Genital Tract Cancers in Females guidelines

Three new guidelines make up the Genital Tract Cancers in Females series available to all physicians on www.bcguidelines.ca. They are Endometrial Cancer; Human Papillomavirus Related Cancers; and Ovarian, Fallopian Tube, and Primary Peritoneal Cancers.

The guidelines provide recommendations for the screening, diagnosis, and follow-up care of these cancers in women who are 19 years or older. Signs and symptoms for the different female genital tract cancers may overlap (e.g., abnormal uterine bleeding); therefore, these guidelines may need to be used in conjunction with each other when performing initial diagnostic investigations.

Key recommendations

Endometrial cancer
•    Refer patients with suspected hereditary cancer syndrome to the BC Cancer Agency’s Hereditary Cancer Program.
•    Investigate abnormal uterine bleeding, starting with a history and physical exam.
•    Endometrial biopsy and transvaginal ultrasound are the recommended initial diagnostic investigations if other causes of abnormal uterine bleeding have been ruled out, and if endometrial cancer is suspected.
•    Routine bloodwork, Pap smear, and imaging are not needed during follow-up visits posttreatment unless indicated by symptoms or signs on examination. 

Human papillomavirus related cancers (cervical, vaginal, and vulvar)
•    HPV immunization is recommended for the prevention of HPV infection, which is the major risk factor for cervical, vaginal, and vulvar cancers. 
•    Screening for cervical cancer in asymptomatic females should be offered following the BC Cancer Agency’s Cervical Cancer Screening Program. 
•    If cancer of the cervix is clinically suspected, proceed to biopsy or colposcopy, even in the case of a normal Pap smear result.

Ovarian, fallopian tube, and primary peritoneal cancers
•    Maintain a high index of suspicion for ovarian cancer—symptoms are nonspecific and variable. 
•    Investigate immediately if abdominal mass or postmenopausal/abnormal bleeding is present since these symptoms have the highest positive predictive value. 
•    Refer patient immediately by telephone referral to gynecologic oncologist at the BC Cancer Agency’s Division of Gynecologic Oncology if epithelial ovarian cancer or germ cell ovarian tumor is suspected.
•    Refer patient with suspected hereditary cancer syndrome to the BC Cancer Agency’s Hereditary Cancer Program.
•    Routine tumor markers or imaging are not needed during follow-up visits, unless indicated by symptoms or signs on examination.