Gynecologic Oncology
Core concepts
Gynaecologic oncology questions test staging, screening, and the principles of management for cervical, endometrial, ovarian, vulval, and gestational trophoblastic disease. Know the FIGO staging systems conceptually, the role of HPV in cervical cancer, the screening pathway, and the indications for conisation versus radical surgery versus chemoradiation.
Ovarian cancer is the highest-yield: understand the risk of malignancy index, the role of surgery (staging or debulking), and the place of chemotherapy. Endometrial cancer is the commonest gynaecologic malignancy; know the risk factors, the diagnostic pathway (endometrial sampling), and the role of lymph node assessment. Vulval cancer requires an understanding of lichen sclerosus as a precursor and the role of groin node assessment. Gestational trophoblastic disease requires serial beta-hCG monitoring and chemotherapy criteria.
Traps
- Staging ovarian cancer by imaging alone rather than surgical staging.
- Missing that cervical cancer screening is not a diagnostic test and requires colposcopy and biopsy.
- Forgetting that endometrial cancer can present in younger women with risk factors.
- Confusing gestational trophoblastic disease follow-up with routine pregnancy care.
Worked rule of thumb
For any gynaecologic malignancy, ask three questions: what is the stage, what is the goal of treatment (curative or palliative), and what is the patient's fitness and fertility wish? The stage determines the modality - surgery for early-stage disease, chemoradiation for locally advanced cervical cancer, and debulking plus chemotherapy for advanced ovarian cancer. The common error is proposing surgery without staging information.
Exam technique
State the stage, the modality, and the rationale. Examiners reward a clear understanding of when surgery is not the answer.