Precision, prevention and progress: charting two decades of change in gynaecological oncology-a narrative review.
Nistor SI., Shao R., Conforti J., Gardner F., Ferrari F., Ismail L., Niu X., Yao D., Soleymani Majd H.
Background and objectiveThe 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.MethodsA 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 findingsIn 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.ConclusionsModern 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.