Gynecologic and Other Solid Tumors
Core concepts
Ovarian cancer: epithelial histology, germline BRCA/HRD testing for PARP inhibitor maintenance, debulking surgery plus platinum-taxane chemotherapy, and CA-125 for monitoring (not screening). Endometrial cancer: type I versus type II, molecular classification (POLE, MSI, p53), and immunotherapy for MSI-high or advanced disease. Cervical cancer: HPV-driven, staged clinically, treated with chemoradiation or radical surgery; immunotherapy for advanced disease. Gestational trophoblastic disease responds well to methotrexate or actinomycin D. Melanoma and sarcoma belong here too: BRAF testing in melanoma with targeted therapy or immunotherapy; sarcoma histology-specific regimens. Know tumor lysis syndrome, fertility preservation, and the distinction between neoadjuvant and adjuvant intent.
Traps
Questions test whether CA-125 is a screening test (it is not), BRCA testing indications in ovarian cancer (all epithelial cases), and molecular classification of endometrial cancer. Watch for confusion between cervical cancer staging (clinical) and surgical staging.
Rule of thumb
In epithelial ovarian cancer, offer germline and somatic BRCA/HRD testing to every patient because it determines PARP inhibitor maintenance.
Worked example
A patient with newly diagnosed advanced high-grade serous ovarian cancer and a BRCA1 mutation achieving response to platinum: olaparib maintenance prolongs progression-free survival.