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Gynecological Cancers—the Changing Paradigm

Review Article
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Abstract

Outstanding research in the last few decades led to newer insights into the management of gynecological cancers. In the preventive arena, the efficacy and safety of HPV vaccination are well accepted and is now in addition to bi- and quadrivalent vaccines; there is a nonavalent vaccine against nine oncogenic HPV strains. Recent studies also looked into the dosaging schedules and age of vaccination against HPV to improve the vaccine efficacy and coverage. HPV testing is now approved as a primary screening test for cervical cancer in women aged more than 30 years with better sensitivity than the traditional cytology. Opportunistic salpingectomy for ovarian cancer prevention and neoadjuvant chemotherapy for advanced ovarian cancers are accepted practices. The role of personalized medicine in ovarian cancer and comprehensive genomic analysis of endometrial cancers are also covered in this review.

Keywords

Gynecological cancers HPV vaccination Personalized treatment Molecular characterization endometrial cancers 

Notes

Compliance with Ethical Standards

Ethical Statement

This is a review article and did not include the study of patients, medical records, or volunteers, so as per our institutional guidelines, this article did not require the approval of a hospital ethical committee. The research did not include human or animal participants.

Conflict of Interest

The author declares no conflict of interest.

References

  1. 1.
    Ferlay J, Soerjomataram I, Ervik M et al (2013) GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC Cancer Base No. 11. International Agency for Research on Cancer, LyonGoogle Scholar
  2. 2.
    National Cancer Registry Programme Three-year report of population-based cancer registries 2012-2014. http://www.ncrpindia.org/ALL_NCRP_REPORTS/PBCR_REPORT_2012_2014/ALL_CONTENT/Printed_Version
  3. 3.
    Crum CP, Abbott DW, Quade BJ (2003) Cervical cancer screening: from the Papanicolaou smear to the vaccine era. J Clin Oncol 21(10 Suppl):224s–230sCrossRefGoogle Scholar
  4. 4.
    Harper DM, Franco EL, Wheeler CM, Moscicki A-B, Romanowski B, Roteli-Martins CM, Jenkins D, Schuind A, Costa Clemens SA, Dubin G (2006) Sustained efficacy up to 4·5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomized control trial. Lancet 367:1247–1255CrossRefGoogle Scholar
  5. 5.
    Alberts CJ, van der Loeff MF, Hazeveld Y (2017) A longitudinal study on determinants of HPV vaccination uptake in parents/guardians from different ethnic backgrounds in Amsterdam, the Netherlands. BMC Public Health 17(1):220CrossRefGoogle Scholar
  6. 6.
    Cates JR, Shafer A, Carpentier FD (2010) How parents hear about human papillomavirus vaccine: implications for uptake. J Adolesc Health 47(3):305–308CrossRefGoogle Scholar
  7. 7.
    Dillner J, Kjaer SK, Wheeler CM, Sigurdsson K, Iversen O-E et al (2010) Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomized controlled trial. BMJ 341:c3493CrossRefGoogle Scholar
  8. 8.
    Schiller JT, Castellsague X, Garland SM (2012) A review of clinical trials of human papillomavirus prophylactic vaccines. Vaccine 30(suppl 5):F123–F138CrossRefGoogle Scholar
  9. 9.
    Erickson BK, Landers EE, Huh WK (2014) Update on vaccination clinical trials for HPV-related disease. Clin Ther 36:8–16CrossRefGoogle Scholar
  10. 10.
    Bosch FX, Broker TR, Forman D, Moscicki AB, Gillison ML, Doorbar J, Stern PL, Stanley M, Arbyn M, Poljak M, Cuzick J, Castle PE, Schiller JT, Markowitz LE, Fisher WA, Canfell K, Denny LA, Franco EL, Steben M, Kane MA, Schiffman M, Meijer CJLM, Sankaranarayanan R, Castellsagué X, Kim JJ, Brotons M, Alemany L, Albero G, Diaz M, Sanjosé S (2013) Comprehensive control of human papillomavirus infections and related diseases. Vaccine 31(suppl 5):F1–F31CrossRefGoogle Scholar
  11. 11.
    Sankaranarayanan R, Prabhu PR, Pawlita M, Gheit T, Bhatla N, Muwonge R, Nene BM, Esmy PO, Joshi S, Poli URR, Jivarajani P, Verma Y, Zomawia E, Siddiqi M, Shastri SS, Jayant K, Malvi SG, Lucas E, Michel A, Butt J, Vijayamma JMB, Sankaran S, Kannan TPRA, Varghese R, Divate U, Thomas S, Joshi G, Willhauck-Fleckenstein M, Waterboer T, Müller M, Sehr P, Hingmire S, Kriplani A, Mishra G, Pimple S, Jadhav R, Sauvaget C, Tommasino M, Pillai MR (2016) Immunogenicity and HPV infection after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicenter prospective cohort study. Lancet Oncol 17(1):67–77CrossRefGoogle Scholar
  12. 12.
    Sankaranarayanan R (2015) HPV vaccination: the most pragmatic cervical cancer primary prevention strategy. Int J Gynaecol Obstet 131(Suppl 1):S33–S35CrossRefGoogle Scholar
  13. 13.
    Vashishtha VM, Choudhury P, Kalra A et al (2014) Indian Academy of Pediatrics (IAP) recommended immunization schedule for children aged 0 through 18 years – India, 2014 and updates on immunization. Indian Pediatr 51:785–803CrossRefGoogle Scholar
  14. 14.
    Skinner SR, Szarewski A, Romanowski B, Garland SM, Lazcano-Ponce E, Salmerón J, del Rosario-Raymundo MR, Verheijen RHM, Quek SC, da Silva DP, Kitchener H, Fong KL, Bouchard C, Money DM, Ilancheran A, Cruickshank ME, Levin MJ, Chatterjee A, Stapleton JT, Martens M, Quint W, David MP, Meric D, Hardt K, Descamps D, Geeraerts B, Struyf F, Dubin G (2014) Efficacy, safety, and immunogenicity of the human papillomavirus 16/18 AS04-adjuvanted vaccine in women older than 25 years: 4-year interim follow-up of the phase 3, double-blind, randomised controlled VIVIANE study. Lancet 384:2213–2227CrossRefGoogle Scholar
  15. 15.
    Wheeler CM, Skinner SR, Del Rosario-Raymundo MR, Garland SM, Chatterjee A, Lazcano-Ponce E et al (2016) Efficacy, safety, and immunogenicity of the human papillomavirus 16/18 AS04-adjuvanted vaccine in women older than 25 years: 7-year follow-up of the phase 3, double-blind, randomised controlled VIVIANE study. Lancet Infect Dis 16:1154–1168CrossRefGoogle Scholar
  16. 16.
    Bosch FX, Robles C, Díaz M, Arbyn M, Baussano I, Clavel C, Ronco G, Dillner J, Lehtinen M, Petry KU, Poljak M, Kjaer SK, Meijer CJLM, Garland SM, Salmerón J, Castellsagué X, Bruni L, de Sanjosé S, Cuzick J (2016) HPV-FASTER: broadening the scope for prevention of HPV-related cancer. Nat Rev Clin Oncol 13:119–132CrossRefGoogle Scholar
  17. 17.
    Muñoz N, Manalastas R, Pitisuttithum P et al (2009) Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine in women aged 24–45 years: a randomised, double-blind trial. Lancet 373:1949–1957CrossRefGoogle Scholar
  18. 18.
    Joura EA, Giuliano AR, Iversen OE, Bouchard C, Mao C, Mehlsen J, Moreira ED, Ngan Y, Petersen LK, Lazcano-Ponce E et al (2015) A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med 372:711–723CrossRefGoogle Scholar
  19. 19.
    Van de Velde N, Boily MC, Drolet M et al (2012) Population-level impact of the bivalent, quadrivalent, and nonavalent human papillomavirus vaccines: a model-based analysis. J Natl Cancer Inst 104(22):1712–1723CrossRefGoogle Scholar
  20. 20.
    Durham DP, Ndeffo-Mbah ML, Skrip LA, Jones FK, Bauch CT, Galvani AP (2016) National and state level impact and cost-effectiveness of nonavalent HPV vaccination in the United States. Proc Natl Acad Sci U S A 113:5107–5112CrossRefGoogle Scholar
  21. 21.
    Bailey HH, Chuang LT, DuPont NC et al (2016) American Society of Clinical Oncology statement: human papillomavirus vaccination human papillomavirus vaccination for cancer prevention. J Clin Oncol 34:1803–1812CrossRefGoogle Scholar
  22. 22.
    Qiao YL, Sellors JW, Eder PS, Bao YP, Lim JM, Zhao FH, Weigl B, Zhang WH, Peck RB, Li L, Chen F, Pan QJ, Lorincz AT (2008) A new HPV-DNA test for cervical cancer screening in developing regions: a cross-sectional study of clinical accuracy in rural China. Lancet Oncol 9:929–936CrossRefGoogle Scholar
  23. 23.
    Castle PE, Stoler MH, Wright TC, Sharma A et al (2011) Performance of carcinogenic human papillomavirus (HPV) testing and HPV16 or HPV18 genotyping for cervical cancer screening of women aged 25 years and older: a sub analysis of the ATHENA study. Lancet Oncol 12:880–890CrossRefGoogle Scholar
  24. 24.
    Stoler MH, Wright TC Jr, Sharma A, Apple R, Gutekunst K, Wright TL (2011) High-risk human papillomavirus testing in women with ASC-US cytology: results from the ATHENA HPV study. Am J Clin Pathol 135:468–475CrossRefGoogle Scholar
  25. 25.
    Ronco G, Dillner J, Elfstrom KM, Tunesi S, Snijders PJ, Arbyn M et al (2014) Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomized controlled trials. Lancet 383:524–532CrossRefGoogle Scholar
  26. 26.
    Naucler P, Ryd W, Tornberg S et al (2007) Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med 357:1589–1597CrossRefGoogle Scholar
  27. 27.
    Szarewski A, Cadman L, Mesher D, Austin J, Ashdown-Barr L, Edwards R, Lyons D, Walker J, Christison J, Frater A, Waller J (2011) HPV self-sampling as an alternative strategy in non-attenders for cervical screening - a randomized controlled trial. Br J Cancer 104:915–920CrossRefGoogle Scholar
  28. 28.
    Lazcano-Ponce E, Lorincz AT, Cruz-Valdez A, Salmerón J, Uribe P, Velasco-Mondragón E, Nevarez PH, Acosta RD, Hernández-Avila M (2011) Self-collection of vaginal specimens for human papillomavirus testing in cervical cancer prevention (MARCH): a community-based randomised controlled trial. Lancet 378:1868–1873CrossRefGoogle Scholar
  29. 29.
    Wikstrom I, Lindell M, Sanner K, Wilander E (2011) Self-sampling and HPV testing or ordinary pap-smear in women not regularly attending screening: a randomized study. Br J Cancer 105:337–339CrossRefGoogle Scholar
  30. 30.
    Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C et al (2011) Effect of screening on ovarian cancer mortality: the prostate, lung, colorectal and ovarian (PLCO) cancer screening randomized controlled trial. JAMA 305:2295–2303CrossRefGoogle Scholar
  31. 31.
    Jacobs IJ, Menon U, Ryan A, Gentry-Maharaj A, Burnell M, Kalsi JK, Amso NN, Apostolidou S, Benjamin E, Cruickshank D, Crump DN, Davies SK, Dawnay A, Dobbs S, Fletcher G, Ford J, Godfrey K, Gunu R, Habib M, Hallett R, Herod J, Jenkins H, Karpinskyj C, Leeson S, Lewis SJ, Liston WR, Lopes A, Mould T, Murdoch J, Oram D, Rabideau DJ, Reynolds K, Scott I, Seif MW, Sharma A, Singh N, Taylor J, Warburton F, Widschwendter M, Williamson K, Woolas R, Fallowfield L, McGuire AJ, Campbell S, Parmar M, Skates SJ (2016) Ovarian cancer screening and mortality in the UK collaborative trial of ovarian cancer screening (UKCTOCS): a randomised controlled trial. Lancet 387:945–956CrossRefGoogle Scholar
  32. 32.
    Barrett J, Jenkins V, Farewell V, Menon U, Jacobs I, Kilkerr J, Ryan A, Langridge C, Fallowfield L, UKCTOCS trialists (2014) Psychological morbidity associated with ovarian cancer screening: results from more than 23,000 women in the randomised trial of ovarian cancer screening (UKCTOCS). BJOG 121:1071–1079CrossRefGoogle Scholar
  33. 33.
    Berek JS, Chalas E, Edelson M, Moore DH, Burke WM, Cliby WA, Berchuck A (2010) Prophylactic and risk-reducing bilateral salpingo-oophorectomy: recommendations based on risk of ovarian cancer. Obstet Gynecol 116:733–743CrossRefGoogle Scholar
  34. 34.
    Rebbeck TR, Lynch HT, Neuhausen SL, Narod SA, van’t Veer L, Garber JE, Evans G, Isaacs C, Daly MB, Matloff E, Olopade OI, Weber BL (2002) Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 346:1616–1622CrossRefGoogle Scholar
  35. 35.
    Kurman RJ, Shih IM (2011) Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer: shifting the paradigm. Hum Pathol 42:918–931CrossRefGoogle Scholar
  36. 36.
    Walker JL, Powell CB, Chen LM, Carter J, Bae Jump VL, Parker LP, Borowsky ME, Gibb RK (2015) Society of Gynecologic Oncology recommendations for the prevention of ovarian cancer. Cancer 121:2108–2120CrossRefGoogle Scholar
  37. 37.
    Madsen C, Baandrup L, Dehlendorff C, Kjaer SK (2015) Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors: a nationwide case–control study. Acta Obstet Gynecol Scand 94(1):86–94CrossRefGoogle Scholar
  38. 38.
    Falconer H, Yin L, Gronberg H, Altman D (2015) Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst 107:1–6CrossRefGoogle Scholar
  39. 39.
    Vergote I, Tropé CG, Amant F et al (2010) Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 363:943–953CrossRefGoogle Scholar
  40. 40.
    Onda T, Yoshikawa H, Shibata T et al (2014) Comparison of treatment invasiveness between upfront debulking surgery versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and peritoneal cancers in phase III randomized trial: JCOG0602. J Clin Oncol 32(suppl; abstr 5508):353sGoogle Scholar
  41. 41.
    Kehoe S, Hook J, Nankivell M, Jayson GC, Kitchener H, Lopes T, Luesley D, Perren T, Bannoo S, Mascarenhas M, Dobbs S, Essapen S, Twigg J, Herod J, McCluggage G, Parmar M, Swart AM (2015) Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet 386:249–257CrossRefGoogle Scholar
  42. 42.
    Shih KK, Chi DS (2010) Maximal cytoreductive effort in epithelial ovarian cancer surgery. J Gynecol Oncol 21:75–80CrossRefGoogle Scholar
  43. 43.
    Hacker NF, Berek JS, Lagasse LD et al (1983) Primary cytoreductive surgery for epithelial ovarian cancer. Obstet Gynecol 61:413–420PubMedGoogle Scholar
  44. 44.
    Bristow RE, Montz FJ, Lagasse LD, Leuchter RS, Karlan BY (1999) Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer. Gynecol Oncol 72:278–287CrossRefGoogle Scholar
  45. 45.
    Chang SJ, Bristow RE (2012) Evolution of surgical treatment paradigms for advanced-stage ovarian cancer: redefining ‘optimal’ residual disease. Gynecol Oncol 125:483–492CrossRefGoogle Scholar
  46. 46.
    Fagotti A, Ferrandina G, Fanfani F, Garganese G, Vizzielli G, Carone V et al (2008) Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma. Am J Obstet Gynecol 199:642.e1–642.e6CrossRefGoogle Scholar
  47. 47.
    Cancer Genome Atlas Research Network (2011) Integrated genomic analyses of ovarian carcinoma. Nature 474:609–615CrossRefGoogle Scholar
  48. 48.
    Alberts DS, Liu PY, Hannigan EV, O'Toole R, Williams SD, Young JA, Franklin EW, Clarke-Pearson DL, Malviya VK, DuBeshter B, Adelson MD, Hoskins WJ (1996) Intraperitoneal cisplatin plus intravenous cyclophosphamide versus intravenous cisplatin plus intravenous cyclophosphamide for stage III ovarian cancer. N Engl J Med 335:1950–1955CrossRefGoogle Scholar
  49. 49.
    Markman M, Bundy BN, Alberts DS et al (2001) Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative Oncology Group. J Clin Oncol 19:1001–1007CrossRefGoogle Scholar
  50. 50.
    Armstrong DK, Bundy B, Wenzel L et al (2006) Intraperitoneal cisplatin and paclitaxel in ovarian cancer. N Engl J Med 354:34CrossRefGoogle Scholar
  51. 51.
    Patch AM, Christie EL, Etemadmoghadam D, Garsed DW, George J, Fereday S et al (2015) Whole-genome characterization of chemoresistant ovarian cancer. Nature 521:489–494CrossRefGoogle Scholar
  52. 52.
    Van Driel WJ, Koole SN, Sikorska K, Schagen van Leeuwen JH, Schreuder HW, Hermans RH, De Hingh IH, Van Der Velden J, Arts HJ, Massuger LF, Aalbers AG (2018) Hyperthermic intraperitoneal chemotherapy in ovarian cancer. N Engl J Med 378(3):230–240CrossRefGoogle Scholar
  53. 53.
    Maheshwari A, Kumar N, Mahantshetty U (2016) Gynecological cancers: a summary of published Indian data. South Asian J Cancer 5:112–120CrossRefGoogle Scholar
  54. 54.
    Bokhman JV (1983) Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 15(1):10–17CrossRefGoogle Scholar
  55. 55.
    Kandoth C, Schultz N, Cherniack AD, Akbani R, Liu Y, Shen H et al (2013) Integrated genomic characterization of endometrial carcinoma. Nature 497:67–73CrossRefGoogle Scholar
  56. 56.
    Meng B, Hoang LN, McIntyre JB, Duggan MA, Nelson GS, Lee CH, Köbel M (2014) POLE exonuclease domain mutation predicts long progression-free survival in grade 3endometrioid carcinoma of the endometrium. Gynecol Oncol 134:15–19CrossRefGoogle Scholar
  57. 57.
    Mackay HJ, Gallinger S, Tsao MS, McLachlin CM et al (2010) Prognostic value of microsatellite instability (MSI) and PTEN expression in women with endometrial cancer: results from studies of the NCIC Clinical Trials Group (NCIC CTG). Eur J Cancer 46:1365–1373CrossRefGoogle Scholar
  58. 58.
    Brown JM, Neuper C, Clayton A et al (2008) Rationale for folate receptor alpha targeted therapy in “high risk” endometrial carcinomas. Int J Cancer 123(7):1699–1703CrossRefGoogle Scholar
  59. 59.
    Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, Spiegel G, Barakat R, Pearl ML, Sharma SK (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 27(32):5331–5336CrossRefGoogle Scholar
  60. 60.
    Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, Barakat R, Pearl ML, Sharma SK (2012 Mar 1) Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol 30(7):695–700CrossRefGoogle Scholar
  61. 61.
    Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira MA, Ribeiro R et al (2018) Phase III randomized trial of laparoscopic or robotic versus abdominal radical hysterectomy in patients with early-stage cervical cancer: LACC rial. Proceedings of the 49th Annual Meeting of the Society of Gynecologic Oncologists, Mar 24–27 2018. Society of Gynecologic Oncology, New OrleansCrossRefGoogle Scholar
  62. 62.
    Rauh-Hain JA (2018) Comparative effectiveness of minimally invasive staging surgery in women with early stage cervical cancer. Proc Soc Gynecol OncolGoogle Scholar
  63. 63.
    Burger RA, Brady MF, Bookman MA, Fleming GF, Monk BJ, Huang H, Mannel RS, Homesley HD, Fowler J, Greer BE, Boente M, Birrer MJ, Liang SX (2011) Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med 365(26):2473–2483CrossRefGoogle Scholar
  64. 64.
    Perren TJ, Swart AM, Pfisterer J, Ledermann JA, Pujade-Lauraine E, Kristensen G, Carey MS, Beale P, Cervantes A, Kurzeder C, Bois A, Sehouli J, Kimmig R, Stähle A, Collinson F, Essapen S, Gourley C, Lortholary A, Selle F, Mirza MR, Leminen A, Plante M, Stark D, Qian W, Parmar MKB, Oza AM (2011) A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med 365(26):2484–2496CrossRefGoogle Scholar
  65. 65.
    Ledermann J, Harter P, Gourley C, Friedlander M, Vergote I, Rustin G, Scott CL, Meier W, Shapira-Frommer R, Safra T, Matei D, Fielding A, Spencer S, Dougherty B, Orr M, Hodgson D, Barrett JC, Matulonis U (2014) Olaparib maintenance therapy in patients with platinum-sensitive relapsed serous ovarian cancer: a preplanned retrospective analysis of outcomes by BRCA status in a randomised phase 2 trial. Lancet Oncol 15(8):852–861CrossRefGoogle Scholar
  66. 66.
    Tewari KS, Sill MW, Long HJ 3rd, Penson RT, Huang H, Ramondetta LM et al (2014) Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med 370(8):734–743CrossRefGoogle Scholar
  67. 67.
    He L, Li J-D, Xiong Y, Huang X, Huang L, Lin JX, Zhou Y, Zheng M (2014) Clinicopathological and molecular markers associated with prognosis and treatment effectiveness of endometrial stromal sarcoma: a retrospective study in China. Arch Gynecol Obstet 289(2):383–391CrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Division of GynaeoncologyRegional Cancer CentreTrivandrumIndia

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