Sentinel lymph node (SLN) biopsy is now the standard of care over inguinofemoral lymphadenectomy (IFL) in properly selected patients with early-stage squamous cell carcinoma (SCC) of the vulva. Patients with negative SLN do well without further intervention. However, a standardized treatment paradigm following the findings of a positive SLN remains lacking. Based on results from the GROINSS-V-II trial, patients with a micrometastasis of ≤2 mm receiving adjuvant inguinofemoral radiation therapy had a two-year ipsilateral isolated groin recurrence rate of 1.6%, and can avoid the morbidity of complete inguinofemoral lymphadenectomy (IFL). The approach for patients with SLN macrometastases (>2 mm) remains undefined – if such patients are treated without further IFL, careful attention to radiation treatment planning, dose, and the addition of concurrent cisplatin-based chemotherapy should be considered.

Neo-adjuvant chemotherapy (NACT) for cervical cancer reduces preoperatively the tumor size and metastatic spread. In addition, long-term adverse events of radiochemotherapy (CCRT), such as early menopause, dyspareunia, radio-enteritis and fistulas can be avoided.

Immune checkpoint inhibitors (ICIs) have attracted attention recently and have received fast-track approvals from the Food and Drug Administration (FDA) in multiple cancer types, including cervical cancer and endometrial cancer. Normally, the expression of immune checkpoint receptors such as programmed death 1 (PD-1) and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) on T cells provides negative feedback mechanisms to prevent autoimmunity. Multiple cancers, including epithelial ovarian cancer (EOC), exploit these mechanisms to inhibit T cell activation, allowing them to escape immune detection. ICIs block immune checkpoint receptors, allowing for unchecked activation of cancer-targeted T cells leading to tumor cell destruction. Despite the success in various other cancer types, there are no approved immune therapies for ovarian cancer, as response of EOC to ICIs thus far have been modest.

When considering the best overall management strategy of recurrent granulosa cell tumors (GCT), given the long survivals and multiple recurrences many patients will experience, chemotherapy is an important component of overall treatment. The recommended first-line chemotherapy regimen includes BEP (bleomycin, etoposide, and cisplatin) and more recently carboplatin and paclitaxel. While chemotherapy has not shown strong OS benefit, the extension of PFS is meaningful and can lead to longer intervals between surgery and perhaps an overall decrease in the total number of surgeries a patient has in their lifetime. There is ongoing research to better understand the various systemic treatment approaches for GCT, bevacizumab, hormonal therapies, and immunotherapy. Overall, a multimodal approach is essential for the effective treatment of recurrent GCT with systemic chemotherapy being an important part of the treatment paradigm for this tumor.

The decision to proceed with primary debulking surgery is complex and depends on multiple factors including patient (age, performance, and nutrition status), center (surgeon/team expertise, volume, ancillary services) and disease factors. Routine laparoscopy has been proposed to assess disease factors: specifically, extent of disease and complexity of surgery required for successful resection. However, laparoscopy requires additional OR time and equipment, lacks sensitivity, and does not accurately assess several of the most agreed upon barriers to successful cytoreduction. Standardized laparoscopic scoring systems have demonstrated high specificity to predict suboptimal debulking, but primarily in single institution studies. These systems are difficult to validate externally, likely due to differing non-disease-related factors. We favor a multi-modality approach beginning with careful patient and center selection and pre-operative imaging. Suitable candidates then undergo exploration via mini-laparotomy at the time of planned debulking surgery to minimize morbidity while maximizing oncologic outcomes.

High-risk stage I ovarian cancer includes clear cell and grade 3 tumours. ESMO–ESGO guidelines suggests carboplatin in monotherapy for six cycles or the combination of carboplatin and paclitaxel for a minimum of three cycles as available options for adjuvant treatment in this setting. Nevertheless, there is not a study that compare the two options. On the basis of data available, three cycles of carboplatin plus paclitaxel represents an effective strategy to reduce the probability of recurrence in high-risk early-stage ovarian cancer patients, especially in non-serous tumors. Three cycles compared with six cycles of carboplatin and paclitaxel do not significantly alter the recurrence rate in high-risk ovarian cancer, but six cycles are associated with more toxicity.

Adjuvant hysterectomy (AH) following concurrent chemoradiation (CCRT) for the management of locally advanced cervical cancer (LACC) is still subject for debate. While it is still not standard of care to perform adjuvant hysterectomy after CCRT due to limited data supporting this approach, as well as possible increased morbidity, there are practitioners who choose this approach in the hope of decreasing local recurrence, especially in the setting of chemo and radiation-resistant tumors after excluding metastatic disease. In this review we will focus on the available data that supports AH in the management of LACC.

Advanced malignant ovarian germ cell tumors (MOGCT), like their testicular counterparts, are exquisitely sensitive to platinum- and etoposide-based chemotherapy. More than 40 years ago Einhorn and colleagues discovered that bleomycin added to this combination was an effective treatment. The resulting five-day bleomycin etoposide and cisplatin (BEP) chemotherapy given three-weekly for three to four cycles depending on disease extent was internationally adopted. Subsequently, many other regimens have been developed attempting to reduce toxicity and/or improve efficacy. However, no randomized controlled trial data exists to demonstrate that any of these are superior to BEP chemotherapy. Moreover, as MOGCT differs from testicular disease in that relapses after primary chemotherapy have much lower survival rates, de-escalation of primary treatment is to be discouraged. Consequently, there is no debate as BEP remains the current standard of care for women presenting with advanced MOGCT.

Overall survival for FIGO stage III–IV epithelial ovarian cancer remains low, with only 10% of women remaining disease-free at 10 years of follow-up. Cytoreductive surgery for newly diagnosed advanced ovarian carcinoma, when performed by high-volume surgeons at high-volume centers, has the potential to place the vast majority of patients (approximately 85%) into sustained clinical remission following completion of adjuvant systemic platinum- and taxane-based chemotherapy. However, because most of these patients are ultimately destined to relapse, there has been great interest in identifying effective and tolerable maintenance therapies that can significantly prolong progression-free survival (PFS) and even possibly improve overall survival (OS) in select subpopulations. The molecular signatures exhibited among patients with germline and/or somatic BRCA mutations, as well as those with homologous recombination deficient BRCA-wild type tumors, characterize distinct patient cohorts that may derive benefit from maintenance therapy using the poly-ADP-ribose polymerase I inhibitor olaparib alone or when combined with the anti-angiogenesis agent bevacizumab, respectively. Patients whose tumors are homologous recombination-proficient should be offered maintenance therapy with bevacizumab which can significantly improve PFS by approximately six months and possibly impact OS among those with FIGO stage IV disease.

Molecular biology concerns the molecular basis of biological activity within a cell. It specifically includes the regulation of interactions between DNA, RNA and protein, as well as how these molecules are biosynthesised.

The inguinal ligament passes from the ASIS→pubic tubercle. Its edge is rolled to form a gutter, the lateral part of which gives partial origin to the internal oblique and transversus abdominis muscles.

Non-neoplastic disease of the female genital tract can be the underlying cause of morbidity. Common gynaecological symptoms include vaginal discharge, bleeding (irregular periods, heavy periods, post-coital bleeding and postmenopausal bleeding), pelvic pain and prolapse. The pathological conditions underlying some of these symptoms include infections, endometriosis, polyps and ovarian cysts.

Situated, retro-peritoneally, on the posterior abdominal wall – 12 cm long, 6 cm wide and 3 cm thick, weighing 100 g. Right kidney is lower than the left.

The anaesthesia of choice for surgical procedures in the puerperium (including Caesarean section, trial of instrumental delivery, complex perineal repairs and manual removal of placenta) is spinal anaesthetic.