Telomere-driven dysfunctional changes in gynecological cancers: mechanistic insights, biomarker potential, and therapeutic targeting

Telomeres are major determinants of chromosome integrity, and when poorly regulated, they have been shown to contribute critically to malignant transformation. However, in gynaecological malignancies, telomeres are interpreted inconsistently and have yet to be smoothly incorporated into diverse disease types. The review incorporates the existing evidence of the relationship between telomere dysfunction and the evolution of cervical, ovarian, endometrial, vulvar, and vaginal cancer. The review discusses the joint causes of telomere erosion, defective capping, defective integrity, and dysregulated telomerase activity in gynaecological cancer development, and the ensuing genomic instability, disruption in tissue homeostasis, inflammation, immune evasion, clonal evolution, and changes in individual organ physiology. According to this integrative framework, there are common and cancer-specific processes, new biomarkers for telomere maintenance, and therapeutic prospects focused on telomere maintenance pathways. The development of standardized, longitudinal methodologies will be key to translating telomere biology into clinically actionable approaches in gynaecological oncology.