gynecologic oncology - Our Fight Against Cancer

FIRST ANNUAL UPDATES IN ONCOLOGY FOR
THE PRIMARY CARE PROVIDER:
GYNECOLOGIC ONCOLOGY
Michael J. Callahan, M.D.
St. Vincent Gynecologic Oncology
mjcalla1@stvincent.org

• I DO NOT have any conflicts of interest to
disclose

OBJECTIVES
• Understand risk factors for and common
presentations of gynecologic cancers
• Understand current screening
recommendations for gynecologic cancers
• Understand guidelines for follow-up and
surveillance of gynecologic cancers

RISK FACTORS
Endometrial Cancer: obesity, age, family history
Ovarian Cancer: age, family history, nulliparity
Cervical Cancer: HPV, smoking
Vulvar Cancer: age, HPV

COMMON PRESENTATIONS
• Endometrial Cancer: abnormal uterine bleeding,
postmenopausal bleeding
• Ovarian Cancer: GI complaints, early satiety,
urinary complaints, bloating
• Cervical Cancer: Abnormal pap smear, abnormal
bleeding/discharge, postcoital bleeding
• Vulvar Cancer: “lump”, mass, pruritis

SCREENING GUIDELINES
• Endometrial Cancer: no screening for average-risk
women, annual endometrial sampling in “high-risk”
women, prophylactic surgery
• Ovarian Cancer: no screening in average-risk
women, concurrent TVU/S and CA-125 every 6
months in “high-risk” women starting at age 30 or
5-10 years before earliest ovarian cancer diagnosis
in family, prophylactic surgery
NCCN Guidelines, 2012

SCREENING GUIDELINES
• Cervical Cancer:
• Begin at age 21
• Age 21-29, cervical cytology alone, performed q 3 yrs
• Age 30-65, co-testing with cytology and HPV q 5 yrs preferred (cytology
alone q 3 yrs is acceptable)
• After age 65, discontinue screening if evidence of adequate prior
screening and no history of CIN2 or higher (3 consecutive negative
cytology results, or 2 consecutive negative co-tests within past 10 years,
most recent test within past 5 years)
• If had total hysterectomy and no history of CIN2 or higher, cytology
screening and HPV testing should be discontinued
ACOG Practice Bulletin, 2012
NCCN Guidelines, 2012

SCREENING GUIDELINES
• Cervical Cancer:
• If ASCUS and negative HPV co-testing: routine screening
• If history of CIN2/3 or ACIS: continue screening for 20 years
(even if over 65 yrs, or have had total hysterectomy)
• If negative cytology and positive HPV: repeat co-testing in
12 months or HPV genotype specific testing for HPV 16/18
• If have received HPV vaccine: screen according to guidelines
ACOG Practice Bulletin, 2012

SURVEILLANCE
RECOMMENDATIONS
• Endometrial Cancer: physical exam q 3-6 mo for 2 yrs, then 6 mo or
annually; vaginal cytology q 6 mo then annually (2B); CA-125 optional;
imaging as indicated; symptom education
• Ovarian Cancer: physical exam q 2-4 mo for 2 yrs, then 3-6 mo for 3 yrs,
then annually; CA-125 or other markers each visit; family history
evaluation; imaging as indicated; symptom education
• Cervical Cancer: physical exam q 3-6 mo for 2 yrs, then q 6-12 mo for 3
yrs, then annually; cytology annually; imaging as indicated; symptom
education
NCCN Guidelines, 2012

REVIEW
• Endometrial Cancer: obesity, age; AUB, postmenopausal bleeding; no
screening except “high-risk” annual endometrial sampling, surveillance
with physical exam and consider cytology and CA-125
• Ovarian Cancer: age, family history; bloating, GI/GU symptoms, early
satiety; no screening except “high-risk” TVU/S and CA-125 q 6 months;
surveillance with physical exam, CA-125, and imaging as indicated
• Cervical Cancer: HPV, smoking; abnormal bleeding/discharge, pap
smear, postcoital bleeding; screening with cytology or co-testing;
surveillance with physical exam and cytology and imaging as indicated