, OR 2.9) and on histology (p = 0.020, OR 2.01), and estimated blood loss (p = 0.048, OR 1.002) were significant predictors of R0 resection. None of these variables retained significance in multivariable logistic regression. Conclusions: Tumour size, primary tumour site, and patient age should be considered when selecting patients for pelvic exenteration following radiotherapy, and blood loss should be kept minimal in order to maximise the chances of achieving R0 resection.

Background/Objectives: Although the binarism between type I and II endometrial cancer was dismissed and substituted with molecular classification, histopathological features remain of paramount importance. Hence, analysing survival outcomes according to histological type, our aim is to clarify whether the morphological features of the tumour retain prognostic relevance in the context of advanced disease. Methods: This is a retrospective analysis led within the Thames Valley Cancer Alliance Network. Results: We include 148 FIGO 2009 stage III–IV patients affected by endometrioid endometrial cancer (EEC) G1, G2, and G3, carcinosarcoma (CS), serous carcinoma (SC), and clear cell carcinoma (CCC) of the uterus. Five year overall survival (OS) is distinct among the histological groups (p-value < 0.001), being 73.3% for G2 endometrioid, 49.2% for G3 endometrioid, 8.3% for CS, and 28.4% for SC. The divergence was marked also for 5 year progression-free survival (PFS) (p-value < 0.001) as follows: for G2 endometrioid, was 76.4%; for G3 endometrioid, 52.7%; and for carcinosarcoma, 5.9%. PFS after 18 months for serous carcinoma was 5.7%. The multivariate analysis found G3 endometrioid (HR 2.91, 95% CI 1.20–7.11, p-value 0.018), carcinosarcoma (HR 12.15, 95% CI 5.07–29.11, p-value < 0.001), and serous carcinoma (HR 4.84, 95% CI 2.16–10.83, p-value < 0.001) as independent predictors of poor survival, as well as cervical invasion (HR 1.83, 95% CI 1.10–3.05, p-value 0.020) as the only histopathological feature confirmed. Regarding progression-free only carcinosarcoma (HR 14.91, 95% CI 5.28–41.11) and serous carcinoma (HR 17.68, 95% CI 6.41–48.75) were associated with an increased risk of recurrence. Conclusions: Our findings testify that, beyond the disease stage, histological subtype remains a major determinant of survival outcome. Cervical involvement is associated with a more aggressive disease, possibly correlated to death beyond relapse. Prospective trials involving advanced stage endometrial cancer, stratified by histological subtype and integrated with the molecular classification, are required.