Three new guidelines make up the Genital Tract Cancers in Females series available to all physicians on www.bcguidelines.ca [9]. 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.
Links
[1] https://bcmj.org/cover/januaryfebruary-2015
[2] https://bcmj.org/node/5720
[3] https://bcmj.org/sites/default/files/BCMJ_57_Vol1_pulsimeter_1_1.pdf
[4] https://bcmj.org/print/news/genital-tract-cancers-females-guidelines
[5] https://bcmj.org/printmail/news/genital-tract-cancers-females-guidelines
[6] http://www.facebook.com/share.php?u=https://bcmj.org/print/news/genital-tract-cancers-females-guidelines
[7] https://twitter.com/intent/tweet?text=Genital Tract Cancers in Females guidelines&url=https://bcmj.org/print/news/genital-tract-cancers-females-guidelines&via=BCMedicalJrnl&tw_p=tweetbutton
[8] https://bcmj.org/javascript%3A%3B
[9] http://www.bcguidelines.ca/
[10] https://bcmj.org/modal_forms/nojs/webform/176
[11] https://bcmj.org/%3Finline%3Dtrue%23citationpop