56. Prevention of the premalignant and malignant disorders of the female reproductive system

Covers prevention of cervical, endometrial, ovarian, vulval and vaginal cancers across three levels: primary (HPV vaccines and their target types), secondary (screening ages and intervals) and precancer management. Includes two tables, one on screening approaches and one on cervical intraepithelial neoplasia grades with their treatment, plus Bethesda cytology terms. Closes with a summary of how vaccination, screening and excision work together.

Inside: 5 sections · 2 tables · 16 flashcards · 2 min

Topic 56 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 5 sections, about 207 words (2 min of reading), with 16 flashcards.

Introduction

Gynaecological cancers can largely be prevented or found early. Prevention works at three levels: avoiding the cause (primary), finding precancer (secondary) and treating it before invasion.

Cervical cancer: the model of prevention

Primary prevention: HPV vaccination

Vaccines: bivalent (16, 18), quadrivalent (+ 6, 11), nonavalent (16, 18, 31, 33, 45, 52, 58 + 6, 11).
Best before sexual debut: girls (and boys) aged 9–14; 1–2 doses in young adolescents, 3 if started later or immunosuppressed.
Also: condoms, stopping smoking.

Secondary prevention: screening

Precancer: cervical intraepithelial neoplasia

Cytology terms (Bethesda): ASC-US, LSIL, HSIL, AGC. Excision slightly raises the risk of preterm birth in later pregnancies.

Endometrial cancer

No population screening; prompt investigation of postmenopausal bleeding.
Treat atypical hyperplasia; progestogen protection with oestrogen therapy; weight control; PCOS: regular withdrawal bleeds.
Lynch syndrome: surveillance and risk-reducing hysterectomy with salpingo-oophorectomy after childbearing.

Ovarian cancer

No effective population screening (CA-125 and ultrasound did not reduce mortality).
BRCA carriers: risk-reducing salpingo-oophorectomy; opportunistic salpingectomy at other pelvic surgery; combined pill lowers risk.