10. Neoplasms

Question 1

Typical endometrial patient characteristics

Answer 1

Post menopausal bleeding; Nulliparious; High BMI; FH of colon CA; Possible PCOS

Question 2

What cancer is most closely linked to obesity?

Answer 2

Endometrial cancer

Question 3

Sentinel sx of endometrial CA

Answer 3

Postmenopausal bleeding

Question 4

Most effect tx for endometrial CA

Answer 4

Surgery;

Question 5

2nd line tx for endometrial CA

Answer 5

Radiation & chemo; Metformin is targeted tx

Question 6

What is the MoA of Metformin in endometrial CA?

Answer 6

PTEN pathway, which is abnormal in almost all endometrial CA

Question 7

3rd line tx for endometrial CA

Answer 7

Progesterone-only HRT

Question 8

What tx is preferred for elderly pts with endometrial CA?

Answer 8

Hormonal

Question 9

Why would progesterone tx be preferrable for young woman with endometrial CA?

Answer 9

Preserves reproductive organs

Question 10

Tumor suppressor genes MLH1, MSH2,PMS2, and MSH6 are associated with what syndrome?

Answer 10

Lynch syndrome

Question 11

What cancers are most common with Lynch syndrome?

Answer 11

Colon & endometrial cancers are most common. Lifetime risk of developing one is 80%.

Question 12

Is Lynch syndrome a dominant or recessive inheritance?

Answer 12

Dominant

Question 13

When is prophylactic hysterectomy and oophorectomy recommended?

Answer 13

Lynch syndrome after age 35 or once childbearing is complete

Question 14

When should Lynch syndrome patients begin colorectal cancer screening? How frequently?

Answer 14

Colonoscopy q1-2 yrs starting at 20-25

Question 15

When should Lynch syndrome patients begin endometrial biopsy screening? How frequently?

Answer 15

Annually beginning at age 30-35

Question 16

When is the most common type of endometrial cancer?

Answer 16

Endometrioid endometrial CA

Question 17

What are the most aggressive endometrial CA types?

Answer 17

Serous & clear cell (not well-understood)

Question 18

When is ovarian cancer most commonly found?

Answer 18

Stage 3 or 4

Question 19

What is the cure rate when ovarian cancer is commonly found?

Answer 19

30%

Question 20

Typical ovarian CA patient characteristics

Answer 20

Postmenopausal; Nulliparious; IBS; FH of Breast CA

Question 21

Ovarian CA tx

Answer 21

Surgery (aggressive debulking) + Chemo (taxane & platinum) via intraperitoneal route + Targeted therapy

Question 22

When is surgery contraindicated in ovarian CA?

Answer 22

If pt isn’t willing to take chemo.

Question 23

What is the relapse rate of ovarian CA?

Answer 23

75%

Question 24

What is one of the most chemo-sensitive cancers?

Answer 24

Ovarian

Question 25

What chemo agents are used in recurrent ovarian CA?

Answer 25

Bevacizumab (Avastin) & PARP inhibitor olaparib

Question 26

Role of radiation in ovarian ca?

Answer 26

Palliative care

Question 27

What cultural group is at highest susceptibility to BRCA1/2 mutations?

Answer 27

Ashkenazi Jews

Question 28

What effect do OCPs have on ovarian cancer?

Answer 28

50% reduction after 5 yrs of use

Question 29

What is the ovarian cancer risk reduction is offered by tubal ligation and hysterectomy?

Answer 29

30-50%

Question 30

What is the gold standard in ovarian CA prevention?

Answer 30

Bilateral salpho-oophorectomy (Upto 95% reduction); Also decreases Breast CA risk by 50%

Question 31

What percentage of women with ovarian cancer receive standard of care tx?

Question 32

Characteristics of cervical CA patients

Answer 32

Postcoital bleeding; Smoker; NL BMI; no GYN care

Question 33

Cervical CA dx - Most common stage

Answer 33

Stage 1

Question 34

What chemotherapy agents are used in cervical cancer tx?

Answer 34

Bevacizumab (Avastin) for recurrent dz

Question 35

Stage IA cervical CA surgery

Answer 35

Cone bx vs. simple hysterectomy

Question 36

Stage IB cervcial CA surgery

Answer 36

Radical hysterectomy/LND

Question 37

When is surgery no longer a tx option for cervical CA?

Answer 37

Stages beyond 1B not surgical candidates

Question 38

When is exenteration indicated?

Answer 38

Palliative care for recurrent cervical cancer

Question 39

What is the most effective cancer screening tool?

Answer 39

PAP

Question 40

Can you contract HPV from the vaccine?

Answer 40

No. It contains no virus DNA or RNA.