Obstetrics and Gynaecology
Cervical and Gynaecological Cancers
Cervical, endometrial, ovarian, vulval cancers and trophoblastic neoplasia for MBBS, with HPV screening, vaccination and FIGO staging, mapped to NMC codes OG33 and OG34.
MedNext Academy | 3 min read
Cervical and Gynaecological Cancers
Cervical, endometrial, ovarian, vulval cancers and trophoblastic neoplasia for MBBS, with HPV screening, vaccination and FIGO staging, mapped to NMC codes OG33 and OG34.
This chapter covers the major gynaecological malignancies: cervical, endometrial, ovarian, vulval and vaginal cancers, along with gestational trophoblastic neoplasia. It emphasises HPV and cervical screening and vaccination, the presentations and risk factors of each cancer, FIGO staging, and the principles of surgical and chemoradiation management.
High-yield: Cervical and Gynaecological Cancers
- Persistent infection with high-risk human papillomavirus, especially types 16 and 18, causes most cervical cancer.
- Cervical screening uses the Pap smear, HPV testing and visual inspection with acetic acid, with colposcopy for abnormal results.
- Visual inspection with acetic acid is a low-cost screening method suited to resource-limited settings in India.
- Cervical cancer is staged clinically by the FIGO 2018 system, and early stages are treated surgically while advanced disease needs chemoradiation.
- The HPV vaccine, including the indigenous Cervavac, is most effective when given before the onset of sexual activity in adolescents.
- Endometrial cancer classically presents with postmenopausal bleeding, which must always be investigated.
- Type I endometrial cancer is oestrogen-dependent endometrioid carcinoma with a better prognosis than type II serous or clear cell tumours.
- Risk factors for endometrial cancer include obesity, nulliparity, late menopause, unopposed oestrogen and tamoxifen.
- Ovarian cancer often presents late with vague abdominal symptoms and ascites, contributing to its high mortality.
- CA-125 and the risk of malignancy index help assess an ovarian mass, and treatment is debulking surgery with chemotherapy.
- BRCA1 and BRCA2 mutations markedly raise the risk of ovarian and breast cancer.
- Gestational trophoblastic neoplasia, including invasive mole and choriocarcinoma, is highly chemosensitive and monitored with beta-hCG.
- Choriocarcinoma spreads early to the lungs and responds well to chemotherapy such as methotrexate.
- Vulval cancer is usually squamous, often preceded by vulval intraepithelial neoplasia, and presents with a lump, ulcer or itching.
Gynaecological cancers at a glance
- **Cervical:** Caused by high-risk HPV; screen and treat precancer; FIGO 2018 clinical staging.
- **Endometrial:** Postmenopausal bleeding; type I oestrogen-dependent with better prognosis.
- **Ovarian:** Presents late; CA-125 and RMI; debulking surgery and chemotherapy; BRCA link.
- **Trophoblastic neoplasia:** Chemosensitive; monitored with beta-hCG; choriocarcinoma spreads to lungs.
NMC competencies in this chapter
- **OG33.1:** Cervical screening: Pap smear, HPV testing, VIA and colposcopy
- **OG33.2:** Cervical cancer: HPV biology, FIGO 2018 staging and management
- **OG33.3:** HPV vaccination: schedule, WHO recommendations and Indian programme
- **OG34.1:** Endometrial cancer: risk factors, types, FIGO staging and management
- **OG34.2:** Ovarian cancer: CA-125, RMI, FIGO staging, debulking surgery and BRCA
- **OG34.3:** Gestational trophoblastic disease and neoplasia management
- **OG34.4:** Vulval and vaginal cancers: VIN, FIGO staging and management
Frequently Asked Questions
What causes cervical cancer and how is it screened?
Persistent infection with high-risk HPV, especially types 16 and 18. Screening uses the Pap smear, HPV testing or visual inspection with acetic acid, with colposcopy for abnormal results.
What is the classic presentation of endometrial cancer?
Postmenopausal bleeding, which must always be investigated. It is linked to obesity, nulliparity, unopposed oestrogen and tamoxifen use.
Why does ovarian cancer have a high mortality?
It often presents late with vague abdominal symptoms and ascites, so it is frequently advanced at diagnosis. CA-125 and the risk of malignancy index aid assessment.
How is gestational trophoblastic neoplasia treated?
It is highly chemosensitive and monitored with serial beta-hCG. Choriocarcinoma responds well to chemotherapy such as methotrexate even when it has spread to the lungs.
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