Knowledge Area 14 | Gynaecological Oncology

Knowledge Area 14 | Gynaecological Oncology

(Aligned with RCOG Core Curriculum 2019)

Gynaecological Oncology is a high-yield module in MRCOG Part 2. Questions are inevitable. The key to scoring well is systematic preparation with emphasis on:

• Staging (FIGO)
• Referral pathways
• MDT management
• Evidence-based treatment protocols
• Genetics & survivorship
• Fertility preservation
• Palliative and end-of-life care

This module must be approached organ-wise but thought about systemically. Your notes are VITAL in this module

What the RCOG Curriculum Expects

According to the RCOG Core Curriculum, trainees must demonstrate competence in:

• Prevention and screening
• Diagnosis and staging (including imaging modalities)
• Interpretation of tumour markers
• Surgical principles
• Chemotherapy, radiotherapy & targeted therapies (basic understanding)
• Referral to specialist cancer centres
• Genetic counselling pathways
• Survivorship issues
• End-of-life care

There is now stronger emphasis on:

• Genomic medicine (BRCA, Lynch syndrome)
• Risk-reducing surgery
• Sentinel lymph node biopsy
• Enhanced recovery after surgery (ERAS)
• Centralisation of oncology care
• Shared decision-making

How to Organise Your Study

Create a master folder: Gynaecological Oncology

Subfolders:

• Cervix
• Endometrium
• Ovary & Fallopian Tube
• Vulva & Vagina
• Genetics & Risk Reduction
• General Oncology Principles

For each cancer, structure your notes under the same headings:

• Epidemiology & risk factors
• Pathogenesis (HPV, genetic mutations, etc.)
• Screening (if applicable)
• Clinical presentation
• Investigations & imaging
• FIGO staging (MUST revise repeatedly)
• Stage-wise management
• Fertility-sparing options
• Prognosis & survival
• Recurrence management
• MDT pathway

Consistency in structure improves retention and recall.

Cervical Cancer

• Core areas include: HPV pathogenesis; Cervical screening programme; Colposcopy principles; CIN management; Reproductive outcomes after LLETZ; Fertility-sparing surgery (trachelectomy); Stage-wise management; Chemoradiation principles
• Know the UK screening framework and HPV primary testing pathway (current national approach).
• Understand centralisation of care and referral to Gynae Oncology MDT.

Endometrial Cancer

• Increasingly common and heavily examined. Important updates include: Obesity as major risk factor; Role of Lynch syndrome testing; Molecular classification (TCGA-based understanding at basic level); Sentinel lymph node biopsy; Adjuvant therapy principles
• Green-top Guideline No. 67 (Endometrial Hyperplasia) remains essential.
• You must know: Management of postmenopausal bleeding; Atypical hyperplasia vs carcinoma; Surgical staging principles; Risk stratification

Ovarian & Fallopian Tube Cancer

• This area has seen significant evolution. You must understand: Risk of Malignancy Index (RMI); CA125 interpretation; NICE referral thresholds; Role of imaging; BRCA mutation testing; PARP inhibitors (basic principle only); Interval debulking vs primary cytoreduction; Borderline tumours; Germ cell tumours (younger women)
• Be aware that high-grade serous carcinomas are now understood to often originate from the distal fallopian tube.
• Risk-reducing salpingo-oophorectomy is an important exam topic.

Vulval & Vaginal Malignancy

• A few questions may come in the exam. You must know: VIN classification; Vulval dermatoses vs malignancy; Sentinel lymph node biopsy; Surgical margins; Management in elderly population; MDT care

Genetics & Risk Reduction (Increasingly Tested)

• Now there is more emphasis in the curriculum. You must understand: BRCA1/2 mutations; Lynch syndrome; Genetic counselling pathways; Risk-reducing surgery; HRT after RRSO; Fertility preservation options
• Genomics is no longer optional knowledge in MRCOG but a MUST.

Fertility-Sparing & Survivorship

• One of the important exam topics. You are expected to know: Trachelectomy; Fertility-sparing treatment in endometrial cancer; Oocyte/embryo preservation; Impact of radiotherapy; Sexual dysfunction after treatment; HRT following gynaecological cancer; Psychological support

General Oncology Principles (Do Not Neglect)

• You must have a basic understanding of: Radiotherapy mechanisms; Chemotherapy drugs and regimens; Targeted therapy principles; Immunotherapy basics; ERAS protocols; Management of bowel obstruction; Ascites management; Palliative care principles: Breaking bad news
• The curriculum now expects holistic oncological competence, not just tumour knowledge.

Main changes in new curriculum

• Greater emphasis on genomics and molecular classification
• Sentinel lymph node biopsy incorporated in staging
• More conservative/fertility-preserving approaches
• Increased focus on survivorship and quality of life
• Stronger governance and MDT centralisation
• Risk-reducing surgery and prophylaxis as examinable topics

For last-minute revision:

• Memorise FIGO staging tables
• Know referral thresholds
• Revise tumour markers
• Remember fertility-sparing indications
• Be confident in genetics
• Revise survival statistics in approximate ranges (do not memorise excessive numbers)