Gynecologic Oncology
Domain 5 - Gynecologic Oncology
This domain tests screening algorithms, staging, and the first diagnostic step for a suspicious lesion in cervical, ovarian, endometrial and trophoblastic disease. Staging numbers must be memorised exactly.
Core rules
- Cervical screening: HPV DNA testing from age 30 (WHO: 30–49, every 5–10 years where capacity allows); cytology every 3 years from 21; VIA where HPV testing is unavailable. Abnormal results go to colposcopy and biopsy - never straight to hysterectomy.
- FIGO 2018 cervical staging is clinical/imaging based: IA1 ≤3 mm depth, IA2 3–5 mm; IB1 ≤2 cm, IB2 >2 to ≤4 cm, IB3 ≥4 cm; IIIC1 pelvic node metastasis, IIIC2 para-aortic.
- Ovarian cancer: CA-125 and HE4 for follow-up, never for population screening. Staging is surgical - total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymphadenectomy. Germline BRCA testing in high-grade serous disease.
- Endometrial cancer: risk factors are unopposed oestrogen, obesity, nulliparity, diabetes, Lynch syndrome. Postmenopausal bleeding with endometrial thickness >4 mm needs Pipelle biopsy.
- GTN: after molar pregnancy, serial β-hCG; plateau over three weeks or rise over two weeks indicates neoplasia requiring methotrexate or actinomycin D.
Worked example
A 58-year-old with postmenopausal bleeding has endometrial thickness 14 mm on transvaginal ultrasound. The next step is endometrial sampling (Pipelle or hysteroscopy), not a repeat scan. Histology shows endometrioid adenocarcinoma; staging then requires pelvic MRI and chest imaging, followed by hysterectomy with salpingo-oophorectomy.
Traps
Using CA-125 as a screening test; assigning FIGO cervical stage at surgery; ignoring a rising β-hCG after evacuation; assuming a polyp explains all postmenopausal bleeding without histology.