Gynaecologic oncology: precision, hope, and the future

In gynaecologic oncology, minimally invasive and personalised techniques are transforming the landscape of care, offering patients new possibilities for hope and well-being.

Femininity, fertility, and quality of life are among the most delicate challenges when addressing gynaecologic cancers.

In recent years, however, oncologic surgery has made remarkable progress. From laparoscopy to sentinel lymph node mapping, and innovative strategies for fertility preservation, today every surgical choice can be tailored like a true personalised project.

«We have moved from a one-size-fits-all surgery to an increasingly personalised approach, tailored to each tumour and each patient. This ensures maximum surgical oncologic radicality and, consequently, better outcomes and greater effectiveness, while minimising side effects», explains Dr. Fabio Martinelli, head of surgical gynaecologic oncology at Humanitas Pio X.

Mini-incisions, maximum precision

«In oncology, treatment is multidisciplinary. Surgery alone, like medical therapy alone, is not sufficient; both must always be integrated into a care plan that is defined at the time of diagnosis for each patient».

Laparoscopy, hysteroscopy, and robotic surgery make it possible to perform gynaecologic procedures while significantly reducing abdominal incisions and cosmetic defects.

«Minimally invasive surgery allows us, with miniaturised instruments, to perform procedures while minimising cosmetic damage to the woman’s abdomen, thus avoiding particularly disfiguring incisions – Martinelli emphasises – Unfortunately, it’s not always possible, but in selected cases, such as endometrial tumours or adnexal masses, we can use this approach, guaranteeing the same radicality and surgical quality as traditional open surgery, without compromising safety or quality for the patient».

Gynaecologic oncology and fertility: protecting the reproductive future

Fertility preservation has become a major focus in gynaecologic oncology. Many women postpone pregnancy for social or personal reasons, and some face cancer diagnoses before starting their reproductive journey. «This makes it necessary to find ways to preserve reproductive organs, allowing women the chance to pursue pregnancy and fulfill their reproductive desire», says Martinelli.

The issue is particularly delicate because gynaecologic cancers affect reproductive organs directly: the uterus and ovaries. Women diagnosed early with endometrial cancer with favorable features, as well as those with cervical cancer, may benefit from fertility-preserving strategies. Martinelli also reminds us: «Cervical cancer is preventable through vaccination and screening such as the Pap test and HPV test».

Not all women, however, are candidates for conservative treatments. «If it becomes necessary to remove the ovaries or adnexa, we can resort to assisted reproduction techniques – the doctor explains – We discuss this path with all young patients with an oncologic diagnosis to explore personalized care within a multidisciplinary team that addresses surgery, medical treatment, fertility preservation, and offers them a reproductive chance for the future».

The potential of the sentinel lymph node

The sentinel lymph node represents one of the breakthroughs that has deeply changed oncologic surgery, with clear benefits in gynaecology.

«We have moved from removing all pelvic, para-aortic, or inguinal lymph nodes for staging to removing only a few nodes. This reduces surgical invasiveness, lowers side effects, yet provides essential information to guide subsequent treatments», Martinelli explains.

Its use is widespread: «In endometrial cancer, early-stage cervical cancer when surgery is feasible, in fertility-preserving approaches, and in vulvar cancer. Although the latter typically affects older women, this method allows us to avoid complete inguinal lymphadenectomy, which can cause sequelae such as lymphedema, leading to mobility difficulties due to leg swelling – Martinelli continues – With this method, we remove only two or three target nodes, the most likely to harbour micrometastases from the primary tumour».

Training and European recognition

In Italy, unlike other European countries, there is no official fellowship or subspecialty dedicated to gynecologic oncology. For this reason, the ESGO (European Society of Gynaecological Oncology) certification is an important recognition for professionals in the field, awarded after a structured training path defined by the society. This certification is one of the few tools available to identify qualified specialists capable of managing patients comprehensively.

«This requires working in a multidisciplinary environment, closely collaborating with oncologists, radiologists, radiotherapists, pathologists, and fertility specialists to build a complete picture of patient care. It also enables participation in clinical trials and, crucially, allows us to personalize therapies for each patient. We can, in a sense, act like tailors, designing treatments specifically for each patient through multidisciplinary discussions in European reference centres».

Knowledge as protection

Gynaecologic cancers differ significantly in prevention and early detection. For example, the Pap test detects cervical cancer but not ovarian cancer.

«Cervical cancer is preventable with HPV vaccination, detectable early in precancerous stages through screening (Pap and HPV testing), and treatable or curable surgically in its early forms. By contrast, ovarian cancer is one of our ‘big killers’ – Martinelli stresses – There is currently no early diagnostic tool. The only patients we can monitor for early disease are those with BRCA mutations or family history. While BRCA is the most well-known gene, there are others as well, but BRCA remains the most publicised due to its association with well-known public figures».

Martinelli also emphasises the importance of specialised care: «Women with this mutation, as well as those with Lynch syndrome for endometrial cancer, must be treated in reference centres where they are informed that the only preventive strategy for cancers such as ovarian cancer is prophylactic surgery, removal of the ovaries and fallopian tubes once childbearing is complete».Similarly, in endometrial cancer: «Women with family history of colon cancer may have Lynch syndrome, which predisposes them to endometrial and ovarian cancers – Martinelli concludes – These women too may enter surveillance programs where gynaecologic oncologists advise on the appropriate timing for prophylactic removal of the uterus and ovaries to prevent gynaecologic cancer onset».