Gynecologic Oncology
Gynecologic oncology tests screening, staging, and evidence-based treatment of cervical, endometrial, ovarian, vulvar, and trophoblastic cancers. The OEOG commonly asks about stage-defining findings and the first management step after biopsy.
Core rules
- Cervical cancer uses FIGO 2018 staging: stage IB1 is ≤2 cm, IB2 is >2 to <4 cm, and IB3 is ≥4 cm; pelvic or para-aortic lymph node involvement is stage IIIC.
- Early cervical cancer is treated with radical hysterectomy plus pelvic lymphadenectomy or with primary chemoradiation; both are acceptable in selected stage IB1-IB2 disease.
- Endometrial cancer is the most common gynecologic malignancy. Type I is endometrioid and estrogen-driven; type II is serous and p53-associated. Stage I treatment is total hysterectomy and bilateral salpingo-oophorectomy with lymph node assessment based on risk.
- Ovarian cancer: high-grade serous is the most common histology; all epithelial ovarian cancers should have BRCA1/2 testing. Choose primary debulking or neoadjuvant chemotherapy based on resectability.
- Gestational trophoblastic neoplasia is diagnosed by a plateau or rise in hCG after evacuation; low-risk disease is treated with single-agent methotrexate or actinomycin D.
Worked example
A 45-year-old has postcoital bleeding and a 3-cm exophytic cervical lesion; biopsy shows squamous cell carcinoma. Examination shows free parametria and no palpable nodes. Reasoning: a 3-cm lesion confined to the cervix is stage IB2. She can be offered radical hysterectomy with pelvic lymph node dissection or primary chemoradiation. Imaging and examination under anesthesia complete staging.
Traps
- Staging cervical cancer by MRI alone without examination under anesthesia.
- Assuming a complex ovarian mass is benign in a postmenopausal woman; use risk of malignancy index and refer.
- Missing gestational trophoblastic neoplasia because hCG falls slowly rather than rising.