Gynecologic Oncology
What this domain tests
Gynecologic oncology questions cover screening and triage, staging, and the first steps in management of cervical, endometrial, ovarian, vulvar, and trophoblastic disease.
Core rules
- Cervical cancer. Persistent HPV 16/18 drives most cases. Triage abnormal cytology with colposcopy; ASC-US with positive HPV or LSIL generally goes to colposcopy. FIGO 2018: stage IB1 ≤2 cm, IB2 >2 cm to 4 cm. Early stage is treated with radical hysterectomy and node assessment; locally advanced with chemoradiation.
- Endometrial cancer. Postmenopausal bleeding is the alarm symptom. Transvaginal thickness >4 mm warrants endometrial sampling. Type I is endometrioid and estrogen-related; type II serous is aggressive. Staging: total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, sentinel node mapping.
- Ovarian cancer. Epithelial tumors are commonest; CA-125 is a marker, not a screening test, and is unreliable in premenopausal women. The risk of malignancy index combines CA-125, menopausal status, and ultrasound. Staging surgery requires omentectomy, washings, and node dissection.
- GTN. After molar pregnancy, follow β-hCG; a plateau over three weeks or a rise over two weeks indicates neoplasia. Low-risk: methotrexate or actinomycin-D; high-risk: EMA-CO.
- Vulvar cancer. Lichen sclerosus is a risk factor; treat with potent steroids and biopsy persistent lesions.
Worked example
A 60-year-old with postmenopausal bleeding has endometrial thickness 14 mm. Office biopsy shows grade 1 endometrioid carcinoma. She undergoes total hysterectomy, bilateral salpingo-oophorectomy, washings, and sentinel node biopsy; final stage IA, grade 1 needs no adjuvant therapy.
Traps
Using CA-125 to screen asymptomatic women; ignoring endometrial cells on a Pap smear in a postmenopausal woman; treating a borderline ovarian tumor as benign without staging; forgetting β-hCG follow-up after evacuation.