Gynaecological oncology
Cervical, endometrial, ovarian and vulval cancers, and the cervical screening program. The screening pathway is very testable.
High-yield points
Cervical screening: HPV test every 5 years for women and people with a cervix aged 25-74, replacing 2-yearly Pap smears since December 2017.
Self-collected vaginal HPV samples are available to everyone eligible since July 2022 and are as accurate as clinician-collected.
HPV 16/18 detected: refer directly for colposcopy; other oncogenic HPV types: reflex liquid-based cytology triages the next step.
Symptomatic women (post-coital or intermenstrual bleeding) need a diagnostic co-test and examination, not a screening test.
Endometrial cancer typically presents with postmenopausal bleeding; risk factors are obesity, unopposed oestrogen, tamoxifen and Lynch syndrome.
Ovarian cancer has no effective screening test; persistent bloating, early satiety or pelvic pain warrants CA-125 and transvaginal ultrasound.
Vulval itch or lesions that do not settle in older women need biopsy (lichen sclerosus and vulval cancer).
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Cervical screening | Opportunistic Pap smear or VIA, usually from 30. | HPV test every 5 years, ages 25-74; self-collection is an option. Cytology only follows a positive HPV test. |
| HPV vaccination | Cervical cancer is a leading cancer in women; HPV vaccination is being scaled up. | School-based program at 12-13 for all genders; aiming to eliminate cervical cancer by 2035. |
| Ovarian cancer | No screening. | Largely the same: no screening; CA-125 and ultrasound are not screening tests in average-risk women. |
| Postmenopausal bleeding | Often D&C. | Transvaginal ultrasound first; endometrial thickness over 4 mm (or ongoing bleeding) needs endometrial sampling. |
Cervical screening
India (MBBS)
Opportunistic Pap smear or VIA, usually from 30.
Australia (AMC): what the exam expects
HPV test every 5 years, ages 25-74; self-collection is an option. Cytology only follows a positive HPV test.
HPV vaccination
India (MBBS)
Cervical cancer is a leading cancer in women; HPV vaccination is being scaled up.
Australia (AMC): what the exam expects
School-based program at 12-13 for all genders; aiming to eliminate cervical cancer by 2035.
Ovarian cancer
India (MBBS)
No screening.
Australia (AMC): what the exam expects
Largely the same: no screening; CA-125 and ultrasound are not screening tests in average-risk women.
Postmenopausal bleeding
India (MBBS)
Often D&C.
Australia (AMC): what the exam expects
Transvaginal ultrasound first; endometrial thickness over 4 mm (or ongoing bleeding) needs endometrial sampling.
The Australian context
Australia aims to eliminate cervical cancer as a public health problem by 2035, thanks to the school HPV vaccination program and HPV-based screening. Indian candidates used to opportunistic Pap or VIA screening should learn the Australian HPV-first pathway.