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Gynecological cancers, such as endometrial cancer, ovarian cancer, and cervical cancers affect women’s health worldwide. Metastatic and recurrent cancers are associated with poor survival, and effective treatment is lacking. A deeper understanding of the molecular mechanisms at the genomic level may help decipher the metastatic process, identify new targets, and develop personalized treatment strategies. Recent tumor evolutionary studies have provided phylogenetic interpretation of gynecological cancer metastasis. This has provided new models of metastatic development and pointed to potential targets for treatment. Moreover, cancer genome analysis of simultaneously detected tumor lesions, initially diagnosed as independent synchronous primary cancers of the endometrium and ovary, suggest that they rather represent a primary tumor-metastasis-pair relationship. This chapter provides an overview of the characterization of cancer genomes, from primary tumors to metastatic lesions of the major gynecological cancers, and how such data are interpreted in an evolutionary context.
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