Prifti, CA; Kwolek, D; Growdon, WB; Palamara, K; ,
Gynecologic malignancies, including uterine, ovarian, cervical, vulvar, and vaginal cancers, affect 107,000 women annually in the United States. Major risk factors for gynecologic malignancies include unopposed estrogen exposure, high-risk HPV infection, and genetic syndromes: BRCA 1 and 2, Lynch, and Cowden syndromes. Women with in utero diethylstilbestrol exposure are also at increased risk. While cervical cancer is detected by guideline-based Pap or HPV screening, routine screening tests, such as ultrasound or endometrial biopsy, for other gynecologic malignancies are not recommended. Providers should strive to identify patients at high genetic risk of malignancy for proper referral and watch for early signs or symptoms of gynecologic malignancy through history and physical exam in all women. Abnormal genital bleeding, bowel or urinary symptoms, visible or palpable lesions, vulvar itching, or persistent abdominal or pelvic pain or discomfort may be signs of malignancy. The role of the primary care provider is to initiate evaluation of suspicious symptoms, coordinate care with specialists, support the patient during and after treatment, and anticipate the sequelae of therapy. Gynecologic cancer is managed in conjunction with a gynecologic oncologist, preferably in a specialized treatment center with up-to-date protocols and multispecialty support for women undergoing treatment. Post-therapy sequelae may include treatment-induced menopause; gastrointestinal, urologic, psychologic, or neuropathic symptoms; mental health issues; or sexual health concerns.