GYN

Question 1

Gestational trophoblastic disease versus neoplasm

Answer 1

GTD = hydratiform moles (treat with evacuation and hcg monitoring)

GTN = single agent MTX versus combination chemo; choriocarcinoma is treated with hysterectomy and is emergency

Question 2

What is preferred cervical cancer prevention?

Answer 2

Guardasil 9
Covers strains 6, 11, 16, 18, 31, 33, 45, 52, 58
Approved for 9-45 yo males and females
2 dose vaccine, typically given around age 11 or 12 (3 doses after age 15 or immunocompromised individuals)

Question 3

When do you give adjuvant chemotherapy in stage I endometrial cancer?

Answer 3

Adjuvant chemo if high risk features
→ Grade 3 dx, >50% myometrial invasion, LVSI, age > 60 (this is for endometrioid which is most common type)

For serous, clear cell, carcinosarcoma → high risk → give chemo+RT (though controversial if stage IA)

Question 4

When do you give adjuvant chemotherapy in Stage I-II cervical cancer?

Answer 4

Stage I-II
Low risk → No LV: surgery (hysterectomy, trachelectomy)

Interm risk → +LV or bulky disease: Radical hysterectomy* + pelvic LN dissection and adjuvant RT if +LNs or +margins

High risk → +pelvic LN, + parametria, +margins: ChemoRT**

Question 5

Adjuvant therapy in early stage vaginal cancer?

Answer 5

Stage I: Surgery or EBRT/brachytherapy

Stage II-IVA: concurrent chemoRT

Question 6

Adjuvant therapy for early stage serous ovarian cancer?

Answer 6

Stage 1A or 1B (low grade - grade 1; confined to ovaries, capsules intact, no malignant cells in fluid) - observation
1c and 2 - carbo + taxol

Also give chemo for clear cell and high grade serous

Question 7

Most common type of ovarian cancer

Answer 7

Epithelial (95%) 
Which is broken down into 
	High grade serous (75%)
	Endometrioid (good px)
	Clear cell (aggressive)
	Mucinous 
	Transitional cell 
	Carcinomsarcoma

Can also have
Metastatic from other site
Germ Cell
Sex cord stromal

Question 8

Ovarian germ cell tumors

Answer 8

Teratoma, dysgerminoma, yolk sac, endodermal sinus tumor

Stage 1, grade 1 teratomas and stage 1 dysgerminoma - ok to observe after surgery; the rest need adjuvant chemo

Question 9

Ovarian sex cord stroma tumors

Answer 9

Includes granulosa tumor, thecoma, fibroma, etc etc

Adjuvant chemo with BEP if > stage 1, high risk, poorly differentiated

Question 10

Cervical cancer staging – differentiate stage 3 (where you do chemoRT) versus stage 1 or 2

Answer 10

Stage III: Extension to pelvic wall, lower ⅓ vagina, or causing hydronephrosis

Stage 1B-IIA - SOC is open radical hysterectomy + pelvic LN dissection

Question 11

Treatment for gestational trophoblastic disease

Answer 11

Low risk (0-6) - MTX

High risk (7 or higher) - EMA/CO

Question 12

Choriocarcinoma

Answer 12

oncology emergency!
can die from hemorrhage (DIC)

versus carcinosarcoma - which is type of endometrial cancer

Question 13

Adjuvant treatment ovarian cancer stage 3 or 4?

Answer 13

Adjuvant chemotherapy with carbo + paclitaxel (weekly or q3 wks)

Maintenance therapy
BRCA WT or unknown: Observation, niraparib*, bev if surgical resection and high risk for recurrence (pleural effusion, ascites)**

BRCA +: Olaparib or niraparib OR olapartib + bev

HRD +: niraparib

Question 14

Maintenance therapy in advanced ovarian cancer

Answer 14

Maintenance therapy
BRCA WT or unknown: Observation, niraparib, bev if surgical resection and high risk for recurrence (pleural effusion, ascites)

BRCA +: Olaparib or niraparib OR olapartib + bev

HRD +: niraparib