New Trends in the Detection of Gynecological Precancerous Lesions and Early-Stage Cancers

The prevention and early diagnostics of precancerous stages hold a crucial position   in contemporary oncology. 

The mutational topography of cancer is induced through a combination of environmental and endogenous stresses that leads to base substitutions, insertions, deletions, and chromosomal rearrangements. These alterations not only cause the disease but can also serve to detect cancer in its early stages. 

Liquid biopsy strategies are promising since they are minimally invasive and are primarily established on the characterization of circulating tumor DNA, circulating tumor cells, and circulating extracellular vesicles as sources of proteomic and genetic information reflecting alterations in transformed cells.

Prevention strategies involve vaccinations and well-organized screening programs, including cytology with an HPV testing triage that enables early diagnostics by expert colposcopies and biopsies, followed in most cases by early treatment in the precancerous stages of the disease. This combination has caused a dramatic decline in invasive cervical cancer (CC) incidence and mortality. Following all these conditions, cervical cancer could be made a preventable disease. However, endometrial and ovarian cancers are diagnosed only after the appearance of symptoms. In these tumors, diagnostics are restricted by the relatively poor accessibility of the uterus and ovaries for sampling. Like in endometrial cancer (EC), transvaginal ultrasound could not be concluded as a promising screening method. Thus the focus remains particularly on women at a higher risk, i.e., characterized by obesity, diabetes, hypertension, or Lynch syndrome. The disease is diagnosed on the onset of the first symptoms, usually bleeding. When curettage is performed instantly and the disease is established, operative treatments show good results. However, for Epithelial Ovarian Cancer (EOC), neither an effective screening method nor the ability to accurately define a high-risk group is established, indicating that > 75% of women are diagnosed with an advanced stage disease. 

Surgical improvements followed by systemic and biologic targeted therapies remains useful for existing patients, but the discovery and implementation of new diagnostic and/or prognostic biomarkers, especially those detectable in liquid biopsies, will aid in early detection and improved patient outcomes.

SOURCE- Cancers. Cancers. 2021; 13(24):6339.

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