Gynecologic Oncology
Domain overview
The Gynecologic Oncology domain tests screening, diagnosis, staging, and treatment of cervical, ovarian, endometrial, and vulvar cancers, plus gestational trophoblastic disease. It emphasizes FIGO staging and timely referral to gynecologic oncology.
Core rules
- Cervical cancer screening follows risk-based ASCCP management. HPV vaccination prevents cancer but does not replace screening. Early cervical cancer is staged clinically (FIGO), with imaging permitted.
- Ovarian cancer often presents with vague bloating, early satiety, and pelvic pain. CA-125 is not a screening test; it can rise in fibroids, endometriosis, and cirrhosis. Refer to gynecologic oncology when an adnexal mass is complex, accompanied by ascites or nodularity, or associated with elevated CA-125.
- Endometrial cancer is the most common gynecologic malignancy and typically presents with postmenopausal bleeding. Diagnosis is by endometrial biopsy. Type I is endometrioid and estrogen-related; Type II is serous and more aggressive.
- Gestational trophoblastic disease: complete mole (46XX, no fetal tissue, markedly elevated hCG) versus partial mole (69XXY, some fetal tissue). Follow hCG to zero; persistent elevation suggests gestational trophoblastic neoplasia.
Worked example
A 62-year-old woman has bloating, early satiety, a complex adnexal mass, and ascites; CA-125 is 450 U/mL. Reasoning: findings strongly suggest ovarian cancer. Do not perform percutaneous biopsy. Refer to gynecologic oncology for staging laparotomy with cytoreduction.
Traps
Using CA-125 to screen asymptomatic women is incorrect. Also, do not assume a benign adnexal mass in a postmenopausal woman without appropriate imaging and follow-up, and do not biopsy a suspected ovarian cancer before surgical staging.