Study guide
8.3 Genitourinary & Gynecologic Malignancies
ABIM Internal Medicine Exam
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1 Chapter 0: The ABIM Exam, Blueprint & Study Strategy
0.1 Exam Format, Question Types & the 2026 Blueprint 0.2 Eligibility, Registration, Fees & Exam-Day Logistics 0.3 Scoring, the Passing Standard & Score Reports 0.4 Building a Blueprint-Weighted Study Plan
2 Chapter 1: Cardiovascular Disease (14% of Exam)
1.1 Ischemic Heart Disease & Acute Coronary Syndromes 1.2 Antithrombotic Therapy, Secondary Prevention & Mechanical Complications of MI 1.3 Atrial Fibrillation, Atrial Flutter & Stroke Prevention 1.4 Supraventricular Tachycardias, Ventricular Arrhythmias & Bradycardias 1.5 Heart Failure: Classification, Staging & Guideline-Directed Medical Therapy 1.6 Device Therapy, HFpEF & the Cardiomyopathies 1.7 Valvular Heart Disease & Endocarditis Prophylaxis 1.8 Pericardial Disease & Acute Aortic Syndromes 1.9 Hypertension: Classification, Diagnosis & Secondary Causes 1.10 Hypertensive Crises & Dyslipidemia 1.11 Adult Congenital Heart Disease & Coarctation of the Aorta 1.12 Syncope: Reflex, Orthostatic & Cardiac Causes 1.13 Cardiac Physical Examination, Murmurs & Antithrombotic Selection
3 Chapter 2: Endocrinology, Diabetes & Metabolism (9% of Exam)
2.1 Diabetes Mellitus: Diagnosis, Glycemic Targets & Pharmacotherapy 2.2 Insulin Therapy, Hyperglycemic Emergencies & Chronic Complications 2.3 Thyroid Function Testing & Hypothyroidism 2.4 Thyrotoxicosis, Thyroid Storm & Thyroid Nodules 2.5 Adrenal & Pituitary Disorders 2.6 Hypercalcemia, Hypocalcemia & Disorders of Mineral Metabolism 2.7 Osteoporosis & Paget Disease of Bone 2.8 Ovarian, Testicular & Reproductive Endocrine Disorders 2.9 Hypoglycemia, Endocrine Tumors, Polyglandular Syndromes & Severe Hypertriglyceridemia
4 Chapter 3: Gastroenterology & Hepatology (9% of Exam)
3.1 Esophageal Disease 3.2 Stomach & Duodenal Disease and Gastrointestinal Hemorrhage 3.3 Inflammatory Bowel Disease 3.4 Celiac Disease & Irritable Bowel Syndrome 3.5 Diverticular Disease & Colorectal Cancer Screening 3.6 Viral Hepatitis, Steatotic & Alcohol-Associated Liver Disease 3.7 Cirrhosis & the Complications of Portal Hypertension 3.8 Acute Pancreatitis 3.9 Chronic Pancreatitis & Biliary Tract Disease 3.10 Inherited, Autoimmune & Drug-Induced Liver Disease 3.11 Small Intestinal Disease, Ischemia & Gastrointestinal Complications of HIV
5 Chapter 4: Infectious Disease (9% of Exam)
4.1 Lower Respiratory Tract Infections & Sepsis Syndromes 4.2 Viral Respiratory Pathogens & Tuberculosis 4.3 Central Nervous System Infections 4.4 Skin, Soft Tissue, Bone & Joint Infections 4.5 Infective Endocarditis & Cardiovascular Infection 4.6 Clostridioides difficile & Catheter-Related Bloodstream Infection 4.7 HIV Diagnosis, Antiretroviral Therapy & Prevention 4.8 Opportunistic Infections & Sexually Transmitted Infections 4.9 Fever of Unknown Origin, Neutropenic Fever & Toxic Shock 4.10 Travel-Related Illness, Vector-Borne Disease & Outbreaks 4.11 Infection Prevention, Nosocomial Infection & Postexposure Prophylaxis 4.12 Rheumatic Fever, Poststreptococcal Disease, Enteric & Hepatic Infections
6 Chapter 5: Pulmonary Disease (9% of Exam)
5.1 COPD: Diagnosis, GOLD Classification & Initial Pharmacotherapy 5.2 Interventions That Reduce COPD Mortality & Exacerbation Management 5.3 Asthma: Diagnosis, Stepwise Therapy & Status Asthmaticus 5.4 Interstitial Lung Disease & Idiopathic Pulmonary Fibrosis 5.5 Sarcoidosis, Hypersensitivity Pneumonitis & Occupational Lung Disease 5.6 Pulmonary Embolism: Diagnosis, Risk Stratification & Anticoagulation 5.7 Pulmonary Hypertension & Sleep-Disordered Breathing 5.8 Acute Respiratory Distress Syndrome & Mechanical Ventilation 5.9 Pleural Disease, Empyema & Pneumothorax 5.10 Bronchiectasis, Cystic Fibrosis & Restrictive Lung Disease 5.11 Evaluation of Cough, Dyspnea, Hemoptysis & the Solitary Pulmonary Nodule
7 Chapter 6: Rheumatology & Orthopedics (9% of Exam)
6.1 Rheumatoid Arthritis: Diagnosis & Systemic Manifestations 6.2 Antirheumatic Pharmacotherapy & the Spondyloarthropathies 6.3 Gout: Pathophysiology & Acute Management 6.4 Urate-Lowering Therapy & Calcium Pyrophosphate Deposition Disease 6.5 Osteoarthritis 6.6 Systemic Lupus Erythematosus 6.7 Systemic Sclerosis, Sjogren Syndrome & Inflammatory Myopathies 6.8 The Vasculitides 6.9 Regional Musculoskeletal Syndromes, Back Pain & Sports Injuries 6.10 Other Primary Rheumatic Disorders & Mixed Connective Tissue Disease 6.11 Osteonecrosis & Metabolic Bone Disease
8 Chapter 7: Hematology (6% of Exam)
7.1 Approach to Anemia & the Microcytic Anemias 7.2 Macrocytic, Normocytic & Hemolytic Anemias 7.3 Hemoglobinopathies, Thalassemias & Paroxysmal Nocturnal Hemoglobinuria 7.4 Platelet Disorders, Thrombocytopenia & the Bleeding Patient 7.5 Coagulation Factor Disorders, Thrombophilia & Anticoagulant Reversal 7.6 Acute Leukemias, Chronic Leukemias & Myeloproliferative Neoplasms 7.7 Lymphomas & Plasma Cell Disorders 7.8 Myelodysplastic Syndrome, Myeloproliferative Neoplasms & Porphyria 7.9 Transfusion Medicine & Late Complications of Transplantation
9 Chapter 8: Medical Oncology (6% of Exam)
8.1 Breast, Lung, Colorectal & Prostate Cancer 8.2 Oncologic Emergencies 8.3 Genitourinary & Gynecologic Malignancies 8.4 Head and Neck, Bone & Soft Tissue Cancer and Cancer of Unknown Primary 8.5 Complications of Cancer & Its Treatment 8.6 Cancer Prevention, Survivorship & Psychosocial Care
10 Chapter 9: Nephrology & Urology (6% of Exam)
9.1 Acute Kidney Injury: Staging, Etiology & Urine Microscopy 9.2 Glomerular Disorders & Nephrotic Syndrome 9.3 Nephritic Syndromes, RPGN & Indications for Renal Replacement Therapy 9.4 Chronic Kidney Disease: Staging & Progression Retardation 9.5 Complications of Chronic Kidney Disease: Anemia, CKD-MBD & Acidosis 9.6 Hyponatremia, Hypernatremia & Water Balance 9.7 Potassium Disorders & Systematic Acid-Base Analysis 9.8 Renal Tubular Acidosis & Nephrolithiasis 9.9 Prostate Disorders, Urinary Incontinence & Other Urologic Conditions 9.10 Cystic Kidney Disease, Obstructive Uropathy, Tubulointerstitial Disease & Hematuria
11 Chapter 10: Neurology (4% of Exam)
10.1 Acute Ischemic Stroke: Syndromes & Reperfusion 10.2 Transient Ischemic Attack, Secondary Prevention & Hemorrhagic Stroke 10.3 Headache & Facial Pain 10.4 Seizures, Epilepsy & Movement Disorders 10.5 Multiple Sclerosis & Neuromuscular Junction Disorders 10.6 Motor Neuron Disease & Acute Peripheral Neuropathy 10.7 Cranial Neuropathies & Neuro-Ophthalmology 10.8 Peripheral Neuropathies, CNS Tumors & Other Neurologic Disorders
12 Chapter 11: Psychiatry & Behavioral Health (4% of Exam)
11.1 Major Depressive Disorder & Medical Mimics 11.2 Antidepressant Pharmacotherapy & Treatment-Resistant Depression 11.3 Bipolar Disorder, Mood Stabilizers & Lithium Toxicity 11.4 Anxiety, Stress-Related & Obsessive-Compulsive Disorders 11.5 Alcohol Use Disorder & Withdrawal 11.6 Pharmacotherapy for Alcohol & Opioid Use Disorder 11.7 Toxidromes, Psychiatric Emergencies & Suicide Risk Assessment 11.8 Psychotic, Somatic Symptom, Factitious & Personality Disorders 11.9 Eating Disorders, Sleep Disorders & Sexual Health
13 Chapter 12: Dermatology (3% of Exam)
12.1 Dermatitis, Papulosquamous & Inflammatory Dermatoses 12.2 Acne, Rosacea & Cutaneous Infections 12.3 Herpes Zoster & Autoimmune Blistering Diseases 12.4 Nodules, Tumors & Cutaneous Oncology 12.5 Dermatologic Emergencies & Severe Cutaneous Adverse Reactions 12.6 Pigment Disorders, Alopecia, Nail Disease & Photosensitivity 12.7 Vascular Dermatoses, Environmental Injury & Cutaneous Signs of Systemic Disease
14 Chapter 13: Obstetrics & Gynecology / Women's Health (3% of Exam)
13.1 Contraception, Preconception Care & Teratogenicity 13.2 Hypertensive Disorders of Pregnancy & Gestational Diabetes 13.3 Thyroid Disease & Venous Thromboembolism in Pregnancy 13.4 Menopause & Menopausal Hormone Therapy 13.5 Abnormal Uterine Bleeding, Endometrial Disease & Gynecologic Cancer Screening 13.6 Breast Disorders & Diseases of the Vulva and Vagina 13.7 Menstrual Disorders, Fibroids, Endometriosis & Early Pregnancy Complications
15 Chapter 14: Geriatric Syndromes (3% of Exam)
14.1 Comprehensive Geriatric Assessment & Frailty 14.2 Falls, Gait Assessment & Polypharmacy 14.3 Urinary Incontinence & Pressure Injuries in Older Adults 14.4 Mild Cognitive Impairment, Dementia & Its Subtypes 14.5 Delirium & the Pharmacotherapy of Cognitive Disorders 14.6 Palliative Care, Hospice & Advance Care Planning 14.7 Chronic Wounds, Nutrition, Swallowing, Constipation & Hip Fracture 14.8 Sensory Impairment, Dizziness, Elder Mistreatment & Care Settings
16 Chapter 15: Allergy & Immunology (2% of Exam)
15.1 Anaphylaxis: Recognition & Emergency Management 15.2 Urticaria & Angioedema 15.3 Drug Allergy, Desensitization & Adult Immunodeficiency 15.4 Food Allergy, Insect Venom Hypersensitivity, Serum Sickness & Contrast Reactions 15.5 Rhinitis, Conjunctivitis, Eosinophilic & Mast Cell Disorders
17 Chapter 16: Preventive Medicine, Immunization & Clinical Epidemiology
16.1 The USPSTF Framework & Evidence-Based Cancer Screening 16.2 Cardiovascular & Metabolic Screening and Primary Prevention 16.3 Adult Immunization & Vaccines in Special Populations 16.4 Clinical Epidemiology, Biostatistics & Study Design
18 Chapter 17: Miscellaneous - Ethics, Patient Safety & Quality Improvement (2% of Exam)
17.1 Principles of Bioethics & Decisional Capacity 17.2 Informed Consent, Treatment Refusal & Special Scenarios 17.3 Surrogate Decision-Making, Advance Directives & Confidentiality 17.4 Patient Safety Science, Medical Error & Diagnostic Reasoning 17.5 Quality Improvement Methods, Health Disparities & Health Equity
19 Chapter 18: Perioperative Medicine & Medical Consultation
18.1 Preoperative Cardiovascular Risk Assessment 18.2 Preoperative Pulmonary Risk & Perioperative Medication Management 18.3 Perioperative Anticoagulation, Bridging & Postoperative Complications
20 Chapter 19: Ophthalmology (1% of Exam)
19.1 The Acute Red Eye & Ophthalmic Emergencies 19.2 Painless Vision Loss & Chronic Ophthalmic Disease 19.3 Uveitis, Scleritis & Orbital Disease
21 Chapter 20: Otolaryngology & Dental Medicine (1% of Exam)
20.1 Dizziness, Vertigo & Epistaxis 20.2 Ear Disorders, Hearing Loss & Upper Respiratory Infections 20.3 Oral Cavity, Salivary Gland, Laryngeal & Taste and Smell Disorders
8.3 Genitourinary & Gynecologic Malignancies
Key Takeaways Explain This Topic AI
Renal cell carcinoma, bladder carcinoma, prostate carcinoma and testicular carcinoma are enumerated under urologic cancer.
Ovarian, endometrial, cervical and vulvar cancer are enumerated under gynecologic cancer.
Painless gross hematuria in an adult requires cystoscopy and upper tract imaging regardless of whether it resolves.
A solid testicular mass is malignant until proven otherwise and requires ultrasound with tumor markers and radical inguinal orchiectomy rather than transscrotal biopsy.
Postmenopausal bleeding requires endometrial evaluation because endometrial carcinoma is the leading concern.
Last updated: August 2026
1. Renal Cell Carcinoma
The classic triad of flank pain, hematuria and a palpable mass occurs in under 10% of patients and usually signals advanced disease. Most renal cell carcinomas today are found incidentally on imaging performed for another reason .
Clues that should prompt suspicion:
Paraneoplastic syndromes are unusually common: hypercalcemia (parathyroid hormone-related peptide), erythrocytosis (autonomous erythropoietin production), hypertension (renin), Stauffer syndrome (non-metastatic hepatic dysfunction with elevated alkaline phosphatase that reverses after nephrectomy), fever and amyloidosis.
A new left-sided varicocele that does not decompress when supine suggests left renal vein obstruction by tumor thrombus.
Risk factors: smoking, obesity, hypertension, acquired cystic disease of dialysis, and hereditary syndromes — von Hippel-Lindau disease (clear cell, often bilateral and multifocal, with hemangioblastomas and pheochromocytoma), Birt-Hogg-Dube syndrome and hereditary leiomyomatosis.
Diagnosis is radiologic , using contrast-enhanced CT or MRI; percutaneous biopsy is not routinely required before nephrectomy for a classic enhancing solid renal mass. Renal cell carcinoma is characteristically resistant to conventional cytotoxic chemotherapy ; advanced disease is treated with immune checkpoint inhibitors and tyrosine kinase inhibitors. There is no recommended screening for the general population.
2. Bladder Cancer
Painless gross hematuria is the cardinal presentation , and the single most important teaching point is that it must be evaluated even if it resolves spontaneously and even if a urinary tract infection is present . Intermittency is characteristic of malignancy, not reassuring.
Evaluation of hematuria in an adult: urinalysis with microscopy to confirm true hematuria and assess for glomerular features (dysmorphic red cells, red cell casts, proteinuria), then cystoscopy plus upper tract imaging with CT urography for non-glomerular hematuria. Urine cytology supplements but does not replace cystoscopy.
Risk factors: cigarette smoking (the dominant modifiable factor), occupational aromatic amine exposure (dye, rubber, leather, painting), cyclophosphamide , pelvic radiation, and chronic irritation; chronic Schistosoma haematobium infection causes squamous cell carcinoma of the bladder.
Most tumors are non-muscle-invasive urothelial carcinoma at diagnosis, managed with transurethral resection and intravesical therapy — bacillus Calmette-Guerin for high-grade disease — with lifelong surveillance cystoscopy because recurrence is the rule.
3. Prostate Cancer
Screening is a shared decision, not a routine order. Prostate-specific antigen screening should be individualized after discussion of benefits and harms in men aged roughly 55 to 69, and is not recommended at age 70 and above. The harms — overdiagnosis of indolent disease and treatment-related incontinence and erectile dysfunction — are substantial and must be part of the conversation.
Diagnosis uses PSA and digital rectal examination, increasingly with multiparametric MRI before biopsy to target lesions and avoid unnecessary sampling. Grading uses the Gleason score and Grade Group .
Management by risk:
Low-risk, low-volume disease: active surveillance with serial PSA, MRI and biopsy is preferred, because these cancers frequently never threaten life.
Localized intermediate or high risk: radical prostatectomy or radiation with androgen deprivation.
Metastatic: androgen deprivation therapy combined with an androgen-receptor pathway inhibitor or docetaxel.
Complications the internist manages: androgen deprivation causes osteoporosis (monitor bone density and supplement calcium and vitamin D), metabolic syndrome, cardiovascular risk, hot flashes and sarcopenia. Osteoblastic bone metastases are the classic pattern and may cause spinal cord compression; a bone scan is sensitive precisely because the lesions are blastic, in contrast to myeloma.
4. Testicular Cancer
The most common solid malignancy in men aged 15 to 35, and highly curable even when metastatic , which is why the exam treats a missed diagnosis as a serious error.
Presentation: a painless firm testicular mass or swelling . Any solid intratesticular mass is malignant until proven otherwise. A minority present with pain that is mistaken for epididymitis; failure to resolve on antibiotics requires ultrasound.
Evaluation:
Scrotal ultrasound
Serum tumor markers before orchiectomy: alpha-fetoprotein, beta-human chorionic gonadotropin, lactate dehydrogenase
Radical inguinal orchiectomy — both diagnostic and therapeutic
Transscrotal biopsy or orchiectomy is contraindicated because it violates the scrotal lymphatic drainage and alters the pattern of spread. This is a favorite exam point.
Marker interpretation: pure seminoma never produces alpha-fetoprotein. An elevated alpha-fetoprotein in a tumor that looks like seminoma histologically means it contains non-seminomatous elements and must be treated as a non-seminoma. Beta-hCG may be modestly elevated in seminoma.
Risk factors: cryptorchidism (risk persists in the contralateral testis and after orchiopexy), prior testicular cancer, family history. Sperm banking should be discussed before treatment.
5. Ovarian Cancer
There is no effective screening test , and this is a heavily tested negative: neither CA-125 nor transvaginal ultrasound reduces mortality in average-risk women, and both generate harmful false positives leading to unnecessary surgery.
Presentation is nonspecific and late — bloating, early satiety, pelvic or abdominal pain, urinary urgency — which is why most disease presents at an advanced stage with ascites and carcinomatosis.
Hereditary risk drives management. BRCA1 and BRCA2 mutations confer substantially elevated risk, as does Lynch syndrome . For known carriers, risk-reducing bilateral salpingo-oophorectomy is recommended, generally at ages 35 to 40 for BRCA1 and 40 to 45 for BRCA2 after childbearing. A family history of breast and ovarian cancer should trigger genetic counseling.
Protective factors include combined oral contraceptive use, multiparity and breastfeeding. Treatment is cytoreductive surgery with platinum-taxane chemotherapy, with PARP inhibitor maintenance in homologous recombination-deficient disease.
6. Endometrial Cancer
The most common gynecologic malignancy in the United States, and unusually favorable because it announces itself early.
Postmenopausal bleeding is endometrial cancer until proven otherwise and always requires evaluation — transvaginal ultrasound with an endometrial thickness threshold, or direct endometrial biopsy. Any bleeding after menopause, however slight, qualifies.
Risk factors all reduce to unopposed estrogen exposure:
- Obesity — peripheral aromatization of androgens; the dominant modifiable risk factor
- Chronic anovulation / polycystic ovary syndrome
- Nulliparity, early menarche, late menopause
- Estrogen therapy without a progestin in a woman with a uterus
- Tamoxifen — an estrogen agonist at the endometrium
Lynch syndrome — lifetime risk approaching that of colorectal cancer; endometrial cancer is frequently the sentinel malignancy in affected women
Combined oral contraceptives and progestin-containing intrauterine devices are protective. Routine screening is not recommended , even in tamoxifen users; the recommendation is prompt evaluation of any abnormal bleeding.
7. Cervical Cancer
Almost entirely attributable to persistent high-risk human papillomavirus infection, particularly types 16 and 18 — which makes it both preventable by vaccination and detectable by screening.
Screening combines cytology and HPV testing at guideline-defined intervals beginning at age 21, with primary HPV testing increasingly preferred in older cohorts. HPV vaccination does not change screening recommendations for those already vaccinated.
Presentation when screening fails: postcoital bleeding, abnormal vaginal bleeding, or malodorous discharge. Advanced disease causes obstructive uropathy from ureteral involvement, which is a common cause of death.
Immunosuppression, including HIV infection, increases risk and progression rate and mandates more frequent screening.
8. Vulvar Cancer
Uncommon, and important chiefly because it is frequently misdiagnosed as a benign dermatosis for months or years . A persistent vulvar plaque, ulcer, pruritus or pigmented lesion that does not respond to topical therapy requires biopsy rather than another prescription .
Two pathways: an HPV-related pathway in younger women and a non-HPV pathway arising in lichen sclerosus in older women — which is why lichen sclerosus warrants surveillance rather than indefinite empiric treatment.
9. Urologic and Gynecologic Cancer Screening: What Is and Is Not Recommended
- Cancer Screening recommendation
- Cervical Yes — cytology and/or HPV testing per age-based schedule
- Prostate Shared decision-making , roughly ages 55 to 69; not routine after 70
- Ovarian No — CA-125 and ultrasound do not reduce mortality in average-risk women
- Endometrial No — evaluate abnormal bleeding promptly instead
- Bladder No — evaluate hematuria instead
- Renal No — except surveillance in hereditary syndromes
- Testicular No — self-examination is not evidence-based screening
The pattern to internalize: for most genitourinary and gynecologic cancers, the evidence supports rapid evaluation of a specific symptom rather than population screening. Cervical cancer is the outlier, because a long, detectable pre-invasive phase makes screening effective.