Gyn Onc

Question 1

Poor prognostic factors endometrial adenocarcinoma

Answer 1

High grade
Non endometrioid subtype
Lymphovascular space invasion
>50% myometrial invasion 
Cervical involvement
Extrauterine spread
Age >65
Medical factors preventing surgery
Generic factors - aneuploidy, p53 positive

Question 2

Ovarian cancer

What do you ask for with Rr BSO or prophylactic salpingectomy

Answer 2

SEE-FIM protocol

Serial examination end fimbriae

Lots of sections of fimbrial ends looking for precursor lesions that are likely to develop into peritoneal or primary ovarian carcinoma

Question 3

Work up of adnexal mass and also epithelial ovarian cancer

Answer 3

MDT
(Histology biopsy if readily available eg ascites or surgery)
Imaging: USS +/- CT CaP
Tumour markers (epithelial Ca125 Cea Ca199 and others depending on age appropriateness)
Risk score (IOTA or RMI)
Mode of surgery
Type of surgeon

Functional, comorbidity, nutritional status (albumin, ferritin, weight, bmi, skin fold test)

Question 4

Important UsS features as adnexal mass (6)

Answer 4

Size
Morphology (inner wall,septa,echogeneicty) 
Excrescences
Adores
Colour flow
Abnormal resistance

Question 5

Risk factors ovarian epithelial cancer

Answer 5

Age
Incessant ovulation (low parity, infertility)
Family history: 10-15% have hereditary component
Talc, race, mumps

Protective: ocp, hysterectomy, tubal ligation

Question 6

Signs epithelial ovarian cancer

Answer 6

Abdominal distension
Abdomino (pelvic) mass
Modularity in POD
Pleural effusion 
Other: nutritional depletion, SBO

Question 7

How to assess nutritional status pre op

Answer 7

Weight/BMI
Albumin
Ferritin
Skin fold assessment

Question 8

Surgery for ovarian epithelial adenocarcinom

Answer 8

Extrafascial hysterectomy + bilateral salping oophrectomy + infracolic omentectomy + cytoreduction + peritoneal cytology

NO indication for lymphadenectomy

Question 9

Which ovarian cancers are less chemo-responsive ?

Answer 9

Low grade serous
Mucinous
Clear cell

in these situations, primary resection, bulk reduction really important

Question 10

Common general chemo side effects

Answer 10

Myalgia
Alopecia
Weakness

Neuropathy/thrombocytoneia also common

Question 11

PARP inhibitors

Answer 11

Standard of care

survival advantage in BRCA patients

Question 12

What size tumour should be operated on premenarchal and premenopausal ?

Answer 12

Premen >2cm

Premeno >8cm (altho can be managed w observation or hormone suppression for 2 cycles)

Question 13

Young girl with adnexal mass

Answer 13

Think GERM cell tumour
If >2cm, operate
Needs KARYOTYPE can due to dysgenetic gonads

Question 14

Dysgerminoma

Answer 14

Germ cell tumour
often young patient
Often bilateral
Do karyotype
CAn be fertility sparing, aim for surgery first, if get recurrence or other side involved, chemo sensitive

Chemo - BEP, can often avoid in early stage disease

Question 15

What to do about borderlines ? Amount of recurrence

Answer 15

Cystectomy 25-30
Oophrectomy 5%
Whole pelvic clearance <5%