OB/GYN
Gynecologic Cancers
OB/GYN

Gynecologic Cancers

Endometrial, ovarian, cervical, vulvar cancers.

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◆Endometrial cancer

  • •Most common gynecologic malignancy in developed countries
  • •Postmenopausal bleeding = endometrial cancer until proven otherwise → endometrial biopsy
  • •RFs: unopposed estrogen, obesity, PCOS, nulliparity, late menopause, tamoxifen, Lynch syndrome
  • •Type I (endometrioid): estrogen-driven, better prognosis
  • •Type II (serous, clear cell): older, aggressive, p53
  • •TVUS endometrial stripe ≤4 mm in postmenopausal: reassuring
  • •Tx: total hysterectomy + BSO ± lymph node dissection

◆Ovarian cancer

  • •5th leading cause of cancer death in women
  • •'Silent killer' — usually advanced at diagnosis
  • •Symptoms: bloating, pelvic pain, early satiety, urinary symptoms
  • •RFs: family history (BRCA), age, nulliparity, infertility, Lynch
  • •Protective: OCPs, breastfeeding, pregnancy
  • •Markers: CA-125 (elevated but not specific), HE4, alpha-fetoprotein (yolk sac), β-hCG (choriocarcinoma), LDH (dysgerminoma)
  • •Tx: surgical debulking + platinum-based chemo
  • •BRCA1/2: consider prophylactic BSO after childbearing complete

◆Cervical cancer

  • •Caused by high-risk HPV (16, 18, others)
  • •Vaccine: 11–12 (catch-up to 26)
  • •Screening: Pap 21–29 q3y; 30–65 Pap+HPV q5y
  • •Squamous cell most common (HPV); adenocarcinoma less common
  • •Tx: cone biopsy for early → radical hysterectomy ± chemoradiation

◆Vulvar cancer

  • •Postmenopausal women
  • •Mostly squamous cell (HPV-related or lichen sclerosus background)
  • •Biopsy any persistent lesion
  • •Tx: wide local excision ± vulvectomy + LN dissection

◆Gestational trophoblastic disease (GTD)

  • •Spectrum: complete mole → partial mole → invasive mole → choriocarcinoma → placental site trophoblastic tumor
  • •Choriocarcinoma: hematogenous spread (lungs); very chemo-sensitive (methotrexate)
  • •Persistent ↑ β-hCG after mole evacuation → suspect malignant GTD

High-yield pearls

  • ◆Postmenopausal bleeding = endometrial biopsy
  • ◆Ovarian 'silent killer' — vague abdominal symptoms
  • ◆BRCA: consider prophylactic BSO after childbearing
  • ◆Cervical cancer: HPV vaccine + screening prevents most
  • ◆Choriocarcinoma: highly chemosensitive (methotrexate)
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