USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

Table II-6-4. Gynecologic   Malignancy

Clinical staging Cervical cancer

Surgical staging Endometrial, ovarian, vulvar, and trophoblastic cancer

Benign  GTN:    Weekly  serial  β-hCG   titers  until   negative    for 3   weeks,  then

monthly titers  until   negative    for 12  months. Follow-up   is  for 1   year.   If  serial

β-hCG   titers  plateau or  rise    and normal  intrauterine    pregnancy   is  ruled   out by

vaginal sonogram,   patient is  diagnosed   with    persistent  gestational

trophoblastic   disease.    Proceed with    a   metastatic  workup  (CT scan    of  the

brain,  thorax, abdomen,    and pelvis) and manage  as  indicated   below.

Non-metastatic  or  good    prognosis   metastatic  disease:    single  agent

(methotrexate   or  actinomycin D)  until   weekly  β-hCG   titers  become  negative

for 3   weeks,  then    monthly titers  until   negative    for 12  months. Follow-up   is

for 1   year.

Poor    prognosis metastatic    disease:    multiple    agent   chemotherapy    (which

includes    methotrexate,   actinomycin-D,  and cyclophosphamide    until   weekly  β-

hCG titers  become  negative    for 3   weeks,  then    monthly titers  for 2   years,  then

every   3   months  for another 3   years.  Follow-up   is  for 5   years.