OG33.1-5,OG34.1-5 | Gynaecological Oncology and Operative Gynaecology — Glossary

HPV vaccine (Gardasil-9) protecting against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58; covers approximately 85–90% of cervical cancers.

Glandular premalignant cervical lesion; an absolute contraindication to ablative treatment — requires excisional treatment (preferably cold-knife cone) to ensure complete excision with adequate histological margins.

The second most common cervical cancer type (~15-20%), arising from endocervical glandular epithelium, predominantly associated with HPV 18.

Containing only paternal (androgenic) chromosomes; the genetic basis of complete moles — all chromosomes are of paternal origin (from dispermy or a haploid sperm that duplicates), with no maternal contribution.

Repair of anterior vaginal wall descent (cystocoele) by plicating the paravaginal fascia and closing the anterior vaginal wall; typically combined with vaginal hysterectomy for prolapse repair.

Atypical squamous cells of undetermined significance — a Bethesda category indicating equivocal squamous cell changes; requires HPV reflex testing or repeat cytology.

Intrauterine adhesions (synechiae) following overzealous D&C (particularly post-partum or post-abortal), stripping the endometrial basalis; manifests as secondary amenorrhoea, hypomenorrhoea, and infertility; highest risk after postpartum curettage.

Minimised by using suction rather than sharp curettage in post-partum/post-abortal procedures, stopping curettage when the cavity is cleared, and avoiding unnecessary repeat D&Cs.

Bleomycin + etoposide + cisplatin; standard first-line chemotherapy for ovarian germ cell tumours; achieves cure rates >95% in dysgerminoma and excellent outcomes in yolk sac and immature teratoma.

The standardised classification for reporting cervical cytology: NILM (negative), ASCUS (atypical squamous cells, undetermined significance), LSIL (low-grade SIL = CIN1/HPV), HSIL (high-grade SIL = CIN2/3), carcinoma.

Surgical step in TAH where the vesicouterine peritoneum is opened and the bladder is dissected off the lower uterine segment, exposing the cervicovaginal junction; inadequate reflection is the main cause of cystotomy.

Epithelial tumour of low malignant potential with atypical cell proliferation but no stromal invasion; excellent prognosis; may be managed conservatively with fertility-sparing surgery in young women.

Intracavitary radiation therapy in which a radioactive source (e.g., iridium-192) is placed in the vaginal vault or uterine cavity to deliver a high dose to the cervix and parametria while sparing the bladder and rectum.

Cancer Antigen 125; a glycoprotein tumour marker elevated in most epithelial ovarian cancers; used for monitoring treatment response and surveillance, not for screening; non-specific (elevated in endometriosis, PID, liver disease).

Malignant mixed Müllerian tumour — contains both carcinomatous and sarcomatous malignant components; classified as a metaplastic carcinoma; the most aggressive endometrial cancer subtype.

India's indigenous quadrivalent HPV vaccine (Serum Institute of India), approved by DCGI 2022; included in the Universal Immunisation Programme from 2023.

Eversion of the endocervical columnar epithelium onto the ectocervix, appearing reddish and granular; physiological in adolescents and pregnant/OCP-using women; benign, no malignant potential.

Pedunculated growth arising from the endocervical mucosa; causes contact/intermenstrual bleeding; benign but requires polypectomy with histology to exclude malignancy.

Malignant GTN characterised by the absence of chorionic villi, sheets of cytotrophoblast and syncytiotrophoblast, and extreme chemosensitivity; can follow any form of pregnancy.

Precancerous dysplastic change of the squamous epithelium of the cervix, graded 1 (LSIL) through 3 (HSIL/carcinoma in situ).

Low-grade dysplasia confined to the lower third of the cervical squamous epithelium; corresponds to LSIL; ~60% regress spontaneously; managed by surveillance.

Intermediate dysplasia involving the lower two-thirds of the epithelium; corresponds to HSIL; ~40% regress, ~20% progress; treatment recommended in adults.

High-grade dysplasia/carcinoma in situ involving more than two-thirds to full epithelial thickness; corresponds to HSIL; ~31% cumulative 30-year invasion risk untreated; always requires treatment.

Surgical excision of a cone-shaped cervical specimen including the TZ using a scalpel under anaesthesia; gold standard when endocervical lesion, microinvasion suspicion, or glandular disease is present; provides clean thermal-artefact-free margins.

Magnified (×6–40) examination of the cervix using a colposcope, with acetic acid and Lugol's iodine, to identify and direct biopsy of abnormal areas; the standard diagnostic follow-up to abnormal screening.

Magnified examination of the cervix after acetic acid application, with targeted punch biopsy of acetowhite areas; the standard method for histological diagnosis of cervical lesions.

Diploid (46,XX or 46,XY), androgenetic molar pregnancy with no fetal tissue, generalised trophoblastic hyperplasia, and ~15–20% risk of malignant transformation to GTN.

External beam pelvic radiation combined with weekly cisplatin chemotherapy, followed by brachytherapy boost; standard treatment for locally advanced cervical cancer (Stage IIB-IVA).

Ablative treatment of CIN using a nitrous oxide or CO2 cryoprobe to freeze and destroy abnormal cervical epithelium; used in screen-and-treat for eligible VIA-positive lesions.

Surgery aimed at removing as much tumour as possible from the peritoneal cavity; 'optimal' cytoreduction = residual tumour ≤1 cm; complete cytoreduction (R0) is the goal as it correlates with improved survival.

A surgical procedure performed under anaesthesia involving sequential dilatation of the cervical canal with Hegar dilators followed by systematic curettage of the uterine cavity to obtain endometrial tissue for diagnosis or to evacuate uterine contents.

Pharmacological (LMWH, e.g. enoxaparin 40 mg SC once daily) and mechanical (TED stockings, pneumatic compression) measures to prevent deep vein thrombosis after major gynaecological surgery; started 12 hours post-operatively.

The most common malignant germ cell tumour of the ovary; counterpart of testicular seminoma; occurs in young women; highly chemosensitive (BEP) and curable even at advanced stage; LDH is the associated marker.

The standard multi-agent chemotherapy regimen for high-risk GTN: Etoposide, Methotrexate, Actinomycin-D (days 1–2) alternating with Cyclophosphamide and vincristine (Oncovin) on day 8; achieves >85% overall survival in high-risk disease.

Salvage multi-agent chemotherapy for EMA-CO-resistant GTN, substituting Cisplatin and Etoposide for the CO component; achieves cure in ~70–80% of EMA-CO failures.

Sampling of the endocervical canal using a small curette to obtain endocervical tissue; performed before endometrial curettage in fractional D&C to localise disease without contamination.

Outpatient endometrial sampling using a thin flexible device (Pipelle de Cornier) that creates suction to aspirate endometrial cells and tissue; performed without anaesthesia in most women; sensitivity ~91% for endometrial carcinoma.

Abnormal proliferation of endometrial glands with cytological atypia (nuclear enlargement, irregular chromatin); carries ~25–30% risk of concurrent or subsequent endometrial carcinoma; treated by hysterectomy.

Pre-malignant endometrial lesion with cytological atypia; approximately 25-40% harbour concurrent cancer; requires hysterectomy in women who have completed childbearing.

On transvaginal ultrasound, the double-layer endometrial thickness; ≤4 mm in a postmenopausal woman not on HRT has a ~99% negative predictive value for endometrial cancer; >4 mm requires biopsy.

The most common endometrial cancer histological subtype (~75-80%), characterised by glandular structures resembling normal endometrium; the prototypic Type I cancer.

The most common type of ovarian malignancy (~90%), arising from the surface epithelium of the ovary or fimbriated end of the fallopian tube; subtypes include serous, mucinous, endometrioid, and clear cell carcinoma.

The current international classification of cervical cancer that introduces IB sub-staging by tumour size (IB1/IB2/IB3) and Stage IIIC for nodal involvement with radiological (r) or pathological (p) confirmation.

Endometrial cancer confined to the uterus with myometrial invasion less than 50% of myometrial thickness.

Endometrial cancer confined to the uterus with myometrial invasion 50% or more of myometrial thickness.

Endometrial cancer with cervical stromal invasion but without extrauterine spread. Endocervical gland involvement alone is NOT Stage II.

Anatomical staging for GTN: Stage I = uterus only; II = genital structures; III = lung metastases; IV = other distant metastases. Used alongside the WHO/FIGO prognostic score to determine treatment.

Surgical staging system for gynaecological cancers; the ovarian FIGO 2014 system assigns Stages I–IV based on intraoperative findings and is distinct from cervical and endometrial FIGO staging.

A prolapse operation that preserves the uterus: anterior colporrhaphy + cervical amputation + resuturing of the cardinal ligaments to the cervical stump to correct cervical elongation with prolapse; subsequent deliveries require caesarean section.

A D&C variant in which ECC is performed first (before cervical dilatation), followed by endometrial curettage, with specimens labelled separately; used to determine whether disease (e.g. endometrial carcinoma) involves the endocervix.

Standard cryotherapy cycle: freeze 3 minutes (ice ball ≥5 mm beyond probe), thaw 5 minutes, freeze 3 minutes; destroys abnormal epithelium to adequate depth.

Ovarian tumour arising from the primordial germ cells; predominantly affects young women; types include dysgerminoma, yolk sac tumour, and immature teratoma; often curable with BEP chemotherapy.

Malignant entities within the GTD spectrum including invasive mole, choriocarcinoma, PSTT, and ETT; diagnosed clinically by β-hCG criteria and staged by FIGO anatomical staging + WHO/FIGO prognostic score.

A sex-cord stromal tumour of the ovary that secretes oestrogen and inhibin; hallmarked by late recurrence (decades after initial treatment); associated with endometrial hyperplasia from oestrogen excess.

Graduated metal rods (sizes 1–20) used to progressively dilate the cervical canal before D&C; used sequentially by single sizes to prevent cervical laceration.

Molecular test detecting high-risk HPV genotypes in cervical cells; ~95% sensitivity for CIN2+; WHO and NHM India recommended as primary screening method.

A viral protein encoded by high-risk HPV that targets p53 for proteasomal degradation, eliminating apoptosis of damaged cells.

A viral protein encoded by high-risk HPV that inactivates the retinoblastoma protein (Rb), releasing E2F and driving uncontrolled S-phase entry.

High-grade squamous intraepithelial lesion (Bethesda) — corresponds to CIN 2/3; requires colposcopic evaluation and usually treatment.

The difference between irrigating fluid inflow and outflow during operative hysteroscopy; threshold for stopping is 1,000 mL with normal saline or 750 mL with hypotonic media (glycine/sorbitol) to prevent fluid overload/hyponatraemia.

International Federation for Cervical Pathology and Colposcopy grading of colposcopic findings: Grade 1 (minor — thin acetowhite, fine punctation) and Grade 2 (major — dense acetowhite, coarse punctation/mosaic, sharp geographic borders).

The anatomical narrowing at the junction of the cervical canal and uterine cavity; must be negotiated during cervical dilatation; perforation most commonly occurs just beyond this point when the uterine axis is misjudged.

Hydatidiform mole (usually CHM) that invades the myometrium or uterine vasculature; distinguished from choriocarcinoma by the presence of recognisable molar villi; responds well to chemotherapy.

Bilateral metastatic ovarian tumour arising from a primary gastric carcinoma (signet-ring cell type); less commonly from colorectal, breast, or appendiceal primary; always consider when bilateral solid ovarian masses present.

Excision of the transformation zone using a diathermy wire loop under local anaesthesia; also called LLETZ; provides histological specimen for margin and microinvasion assessment.

Low-grade squamous intraepithelial lesion (Bethesda) — corresponds to CIN 1 and HPV cytopathic effect; often regresses spontaneously.

Hereditary autosomal dominant mismatch repair gene mutation syndrome; 40-60% lifetime endometrial cancer risk in women (often exceeding colorectal cancer risk); requires annual endometrial surveillance from age 30-35.

First-line single-agent regimen for low-risk GTN; folinic acid (leucovorin) rescues normal host cells from methotrexate toxicity while allowing anti-tumour effect; achieves >95% cure in low-risk GTN.

Surgical removal of uterine fibroids with preservation of the uterus; indicated in women desiring fertility; approaches include abdominal (open), laparoscopic, and hysteroscopic depending on fibroid size and location.

Mucus retention cysts on the cervix formed by obstruction of endocervical gland ducts during squamous metaplasia; entirely benign; require no treatment.

Chemotherapy given before surgery in patients with advanced ovarian cancer unsuitable for upfront debulking; aims to reduce tumour burden before interval debulking surgery (IDS); carboplatin-paclitaxel is standard.

Surgical removal of the greater omentum (infragastric omentectomy); performed routinely in ovarian cancer surgery as the omentum is a common site of metastasis ('omental cake').

Exfoliative cervical cytology test sampling cells from the transformation zone; reported per Bethesda 2014 classification (NILM, ASCUS, LSIL, HSIL, carcinoma).

The lateral connective tissue flanking the uterus, containing the cardinal and uterosacral ligaments; its involvement (Stage IIB+) is a key staging parameter in cervical cancer.

Targeted therapy blocking poly(ADP-ribose) polymerase, which cancer cells with BRCA1/2 mutations rely on for DNA repair; examples include olaparib and niraparib; used as maintenance therapy after first-line chemotherapy in BRCA-mutated advanced ovarian cancer.

Triploid molar pregnancy with biparental chromosome contribution, some fetal/embryonic tissue, focal trophoblastic proliferation, and a lower malignant transformation risk of ~0.5–5%.

A radical salvage operation removing the uterus, bladder, and/or rectum with reconstruction; used for isolated central pelvic recurrence of cervical cancer after prior chemoradiation.

A 3.1 mm flexible plastic disposable suction curette used for outpatient endometrial aspiration; the standard device for first-line endometrial sampling in postmenopausal bleeding.

A narrow plastic aspiration device for office endometrial biopsy without anaesthesia; approximately 99% sensitivity for endometrial cancer in postmenopausal women.

A rare, slow-growing GTN variant arising from intermediate trophoblast; characterised by relatively low β-hCG, high hPL, and relative chemoresistance; treated primarily by hysterectomy.

CO₂ gas-filled peritoneal cavity created during laparoscopy to provide a working space for instruments and optics; standard insufflation pressure 12–15 mmHg; high initial pressure indicates incorrect Veress needle placement.

Mandatory serial serum β-hCG monitoring after molar evacuation to detect malignant transformation (GTN) early; weekly measurements until normalisation, then monthly for 6–12 months depending on mole type.

Repair of posterior vaginal wall descent (rectocoele/perineocoele) by plicating the levator ani muscles; combined with anterior colporrhaphy and VH in complete pelvic floor repair.

Any vaginal bleeding occurring more than 12 months after the last menstrual period in a woman not on HRT; ~10-15% prevalence of endometrial cancer; must be investigated with TVUS and biopsy.

The most common molecular alteration in Type I endometrial cancer; PTEN is a tumour suppressor gene whose loss drives PI3K/AKT pathway activation and promotes endometrial proliferation.

HPV vaccine (Gardasil, Cervarix-4, Cervavac) protecting against HPV types 6, 11, 16, and 18; two doses for ages 9–14, three doses for ≥15 or immunocompromised.

A validated triage tool calculated as menopausal status score × ultrasound score × CA-125 (IU/mL); RMI >200 indicates high risk of malignancy requiring referral to a gynaecological oncology centre.

A colposcopic examination in which the entire transformation zone and squamocolumnar junction are fully visualised; required for accurate directed biopsy.

A serum tumour marker elevated in squamous cell carcinoma of the cervix; used to monitor treatment response and detect early recurrence.

A simplified cervical cancer control approach where women who are VIA-positive and meet eligibility criteria are treated with cryotherapy on the same visit as screening, eliminating referral default.

Bleeding 7–14 days after cryotherapy or LEEP, caused by sloughing of the necrotic eschar; managed by speculum examination and cautery or suture.

Ovarian tumour arising from the gonadal supporting cells; includes granulosa cell tumour (oestrogen-secreting, inhibin-positive) and Sertoli-Leydig tumours (androgen-secreting); characterised by late recurrence.

The most common histological type of cervical cancer (~70-80%), arising from squamous epithelium of the ectocervix or transformation zone.

FIGO 2018: visible cervical tumour ≤2 cm in greatest dimension, confined to the cervix.

FIGO 2018: visible cervical tumour >2 cm and ≤4 cm, confined to the cervix.

FIGO 2018: visible cervical tumour >4 cm, confined to the cervix.

FIGO 2018: pelvic lymph node metastasis confirmed by radiological (r) or pathological (p) means, irrespective of tumour size.

FIGO 2018: para-aortic lymph node metastasis confirmed by radiological or pathological means.

Systematic surgical exploration to assign FIGO stage: midline incision, peritoneal washings, TAH+BSO, omentectomy, pelvic and para-aortic node dissection, and random peritoneal biopsies.

Definitive surgical staging procedure: total abdominal hysterectomy + bilateral salpingo-oophorectomy + pelvic and para-aortic lymph node dissection + peritoneal washings for cytology.

Forceps with single or double teeth applied to the anterior cervical lip to stabilise and provide traction on the cervix during D&C, straightening the cervicouterine angle.

Bilateral ovarian cysts due to excessive β-hCG stimulation of ovarian follicles; present in ~25–30% of complete moles; resolve spontaneously after evacuation and β-hCG normalisation.

Cervical ablative method using a heated probe (100–120°C); effective for CIN 1/2 meeting ablation eligibility criteria; no histological specimen.

Removal of the uterus and cervix via abdominal laparotomy; performed for fibroids, endometrial cancer, cervical cancer, adenomyosis; may be combined with bilateral salpingo-oophorectomy (TAH+BSO).

The squamocolumnar junction region of the cervix where squamous metaplasia occurs and where HPV integration and cervical carcinogenesis primarily arise.

The region of the cervix between the original and current squamocolumnar junctions, where active squamous metaplasia occurs and where HPV-driven CIN and cervical carcinogenesis arise.

Oestrogen-driven endometrial cancer (~80%), arising via the hyperplasia pathway; predominantly endometrioid adenocarcinoma, low grade (G1/G2), PTEN mutations; associated with obesity/nulliparity/late menopause; good prognosis.

Non-oestrogen-driven endometrial cancer (~20%), arising from atrophic endometrium; includes serous, clear cell, and carcinosarcoma subtypes; TP53 mutations; high grade; poor prognosis.

Abnormal communication between the ureter and vaginal vault from ureteric injury during pelvic surgery; presents with loin pain and watery vaginal discharge; managed by ureteric stenting or surgical reimplantation.

Inadvertent breach of the uterine wall during D&C, most commonly at the fundus; recognised by sudden loss of resistance; managed conservatively (if minor, fundal) or with laparoscopy/laparotomy if visceral injury is suspected.

An aggressive Type II endometrial cancer (~10%) with papillary architecture and severe nuclear atypia; spreads early peritoneally; treated like ovarian serous carcinoma.

A slender graduated probe inserted into the uterine cavity before dilatation to confirm the direction, angle, and depth of the cavity; essential safety step before D&C.

Removal of the uterus through the vagina without abdominal incision; preferred route for uterovaginal prolapse in women with a small, mobile uterus and adequate vaginal access.

Intracavitary radiation therapy to the vaginal vault after hysterectomy; recommended as adjuvant treatment for intermediate-risk Stage I endometrial cancer (PORTEC-2 evidence).

A spring-loaded needle with a blunt retractable tip used to create pneumoperitoneum for laparoscopy; confirmed by the drop test (saline enters freely) and low initial insufflation pressure (<8 mmHg).

Abnormal communication between the bladder and vaginal vault, usually from a missed cystotomy or ischaemia during hysterectomy; presents with constant urinary dribbling from the vagina; repaired surgically after 6–12 weeks' delay.

Point-of-care cervical screening method using 3–5% acetic acid; a sharply demarcated, persistent acetowhite area in the transformation zone after 1 minute constitutes a positive result.

Cervical screening method using Lugol's iodine; failure of normal staining (mustard-yellow rather than mahogany-brown) in the transformation zone constitutes a positive result.

Type III radical hysterectomy: removal of uterus, cervix, upper 1-2 cm vagina, and the parametria (cardinal and uterosacral ligaments) with pelvic lymph node dissection; standard surgical treatment for Stage IB1-IB2.

WHO global cervical cancer elimination targets by 2030: 90% of girls vaccinated by age 15, 70% of women screened by age 35 and 45, 90% of women with disease receiving treatment.

An 8-variable scoring system (age, antecedent pregnancy, interval, β-hCG level, tumour size, metastasis site/number, prior chemo) that stratifies GTN into low risk (≤6) for single-agent chemotherapy and high risk (≥7) for EMA-CO multi-agent therapy.

An aggressive germ cell tumour of the ovary secreting AFP (alpha-fetoprotein); treated with BEP chemotherapy with excellent outcomes; occurs predominantly in young women.

A rise of less than 10% across three consecutive weekly serum β-hCG measurements; meets the FIGO diagnostic criterion for post-molar GTN requiring chemotherapy.