Gynecologic Oncology
Cervical cancer staging is clinical: FIGO 2018 allows imaging and pathological confirmation, but examination remains central. Stage IB is confined to the cervix, II extends beyond the uterus but not to the pelvic wall or lower third of the vagina, III reaches the pelvic wall or lower vagina or causes hydronephrosis, and IV involves bladder or rectum or distant spread. Screening is now HPV-based, with cytology triage.
Endometrial cancer usually presents with postmenopausal bleeding and is staged surgically; type I is oestrogen-driven and endometrioid, type II is serous and aggressive. Ovarian cancer is the deadliest gynaecological malignancy; most are high-grade serous, present at an advanced stage with bloating and abdominal distension, and are staged surgically with cytoreduction. Germ cell tumours affect young women and are managed with fertility-sparing surgery plus platinum-based chemotherapy. Gestational trophoblastic neoplasia is monitored with beta-hCG; low-risk disease (FIGO score 6 or less) is treated with single-agent methotrexate or actinomycin D.
Traps: assuming ovarian cancer can be staged radiologically; forgetting that borderline tumours are not staged like invasive carcinoma and rarely need chemotherapy; omitting nodal assessment in endometrial cancer; and treating vulvar cancer by wide local excision without assessing the groins.
Rule of thumb: postmenopausal bleeding always needs endometrial sampling, since about 90% of endometrial cancers present this way.