Cancer

Question 1

What clinical feature might a patient with stage 3 cervical cancer present with?

Answer 1

flank pain due to ureteric obstruction - hydronephrosis (stageIIIB can result in hydronephrosis)

Question 2

What factors reduce the risk of ovarian cancer?

Answer 2

oral contraceptives, high parity, breast feeding, hysterectomy, tubal ligation, statins, SLE

Question 3

what factors reduce the risk of endometrial cancer?

Answer 3

aspirin use, coffee consumption, SLE, mirena coil

Question 4

What factors increase the risk of endometrial cancer?

Answer 4

PCOS, obesity, early menarche, late menopause, HRT, nulliparity, diabetes, parkinson’s, tamoxifen

Question 5

What are the IOTA ultrasound rules for ovarian malignancy on ultrasound?

Answer 5

very high blood flow, irregular solid tumour, ascites, at least four papillary structures, irregular multilocular tumour with largest diameter >100mm

Question 6

What are the IOTA ultrasound rules for benign ovarian pathology on ultrasound?

Answer 6

no blood flow, unilocular cysts, solid components <7mm, acoustic shadowing, smooth multilocular tumour with largest diamete <100mm

Question 7

What does Gardasil vaccinate against?

Answer 7

HPV 6 11 16 18

Question 8

Which HPV most commonly cause cervical cancer?

Answer 8

16 18

Question 9

Which HPV most commonly cause anogenital warts?

Answer 9

6 and 11

Question 10

How does HPV induce cancer?

Answer 10

Induce onco-protein E6 which inactivates tumour suppressor p53 and onco-protein E7 which inactivates tumour suppressor pRB

Question 11

Management of a Simple cyst on uss 50-70mm diameter in pre-menopausal woman?

Answer 11

yearly ultrasound

Question 12

Management of a large Simple cyst on uss >70mm diameted in pre-menopausal woman?

Answer 12

MRI or surgical intervention can be considered

Question 13

How do you assess risk of malignancy for ovarian cancer?

Answer 13

Risk of malignancy 1: ultrasound score x Ca125 level x menopausal score

Question 14

What abnormal features on ultrasound are suggestive of ovarian cancer?

Answer 14

multi-locular cyst
solid areas
ascites
intra-abdo mets

Question 15

What are classic histological features of serous cystadenocarcinoma of the ovary?

Answer 15

psammoma bodies - round microscopic calcifications

Question 16

What are the classic histrological features of mucinous tumours of the ovary?

Answer 16

mucin vacuoles

Question 17

Definition of endometrial hyperplasia

Answer 17

irregular proliferation of the endometrium - increased gland to stroma ratio

Question 18

What is the association between granulosa cell tumours of the ovary and endometrial hyperplasia?

Answer 18

granulosa cell tumours secrete oestrogen and therefore induce endometrial hyperplasia in 40% of cases

Question 19

Wha tis the risk of progression from endometrial hyperplasia without atypia to carcinoma?

Answer 19

<5% in 20 years

Question 20

Treatment of endometrial hyperplasia without atypia

Answer 20

removal of risk factors i.e. losing weight if high BMI

medical treatment - mirena has higher regression rate than oral progesterone

Question 21

What to give patients with endometrial hyperplasia without atypia who decline local treatment with mirena

Answer 21

continuous progesterone: medroxyprogesterone 10-20mg or norethisterone 10-15mg

Question 22

Follow up of patients with endometrial hyperplasia without atypia

Answer 22

6 monthly - should have 2 negative biopsies before discharge

patients at higher risk (oral treatment and high BMI) should have annual biopsies

Question 23

Treatment duration for endometrial hyperplasia without atypia

Answer 23

minimum 6 months, advise 5 years for mirena to prevent recurrence

Question 24

Treatment of endometrial hyperplasia with atypia

Answer 24

Total abdominal hysterectomy - laparoscopic approach

NOT ENDOMETRIAL ABLATION

Question 25

What is the most common type of ovarian cancer?

Answer 25

epithelial (68% serous)

Question 26

What are the different categories of ovarian cancer?

Answer 26

epithelial
germ cell
sex cord/stromal