ABOG Gynecologic Oncology cheat sheet

Average-risk cervical screening: cytology alone every 3 years at ages 21–29; at ages 30–65, cytology every 3 years, HPV testing every 5 years, or co-testing every 5 years.

Cervical screening may stop after age 65 only with adequate prior negative screening and no CIN2+ in the prior 25 years; otherwise continue screening.

Colposcopy is indicated for ASC-US with positive HPV, LSIL, ASC-H, HSIL, AGC, or HPV16/18 positivity; AGC also requires endocervical and endometrial sampling when indicated.

Postmenopausal bleeding requires endometrial biopsy; transvaginal ultrasound endometrial thickness of 4 mm or less has high negative predictive value but does not replace biopsy in recurrent bleeding.

No routine ovarian cancer screening is recommended in average-risk women; high-risk BRCA carriers consider risk-reducing salpingo-oophorectomy and surveillance with CA125 plus transvaginal ultrasound.

HPV vaccination prevents HPV16/18-associated cancers and is recommended in adolescence; catch-up vaccination is generally approved through age 26 and may be considered to age 45.

Universal Lynch syndrome screening for endometrial cancer uses mismatch repair immunohistochemistry or microsatellite instability testing, with germline testing for abnormal results.

Early ovarian cancer staging includes hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymphadenectomy, peritoneal biopsies, and peritoneal cytology.

Fertility-sparing surgery for ovarian cancer may be considered in young patients with early-stage, low-risk histology; unilateral salpingo-oophorectomy with comprehensive staging preserves the uterus and contralateral ovary.

Endometrial cancer surgical staging is minimally invasive hysterectomy and bilateral salpingo-oophorectomy; sentinel lymph node mapping can replace routine full lymphadenectomy in many early-stage cases.

Omentectomy is routine for endometrial serous or clear cell carcinoma but not for low-grade endometrioid cancer confined to the uterus.

Early cervical cancer treatment is radical hysterectomy with pelvic lymphadenectomy or definitive chemoradiation; sentinel lymph node biopsy is an alternative to full pelvic dissection in selected tumors.

Vulvar cancer with invasion greater than 1 mm requires inguinofemoral lymph node evaluation; sentinel node biopsy is acceptable for unifocal tumors up to 4 cm with clinically negative groins.

Primary cytoreductive surgery for advanced ovarian cancer aims for no visible residual disease; neoadjuvant chemotherapy followed by interval cytoreduction is used when primary debulking is not feasible.

First-line epithelial ovarian cancer chemotherapy is paclitaxel plus carboplatin; bevacizumab and PARP inhibitor maintenance are selected by stage, BRCA status, and homologous recombination deficiency.

Advanced or recurrent endometrial cancer: carboplatin plus paclitaxel; add pembrolizumab for mismatch repair deficient tumors or pembrolizumab plus lenvatinib for mismatch repair proficient tumors.

Recurrent or metastatic cervical cancer: cisplatin or carboplatin plus paclitaxel with bevacizumab; pembrolizumab is added for PD-L1-positive tumors.

Low-risk gestational trophoblastic neoplasia is treated with single-agent methotrexate or actinomycin D; high-risk disease uses multiagent EMA-CO.

Carboplatin dosing uses the Calvert formula with target AUC and measured glomerular filtration rate; paclitaxel requires premedication to prevent hypersensitivity reactions.

Cisplatin requires vigorous hydration and monitoring of renal function, magnesium, and electrolytes; doxorubicin has cumulative cardiotoxicity and bleomycin can cause pulmonary toxicity.

Granulocyte colony-stimulating factor is used for primary prophylaxis when febrile neutropenia risk is approximately 20% or higher, or with selected high-risk regimens.

Definitive cervical cancer chemoradiation combines external beam radiation, weekly cisplatin, and image-guided brachytherapy; treatment should be completed without prolongation.

Cervical brachytherapy delivers a high dose to the primary tumor while limiting bladder and rectal dose; dose-volume constraints are assessed in 3D or MRI-based planning.

Adjuvant pelvic radiation for endometrial cancer is selected by stage, grade, depth of invasion, lymphovascular space invasion, and nodal status; vaginal brachytherapy is used for vaginal cuff control.

Concurrent cisplatin with radiation is a standard radiosensitizing approach for locally advanced cervical and vulvar cancers.

For vulvar cancer, radiation with concurrent cisplatin may be used for locally advanced disease or when nodal resection is inadequate; groin radiation can be used for unresectable nodes.

Whole-abdominal radiotherapy is not standard primary therapy for ovarian cancer; palliative radiation may relieve symptoms from localized disease.

Radiation recall and mucosal toxicity are increased when radiation is combined with certain systemic agents; concurrent doxorubicin is generally avoided because of severe toxicity.

High-grade serous ovarian carcinoma typically has TP53 mutations and frequent homologous recombination deficiency; low-grade serous carcinoma often has KRAS or BRAF mutations.

Endometrioid ovarian carcinoma is associated with PTEN, PIK3CA, KRAS, and CTNNB1 alterations; clear cell carcinoma is associated with ARID1A and PIK3CA mutations.

Endometrial carcinoma molecular subtypes are POLE ultramutated, mismatch repair deficient, p53 abnormal, and no specific molecular profile; these groups have prognostic significance.

Cervical carcinoma is driven by high-risk HPV E6 and E7, which inactivate p53 and Rb; HPV 16 and 18 cause most HPV-associated cervical cancers.

Mismatch repair deficiency and microsatellite instability predict benefit from immune checkpoint inhibitors in endometrial and other gynecologic cancers.

Pathologic risk factors for endometrial cancer recurrence include high grade, deep myometrial invasion, lymphovascular space invasion, and cervical stromal involvement.

HER2 overexpression or amplification is uncommon in endometrial cancer but is enriched in serous carcinoma and can guide trastuzumab use in advanced disease.

Phase I trials assess safety, dose-limiting toxicity, and maximum tolerated dose; phase II trials assess activity; phase III trials compare efficacy against a control.

Overall survival is the most definitive oncology endpoint; progression-free survival is commonly used but can be affected by assessment frequency and crossover.

Intention-to-treat analysis includes all randomized patients and preserves randomization; per-protocol analysis can introduce bias.

A hazard ratio compares instantaneous event risk over time; a value below 1 favors the experimental arm when the event is adverse.

Statistical power increases with larger sample size, larger effect size, and lower variability; alpha is the prespecified false-positive rate, commonly 0.05.

Screening test performance includes sensitivity, specificity, positive predictive value, and negative predictive value; predictive values depend on prevalence.

Lead-time bias makes screening appear to extend survival by earlier diagnosis; length-biased sampling overrepresents slower-growing tumors.

Highly emetogenic chemotherapy prophylaxis combines a 5-HT3 antagonist, dexamethasone, and an NK1 receptor antagonist; olanzapine can be added for breakthrough or prevention.

Febrile neutropenia is fever plus severe neutropenia; empiric broad-spectrum antipseudomonal antibiotics should start promptly after cultures.

Opioid therapy for cancer pain follows the WHO analgesic ladder; prophylactic laxatives are used with opioids, and naloxone treats opioid-induced respiratory depression.

Malignant bowel obstruction may be managed with octreotide, dexamethasone, and antiemetics; surgery is selected for suitable patients.

Palliative care focuses on symptom control and goals of care and can be integrated alongside cancer-directed therapy; hospice eligibility generally requires prognosis of six months or less.

Lymphedema after lymphadenectomy or radiation is managed with compression, manual lymphatic drainage, and exercise; cellulitis prevention is important.

Cancer-related anemia may require transfusion or erythropoiesis-stimulating agents when appropriate; thrombocytopenia management depends on bleeding risk and platelet count.