Gynecologic Oncology and Breast Disease
Core concepts
Gynecologic oncology requires stage-appropriate thinking. Cervical cancer screening uses HPV testing and cytology; vaccination prevents HPV-related disease. Early cervical cancer is treated surgically; locally advanced disease is treated with chemoradiation. Endometrial cancer usually presents with postmenopausal bleeding; endometrioid histology is estrogen-driven, while serous and clear-cell cancers are more aggressive. Ovarian cancer is often advanced at diagnosis; epithelial subtypes include high-grade serous, endometrioid, mucinous, and clear cell. BRCA mutations increase ovarian and breast cancer risk. Vulvar cancer commonly arises in older women and may be HPV-related or associated with lichen sclerosus. Gestational trophoblastic neoplasia follows molar pregnancy or any pregnancy and is monitored with beta-hCG. Breast disease requires triple assessment: clinical examination, imaging, and tissue diagnosis.
Traps
Do not use CA-125 for population screening. Do not stage cervical cancer surgically by default; staging is clinical and imaging-based. In endometrial cancer, the grade and depth of myometrial invasion guide lymph node assessment. In breast cancer, receptor status (ER, PR, HER2) drives treatment.
Worked example
A 62-year-old woman has postmenopausal bleeding and a thickened endometrium of 12 mm. She needs endometrial sampling, usually by pipelle or hysteroscopy and curettage. Cancer must be excluded before assuming atrophy.
Rule of thumb: postmenopausal bleeding is endometrial cancer until proven otherwise; investigate, do not observe.