Gynecologic Oncology
What the exam tests
Cervical, endometrial, ovarian, vulvar, and gestational trophoblastic disease: screening, staging, and initial management. The exam favours postmenopausal bleeding and adnexal mass scenarios.
Core rules
- Cervical screening: HPV primary testing from age 30 or as nationally scheduled; colposcopy for positive HPV or abnormal cytology. FIGO stage, not TNM alone, guides treatment.
- Endometrial cancer: postmenopausal bleeding is the classic presentation; transvaginal ultrasound shows thickened endometrium; tissue diagnosis is by pipelle or hysteroscopy. Most are endometrioid and oestrogen-driven.
- Ovarian cancer: vague bloating, early satiety, and pelvic pain; CA125 is not a screening test and is unreliable in premenopausal women. Staging is surgical.
- Vulvar cancer: lichen sclerosus is a risk factor; biopsy any non-healing ulcer.
- Gestational trophoblastic disease: rising β-hCG after evacuation suggests persistent disease; register for follow-up.
Worked example
A 58-year-old para 2 has postmenopausal bleeding; ultrasound shows a 12 mm endometrium. Office biopsy shows grade 1 endometrioid adenocarcinoma. Initial management is total hysterectomy and bilateral salpingo-oophorectomy with pelvic washings and lymph node assessment according to risk. The reasoning: thickness >4 mm warrants biopsy; grade and myometrial invasion determine adjuvant treatment.
Traps
Attributing bleeding to fibroids without biopsy; using CA125 to exclude ovarian cancer; forgetting to assess nodes; and missing endometrial cancer in a woman on tamoxifen.