Gynecologic Oncology
Core concepts
Gynecologic oncology questions test staging, risk factors, and treatment principles for cervical, endometrial, ovarian, vulvar, and gestational trophoblastic disease. Know that cervical cancer is HPV-driven and staged clinically with imaging, endometrial cancer is the most common gynecologic malignancy and often estrogen-related, and ovarian cancer is the deadliest due to late presentation. Understand the role of surgery (staging/debulking), chemotherapy, radiation, and the difference between germ cell, sex cord-stromal, and epithelial ovarian tumors.
Traps
- Endometrial vs. cervical cancer: abnormal bleeding in a postmenopausal patient most often reflects endometrial cancer; cervical cancer often presents with postcoital bleeding.
- Ovarian cancer debulking: optimal cytoreduction improves survival; neoadjuvant chemotherapy is an option when primary debulking is not feasible.
- Gestational trophoblastic disease: follow serial beta-hCG to zero; rising or plateauing titers suggest persistent disease requiring chemotherapy.
- Vulvar cancer: often HPV-independent in older patients and may present as a chronic lesion; biopsy any suspicious vulvar lesion.
- Staging nuance: ovarian cancer is surgically staged; endometrial and cervical cancers have defined clinical/surgical staging pathways.
Worked example / rule of thumb
A patient with a suspicious adnexal mass and ascites. Rule of thumb: complex mass plus ascites suggests malignancy; refer to gynecologic oncology and plan surgical staging/debulking rather than simple cystectomy.
Study strategy
Build a one-page table of the five major gynecologic malignancies with risk factors, presentation, staging method, and primary treatment.