Oncology: Breast and Gynae Cancers

• Breast: Breast Symptoms and Benign Disease | Breast Cancer: Risk and Types | Treating Early Breast Cancer | Metastatic Breast Cancer | After Breast Cancer | Male Breast Problems
• Gynaecological: Ovarian Cancer | Treating Ovarian Cancer | Endometrial Cancer | Cervical Cancer | Vulval and Vaginal Cancer | Gestational Trophoblastic Disease | Cancer, Pregnancy and Fertility
• Revision: Drug Reference Table | Spot the Diagnosis | Exam-style Scenarios | Key Points | Guidelines and Further Reading

🎀 Breast and gynaecological cancers together affect more than 1 in 7 women in the UK. Breast cancer is the commonest cancer overall, and ovarian cancer is the deadliest gynaecological cancer because it presents late. Recognising red-flag symptoms - a breast lump, postmenopausal bleeding, persistent bloating, post-coital bleeding - is the most important skill.
Your four questions for every patient: Does this symptom need an urgent referral? What are the tumour type, stage and receptor or molecular status? Is there an inherited cause (BRCA, Lynch) that matters for the family? What are the effects of treatment on fertility, menopause, bones and the heart?

Breast Symptoms and Benign Disease

Urgent referral (NICE NG12) - suspected cancer pathway:

• Age 30 or over with an unexplained breast lump.
• Age 50 or over with nipple discharge, retraction or other changes in one nipple.
• Skin changes suggesting cancer (dimpling, peau d'orange, ulceration).
• Age 30 or over with an unexplained lump in the axilla.
• Under 30 with a lump - consider non-urgent referral.

Triple assessment at the breast clinic:

• Clinical examination.
• Imaging - mammography (and ultrasound); ultrasound alone in women under 35.
• Biopsy - core needle biopsy (or FNA for cysts and nodes).

Benign breast conditions:

• Fibroadenoma - a smooth, mobile, rubbery lump ("breast mouse") in young women. Usually left alone once confirmed; removed if large or growing.
• Breast cysts - smooth, often tender lumps in women aged 35–55. Aspirate if symptomatic; check for residual lump or bloody fluid.
• Fibrocystic change (cyclical lumpiness and pain) - supportive bra, analgesia.
• Mastitis and breast abscess - usually in breastfeeding women (Staph aureus):
  • Flucloxacillin; continue feeding or expressing.
  • Abscesses need ultrasound-guided aspiration or drainage.
  • Non-lactational abscesses (smokers) - consider underlying duct ectasia, and exclude cancer.
• Fat necrosis - a firm lump after trauma or surgery; can mimic cancer.
• Duct ectasia - thick, coloured nipple discharge in older women; nipple slit-like retraction.
• Intraductal papilloma - bloody nipple discharge from a single duct.
• Breast pain (mastalgia) alone is rarely cancer - supportive bra, topical NSAIDs.

↑ Back to index

Breast Cancer: Risk and Types

The basics: About 1 in 7 women in the UK develop breast cancer - around 56,000 cases a year. Most are over 50.

Risk factors:

• Age; female sex.
• Family history; BRCA1/2, PALB2, TP53.
• Hormones:
  • Early menarche; late menopause.
  • Nulliparity, or first pregnancy after 30.
  • Combined HRT (risk rises with duration).
  • The combined pill (small, temporary).
• Obesity after menopause; alcohol; inactivity.
• Previous chest radiotherapy (e.g. Hodgkin lymphoma).
• Dense breasts; previous atypical hyperplasia or LCIS.
• Protective: Breastfeeding; physical activity.

Types:

• Ductal carcinoma in situ (DCIS) - non-invasive cancer inside the ducts, often found as calcifications on screening mammograms. Treated with surgery, with or without radiotherapy.
• Invasive breast cancer of no special type (ductal) - about 75%.
• Invasive lobular carcinoma - about 10–15%; harder to see on mammography; can be multifocal or bilateral; spreads to unusual sites (peritoneum, GI tract).
• Inflammatory breast cancer - a red, swollen, warm breast with "peau d'orange" skin, often mistaken for mastitis. Aggressive - any "mastitis" not settling with antibiotics needs urgent assessment.
• Paget's disease of the nipple - eczema-like change of the nipple (not the areola first), often with underlying cancer.

Receptor subtypes - these guide treatment:

• Hormone receptor-positive (ER and/or PR), HER2-negative - about 70%. Endocrine therapy.
• HER2-positive - about 15%. Anti-HER2 therapy.
• Triple-negative (ER, PR and HER2 negative) - about 15%. Younger women, BRCA1, more aggressive, chemotherapy and immunotherapy.

↑ Back to index

Treating Early Breast Cancer

(NICE NG101)

• Surgery:
  • Breast-conserving surgery (wide local excision) plus radiotherapy - as effective as mastectomy for most.
  • Mastectomy (with or without reconstruction) - large or multifocal tumours, patient choice, BRCA.
  • Axilla - sentinel lymph node biopsy if nodes are clinically normal; axillary clearance or radiotherapy if nodes are involved.
• Radiotherapy:
  • After breast-conserving surgery (usually 26 Gy in 5 fractions over 1 week).
  • After mastectomy for high-risk disease.
  • Some low-risk older women with ER-positive tumours can omit it if taking endocrine therapy.
• Endocrine therapy (ER-positive) for 5–10 years:
  • Tamoxifen (premenopausal), or ovarian suppression plus an aromatase inhibitor in higher risk.
  • Aromatase inhibitor (postmenopausal).
  • Abemaciclib (CDK4/6 inhibitor) for 2 years added for high-risk node-positive disease.
• Chemotherapy - based on risk (tumour size, grade, nodes, subtype):
  • Anthracycline- and/or taxane-based.
  • Genomic tests (e.g. Oncotype DX) help decide who benefits in ER-positive disease.
• HER2-positive:
  • Trastuzumab (with pertuzumab in higher risk) for 1 year, with chemotherapy - often neoadjuvant.
  • Trastuzumab emtansine if residual disease remains after surgery.
• Triple-negative:
  • Neoadjuvant chemotherapy with pembrolizumab.
  • Capecitabine or olaparib (BRCA) for residual disease.
• Adjuvant bisphosphonates (zoledronic acid) for postmenopausal women at higher risk - reduce bone recurrence.
• Breast cancer genetics - offer testing to women with triple-negative cancer under 60, and others meeting criteria.

↑ Back to index

Metastatic Breast Cancer

• Common sites:
  • Bone - pain, fractures, hypercalcaemia, spinal cord compression.
  • Liver, lung and pleura (effusions), brain.
  • It can recur many years (even 20) after the original cancer, especially ER-positive disease.
• Biopsy a new metastasis where possible - receptor status can change.
• Treatment is not usually curative, but many live for years:
  • ER-positive, HER2-negative:
    • Aromatase inhibitor or fulvestrant plus a CDK4/6 inhibitor (palbociclib, ribociclib, abemaciclib).
    • Later - targeted drugs for PIK3CA or AKT pathway changes (alpelisib, capivasertib), everolimus, ESR1 mutation drugs.
    • Chemotherapy.
  • HER2-positive:
    • Trastuzumab, pertuzumab and a taxane.
    • Then trastuzumab deruxtecan (watch for ILD), tucatinib (brain metastases).
  • Triple-negative: Chemotherapy with pembrolizumab (PD-L1 positive); sacituzumab govitecan; PARP inhibitors (BRCA).
  • "HER2-low" disease may respond to trastuzumab deruxtecan.
• Bone metastases:
  • Denosumab or zoledronic acid (dental check; calcium and vitamin D).
  • Radiotherapy for pain.
  • Orthopaedic fixation for impending fractures.
• Brain metastases - stereotactic radiosurgery, surgery, tucatinib; DVLA advice.
• Malignant pleural effusion - drainage, pleurodesis or indwelling pleural catheter.
• Palliative care involvement early.

↑ Back to index

After Breast Cancer

• Follow-up:
  • Yearly mammograms for 5 years (then return to screening, or continue if under 50).
  • Patient-led follow-up with fast re-access.
• Menopausal symptoms (from treatment or natural menopause):
  • Systemic HRT is generally avoided after breast cancer.
  • Non-hormonal options:
    • SSRIs or SNRIs (venlafaxine, citalopram - avoid fluoxetine and paroxetine with tamoxifen).
    • Gabapentin.
    • Clonidine.
    • CBT.
    • Newer drugs (e.g. fezolinetant) with specialist advice.
  • Vaginal dryness - moisturisers and lubricants; low-dose vaginal oestrogen can be considered after discussion with the oncology team (caution with aromatase inhibitors).
• Bone health - DEXA on aromatase inhibitors and after early menopause.
• Lymphoedema - arm swelling after axillary surgery or radiotherapy. Early referral; compression; skin care; treat cellulitis promptly. Avoid blood pressure cuffs and cannulas in that arm if possible.
• Heart health - after anthracyclines, trastuzumab or left-sided radiotherapy.
• Fertility and pregnancy - pregnancy after breast cancer doesn't appear to increase recurrence risk; a pause in endocrine therapy can be discussed.
• Psychological support; body image; sexual health; returning to work.

↑ Back to index

Male Breast Problems

• Gynaecomastia - enlargement of male breast tissue, usually behind the nipple, often tender:
  • Physiological - newborns, puberty, older age.
  • Drugs:
    • Spironolactone.
    • Digoxin.
    • Cimetidine.
    • Anti-androgens and ADT (bicalutamide, finasteride).
    • Anabolic steroids.
    • Cannabis; alcohol.
    • Some antipsychotics (high prolactin).
    • Antiretrovirals (efavirenz).
  • Liver cirrhosis; kidney failure.
  • Hypogonadism (including Klinefelter syndrome).
  • Hyperthyroidism.
  • Tumours - testicular tumours (hCG-secreting), adrenal tumours.
  • Tests: LFTs, U&E, TFTs, testosterone, LH, FSH, oestradiol, prolactin, hCG, AFP; examine the testes.
• Male breast cancer:
  • About 1% of breast cancers; older men; often ER-positive.
  • Risk factors: BRCA2, Klinefelter syndrome, high oestrogen states (liver disease, obesity).
  • Features: A firm, painless lump, often off-centre, sometimes with nipple changes.
  • Refer men 50 or over with a unilateral firm subareolar lump, and anyone with a suspicious lump.
  • Offer genetic testing.

↑ Back to index

Ovarian Cancer

The basics: About 7,500 cases a year in the UK. It is the most lethal gynaecological cancer - most present at stage III or IV.

Risk factors:

• Age (most over 50).
• BRCA1/2 (lifetime risk up to 40–50% with BRCA1) and Lynch syndrome.
• Family history.
• Nulliparity; endometriosis (clear cell and endometrioid types).
• HRT (small increase); obesity; smoking (mucinous).

Protective:

• Combined pill.
• Pregnancy; breastfeeding.
• Tubal ligation; salpingectomy.

Symptoms (often vague and persistent - NICE CG122):

• Persistent bloating or abdominal distension.
• Early fullness or loss of appetite.
• Pelvic or abdominal pain.
• Urinary urgency or frequency.
• Change in bowel habit; new IBS-like symptoms in women over 50.
• Fatigue; weight loss.
• Ascites or a pelvic mass (refer urgently).

Investigation:

• CA125 in women with persistent symptoms (especially over 50).
• If CA125 is 35 IU/mL or more - pelvic and abdominal ultrasound.
• If the ultrasound is suspicious - urgent referral.
• Risk of Malignancy Index (ultrasound score × menopausal status × CA125) - over 250 means refer to a specialist gynaecological oncology team.
• CT chest, abdomen and pelvis for staging.
• Young women with a mass - check AFP, hCG and LDH (germ cell tumours).

Types:

• Epithelial (about 90%) - most are high-grade serous carcinomas, thought to start in the fallopian tube. Others: endometrioid, clear cell, mucinous, low-grade serous.
• Germ cell tumours - young women; very chemo-sensitive (curable); raised AFP or hCG.
• Sex cord–stromal tumours - granulosa cell tumours make oestrogen (abnormal bleeding, endometrial hyperplasia; inhibin marker).
• Metastases to the ovary - e.g. Krukenberg tumours from the stomach or bowel.

↑ Back to index

Treating Ovarian Cancer

• Staging: FIGO stages I–IV (stage III means spread within the abdomen, including peritoneal disease).
• Treatment (gynae-oncology MDT):
  • Cytoreductive surgery - remove all visible disease (hysterectomy, removal of tubes, ovaries and omentum). The amount of disease left is a major predictor of survival.
  • Chemotherapy - carboplatin with paclitaxel (6 cycles), either after surgery or before and after it (neoadjuvant, for extensive disease).
  • Maintenance therapy:
    • PARP inhibitors (olaparib, niraparib) - especially with BRCA mutations or homologous recombination deficiency.
    • Bevacizumab.
• Germline BRCA testing for all women with non-mucinous epithelial ovarian cancer (affects treatment and family).
• Relapse is common:
  • Platinum-sensitive (relapse more than 6 months after platinum) - platinum again.
  • Platinum-resistant - other chemotherapy; poorer outlook.
  • CA125 helps monitor, but treatment is usually started on symptoms.
• Palliative problems:
  • Malignant ascites - paracentesis; indwelling peritoneal catheters.
  • Malignant bowel obstruction - often multilevel; usually managed medically (see the Palliative Care chapter).
  • Pleural effusions; VTE.
• Outlook: About 9 in 10 survive 5 years at stage I, but under 3 in 10 at stage III–IV.
• Risk-reducing surgery - bilateral salpingo-oophorectomy for BRCA carriers after childbearing (around 35–45). Opportunistic salpingectomy at other gynaecological surgery is encouraged.

↑ Back to index

Endometrial Cancer

The basics: The commonest gynaecological cancer in the UK, mostly after the menopause. Most present early (with bleeding), so most are cured.

Risk factors - mostly unopposed oestrogen:

• Obesity (the biggest).
• Nulliparity; late menopause.
• PCOS.
• Diabetes.
• Oestrogen-only HRT without progestogen (in women with a uterus).
• Tamoxifen.
• Lynch syndrome (lifetime risk up to about 40–60%).
• Oestrogen-secreting tumours (granulosa cell).
• Protective: Combined pill; progestogens (including LNG-IUS); smoking (reduces risk, but obviously harmful overall).

Symptoms:

• Postmenopausal bleeding (any bleeding 12 months or more after the last period) - about 1 in 10 have cancer.
• Heavy or irregular bleeding around the menopause.
• Discharge.

Investigation:

• NICE NG12: Urgent suspected cancer referral for postmenopausal bleeding in women 55 or over (consider in under-55s).
• Transvaginal ultrasound - endometrial thickness 4 mm or more needs biopsy.
• Endometrial biopsy (pipelle) and/or hysteroscopy.
• MRI for staging.

Types and molecular classification:

• Endometrioid (oestrogen-related, the commonest).
• Serous and clear cell (more aggressive).
• Carcinosarcoma.
• Molecular groups now guide treatment - POLE-mutated (excellent outlook), mismatch repair-deficient, p53-abnormal (poor), and no specific molecular profile.
• Test all for mismatch repair deficiency (Lynch syndrome screening).

Treatment:

• Total hysterectomy with removal of both ovaries and tubes (usually laparoscopic), with sentinel node assessment.
• Adjuvant radiotherapy (vaginal brachytherapy or pelvic radiotherapy) for higher-risk disease.
• Advanced or recurrent disease:
  • Carboplatin and paclitaxel with immunotherapy (dostarlimab or pembrolizumab - especially MMR-deficient).
  • Progestogens (hormonal treatment).
• Frail women or those wanting fertility: High-dose progestogen (LNG-IUS or oral) in selected early cases.
• Atypical endometrial hyperplasia (pre-cancer) - hysterectomy, or LNG-IUS with surveillance biopsies if fertility is wanted.

↑ Back to index

Cervical Cancer

The basics: Almost all cases are caused by persistent high-risk HPV (types 16 and 18 cause about 70%). It peaks at 30–45. It is largely preventable by vaccination and screening.

Risk factors:

• HPV infection - early sexual activity, multiple partners.
• Smoking.
• Immunosuppression (HIV, transplant) - more frequent screening.
• Long-term combined pill use.
• Not attending screening.

Screening and pre-cancer:

• HPV primary testing; cytology if HPV positive.
• Abnormal results lead to colposcopy.
• CIN (cervical intraepithelial neoplasia) 2–3 is treated with LLETZ (large loop excision of the transformation zone). Small increased risk of preterm birth afterwards.

Symptoms:

• Post-coital bleeding.
• Intermenstrual or postmenopausal bleeding.
• Blood-stained or offensive discharge.
• Pelvic pain; dyspareunia.
• Advanced disease: Back or leg pain, leg swelling, kidney failure from ureteric obstruction, fistulas (urine or faeces from the vagina).

Assessment:

• Examine the cervix (speculum) in anyone with these symptoms. A suspicious cervix needs an urgent suspected cancer referral - don't do a screening smear instead.
• Staging: FIGO; MRI pelvis; PET-CT for locally advanced disease.

Treatment:

• Microscopic early cancer (IA1) - cone biopsy or LLETZ.
• Early stage - radical hysterectomy with pelvic node removal, or radical trachelectomy (removes the cervix but keeps the uterus) for fertility.
• Locally advanced - chemoradiotherapy (weekly cisplatin with external beam radiotherapy) followed by brachytherapy; immunotherapy (pembrolizumab) is added for high-risk disease.
• Metastatic or recurrent - chemotherapy with pembrolizumab, with or without bevacizumab.

Late effects of pelvic radiotherapy:

• Early menopause.
• Vaginal narrowing (use dilators).
• Bowel and bladder problems.
• Lymphoedema.
• Insufficiency fractures.

↑ Back to index

Vulval and Vaginal Cancer

• Vulval cancer:
  • Mostly older women (over 65); usually squamous cell carcinoma.
  • Two routes:
    • Lichen sclerosus-related (older women) - treat lichen sclerosus with potent topical steroids and review regularly.
    • HPV-related (younger women, VIN - vulval intraepithelial neoplasia; smokers).
  • Symptoms: Persistent itch, soreness, a lump or ulcer, bleeding, discharge. Often delayed because of embarrassment.
  • Refer urgently any unexplained vulval lump, ulcer or bleeding (NICE NG12). Biopsy any persistent or changing lesion.
  • Treatment: Wide local excision with sentinel node biopsy or groin node dissection; radiotherapy or chemoradiotherapy.
• Vaginal cancer:
  • Rare; often HPV-related, or spread from the cervix or endometrium.
  • Clear cell adenocarcinoma after in utero diethylstilbestrol (DES) exposure (historical).
  • Bleeding, discharge.
  • Radiotherapy is the main treatment.
• Uterine sarcomas: Rare; rapidly growing "fibroid" in a postmenopausal woman is suspicious.

↑ Back to index

Gestational Trophoblastic Disease

• What it is: Abnormal growth of placental (trophoblast) tissue, from molar pregnancy to cancers (invasive mole, choriocarcinoma, placental site tumours). All produce hCG.
• Molar pregnancy (complete or partial):
  • About 1 in 600 pregnancies; more common at the extremes of reproductive age and in women of Asian origin.
  • Features:
    • Vaginal bleeding in early pregnancy.
    • Severe vomiting (hyperemesis).
    • Uterus larger than dates.
    • Very high hCG.
    • Early pre-eclampsia.
    • Hyperthyroidism (hCG stimulates the thyroid).
    • Theca lutein ovarian cysts.
  • Ultrasound - "snowstorm" appearance (complete mole).
  • Treatment: Suction evacuation of the uterus; histology.
• Follow-up:
  • Register with a national trophoblastic screening centre (Charing Cross, Sheffield or Dundee).
  • Serial hCG monitoring until normal and for a set period.
  • Avoid pregnancy until follow-up is complete.
  • Rising or plateauing hCG means persistent disease.
• Choriocarcinoma:
  • Can follow any pregnancy (molar, normal, miscarriage) - sometimes years later.
  • Spreads early to the lungs (haemoptysis), brain and liver.
  • Very chemo-sensitive - methotrexate, or combination chemotherapy (EMA-CO) for high risk. Cure rates are almost 100% for low risk.
• Always check hCG in a woman of reproductive age with unexplained lung or brain metastases, or abnormal bleeding after pregnancy.

↑ Back to index

Cancer, Pregnancy and Fertility

• Cancer in pregnancy (about 1 in 1,000 pregnancies - breast, cervical, melanoma, lymphoma, thyroid):
  • Breast lumps in pregnancy need assessment - don't dismiss them as pregnancy changes.
  • Imaging: Ultrasound and MRI (without gadolinium) are safe; CT and mammography are possible with shielding.
  • Surgery is possible in any trimester.
  • Chemotherapy is avoided in the first trimester, but many regimens are possible in the second and third.
  • Radiotherapy, trastuzumab, hormonal therapy and most targeted drugs are avoided until after delivery.
  • Care through specialist cancer-in-pregnancy services.
• Fertility preservation (before gonadotoxic treatment - discuss with everyone of reproductive age):
  • Egg or embryo freezing (needs about 2 weeks of ovarian stimulation).
  • Ovarian tissue freezing (children, or when urgent).
  • Sperm banking.
  • GnRH agonists during chemotherapy may protect ovarian function.
  • Fertility-sparing surgery (trachelectomy, unilateral oophorectomy for early tumours).
• Contraception during treatment (many treatments are teratogenic). Hormonal methods are avoided in hormone-sensitive cancers - use a copper IUD.
• HRT after gynaecological cancer - usually acceptable after cervical cancer and many ovarian cancers (not hormone-sensitive types); avoided after breast cancer and some endometrial cancers. Seek oncology advice.
• Premature menopause after treatment - bone health, cardiovascular risk and symptom support.

↑ Back to index

Drug Reference Table

↑ Back to index

Spot the Diagnosis

↑ Back to index

Exam-style Scenarios

1. A 46-year-old woman has a 2 cm hard lump in her left breast.
Answer: Urgent suspected cancer referral to a breast clinic.

• Triple assessment - examination, mammogram and ultrasound, core biopsy.
• If cancer: receptor status (ER, PR, HER2), staging, MDT.
• Ask about family history (genetic referral if indicated).

2. A 58-year-old with early ER-positive breast cancer is starting letrozole.
Answer: Aromatase inhibitor for 5–10 years.

• Baseline DEXA; calcium and vitamin D; bisphosphonate if osteoporotic.
• Warn about joint pain and hot flushes.
• Consider adjuvant zoledronic acid if at higher risk.

3. A 64-year-old woman has had bloating and urinary frequency for 2 months. CA125 is 210 IU/mL.
Answer: Suspected ovarian cancer.

• Urgent pelvic and abdominal ultrasound; calculate RMI; urgent gynae-oncology referral.
• CT chest, abdomen and pelvis.
• Likely cytoreductive surgery with carboplatin and paclitaxel; BRCA testing; PARP inhibitor maintenance if eligible.

4. A 60-year-old woman has had one episode of postmenopausal bleeding. Her BMI is 38.
Answer: Urgent suspected cancer pathway (age 55 or over).

• Transvaginal ultrasound - biopsy or hysteroscopy if the endometrium is 4 mm or more.
• If endometrial cancer: MRI staging; total hysterectomy with BSO; MMR testing.

5. A 34-year-old has post-coital bleeding. Her last smear 2 years ago was normal.
Answer: Examine the cervix - don't rely on the previous screening result.

• Speculum examination; check for chlamydia.
• Urgent suspected cancer referral if the cervix looks abnormal; otherwise refer for colposcopy if bleeding persists.

↑ Back to index

Key Points

• Breast lump at 30 or over: urgent referral for triple assessment.
• "Mastitis" that doesn't settle with antibiotics may be inflammatory breast cancer.
• Receptor status (ER, PR, HER2) guides breast cancer treatment.
• Early breast cancer: surgery, radiotherapy, endocrine therapy for 5–10 years, chemotherapy by risk, and anti-HER2 drugs when HER2-positive.
• Metastatic ER-positive breast cancer: endocrine therapy plus a CDK4/6 inhibitor; many live for years.
• After breast cancer, avoid systemic HRT; use non-hormonal options; avoid fluoxetine and paroxetine with tamoxifen.
• Gynaecomastia: review drugs, check LFTs and hormones, examine the testes.
• Ovarian cancer: persistent bloating, early fullness, urinary symptoms over 50 - CA125, then ultrasound.
• Offer BRCA testing in non-mucinous epithelial ovarian cancer; PARP inhibitors for maintenance.
• Postmenopausal bleeding at 55 or over: urgent referral; endometrium 4 mm or more needs biopsy.
• Test all endometrial and colorectal cancers for mismatch repair deficiency (Lynch).
• Post-coital bleeding: examine the cervix; a suspicious cervix needs urgent referral, not a smear.
• Locally advanced cervical cancer: chemoradiotherapy with brachytherapy.
• Persistent vulval itch or ulcer in older women: biopsy.
• Molar pregnancy needs registration and hCG follow-up; choriocarcinoma is highly curable.

↑ Back to index

Guidelines and Further Reading

• NICE NG101: Early and locally advanced breast cancer
• NICE CG81: Advanced breast cancer
• NICE CG164: Familial breast cancer
• NICE CG122: Ovarian cancer - recognition and initial management
• NICE NG12: Suspected cancer - recognition and referral
• BGCS (British Gynaecological Cancer Society) guidelines: ovarian, endometrial, cervical and vulval cancer
• RCOG Green-top Guideline 38: Management of gestational trophoblastic disease
• NHS Breast and Cervical Screening Programmes
• Breast Cancer Now; Target Ovarian Cancer; The Eve Appeal
• BNF - for current doses

↑ Back to index