Family physicians provide preventive care for women of all ages. We screen patients for cancer and other diseases, and we often are the first to evaluate them for signs and symptoms that may ultimately prove to be cancer, including gynecologic cancers. Gynecologic cancers cause significant morbidity and mortality and may be difficult to recognize because of presentation with nonspecific symptoms. Yet, I wonder how many of us can recall many details about these conditions from our medical training. To care for our patients effectively, we need to know how to do more than perform a Papanicolaou test and refer to a gynecologist. This issue of FP Essentials will arm you with current information and better tools to help you diagnose and manage cervical, endometrial, ovarian, and vulvar cancers.

Section One addresses cervical cancer. Cervical cancer has a high incidence and mortality rate but is largely preventable and easily identifiable through proper screening. Although this type of screening is the most familiar to family physicians, recommendations for screening and triaging abnormal cervical cytology results have changed significantly in recent years.

In Section Two, we discuss endometrial cancer, which is increasingly common and deadly because of its association with obesity and type 2 diabetes. We review the roles of endometrial biopsy and transvaginal ultrasonography, diagnostic tools that most family physicians have at their disposal.

Section Three focuses on ovarian cancer. Less common but more lethal than other gynecologic cancers, ovarian cancer often manifests with nonspecific symptoms that are difficult to recognize and diagnose in a timely fashion. In this section, we discuss what to look for and how to evaluate patients properly.

In Section Four, we discuss vulvar cancer. Although less common than cervical cancer, vulvar cancer also is often associated with infection with oncogenic human papillomavirus. This cancer is easy to miss if primary care physicians do not examine the vulva as a routine part of their physical examination. Diagnosis usually can be made with in-office biopsy.

I hope you find this issue of FP Essentials as helpful as I did for updating your knowledge about gynecologic cancers and for enabling you to care for your patients more effectively.

S. Lindsey Clarke, MD, FAAFP, FP Essentials Editorial Board Member
Professor, Medical University of South Carolina
Area Health Education Consortium
Self Regional Healthcare, Greenwood, South Carolina