Gyn Onc

Question 1

Types of ovarian cancer

Answer 1

Epithelial (59%)
Serous cystadenoma- bilat, psammoma bodies
Mucinous 
Undifferentiated 
Endometrioid 
Clear cell
Brenners
Squamous

Question 2

Tumor markers

Answer 2

CEA-elevated in mucinous tumors
HE4- epithelial ovarian ca
AFP- endodermal sinus/yolk sac tumor
HCG- choriocarcinoma
LDH- dusgerminoma
Inhibin- granules a cell tumor
Sertoli Leydig- testosterone

Question 3

Types of germ cell tumors

Answer 3

Immature teratomas
Dysgerminoma can be associated with Gonadoblastoma
Endodermal sinus (Schiller Duvall bodies)
Mature teratoma /(malignant potential 1% SCC)
Choriocarcinoma

Question 4

Sex cord stromal tumors

Answer 4

Granulosa cell tumors- call exner bodies, coffee bean nuclei.
Often associated with endometrial hyperplasia
Inhibin

Sertoli-stromal cell tumors- virilizing, Reinke crystals

Question 5

Adjuvant breast cancer therapies

Use in?
Menopausal status?
Risks

tamoxifen
Raloxifene
AI

Answer 5

ER+/unknown
Both
VTE

ER+
Post
VTE

ER+/unknown
Post
Bone loss

Question 6

Stage 1 cervical cancer

Answer 6

1A: <5 mm
1B: Greater than or equal to 5 mm

Question 7

Stage 2 cervical cancer

Answer 7

Beyond uterus, upper 2/3 of vagina but not to pelvic sidewall

2A1: clinical lesions<4cm in greatest dimension
2A2: > or = 4cm
2B: extension to parametrium

Question 8

Stage 3 cervical ca

Answer 8

3A: lower 1/3 vagina, not pelvic sidewalk
3B: to pelvic SW, hydronephrosis
3C1: pelvic LNs
3C2: paraaortic Lns

Question 9

Cervical cancer stage 4

Answer 9

4A: spread to adjacent pelvic organs

4B: spread to distant organs

*cervical cancer staging is clinical**

Question 10

Treatment for cervical cancer

Answer 10

1A1: cone or simple hysterectomy
1A2: rad hyst + nodes
1B-2A: surgery, nodes OR radiation + cis platinum
2B and up: radiation and cis platinum

Question 11

High risk/oncogenic HPV subtypes

Answer 11

16,18,31,33,35,45,52,58

Question 12

Ovarian cancer staging

Stage 1

Answer 12

Confined to ovary, tube
1A limited to 1 ovary/tube, capsule intact
1B limited to both ovaries/tubes, capsule intact
1C: 1A or 1B with:

1C1: surgical spill
1C2: capsule ruptured or tumor on surface
1C3: positive washings

Question 13

Ovarian cancer

Stage 2

Answer 13

Spread to pelvis

2A: uterus
2B: other pelvic intraperitonral tissues

Question 14

Ovarian cancer stage 3

Answer 14

Peritoneal implants outside the pelvis or positive nodes

3A: positive retroperitoneal nodes and/or microscopic spread outside the pelvis
3B: peritoneal spread <2 cm +or- nodes
3C: peritoneal spread >2cm +or- nodes

Question 15

Ovarian cancer stage 4

Answer 15

4A: pleural effusion +cytology
4B: parenchyma disease or extra-abdominal disease

Question 16

DDX FOR solid tumors

Answer 16

Fibrous
Thecoma
Fibroid
Granulosa cell tumor
Dysgerminoma
Brenner tumor

Question 17

Cystic tumors

Answer 17

Functional cysts
Serous and mucinous tumors
Mature teratoma

Question 18

Endometrial cancer

Stage 1
Stage 2

Answer 18

Stage 1A: <1/2 myometrial invasion
Stage 1B: >1/2 myometrial invasion

Stage 2: cervical stroma

Question 19

Endometrial cancer
Stage 3

Stage 4

Answer 19

3A: serosal or adnexal involvement
3B: vaginal involvement
3C: positive pelvic or para-aortic LNs

4A: bladder and/or rectum
4B: distant metS

Question 20

Complete vs partial mole

Answer 20

Complete 
46XX or 46 XY
No fetus
Theca lutein cysts
15% GTN

Partial
69XXX OR 69XXY
fetus present
3% GTN

Question 21

Bad prognostic factors for GTN

Answer 21

>4 mo since pregnancy
Pretreatment HCG >40000
Mets to liver and brain
Preceded by term pregnancy instead of ab 
Previous therapy failed

Question 22

Treatment for GTN

Answer 22

Single agent MtX vs actinomycin D for low risk dz

EMA CO for high risk dz (etoposide, MTX, actinomycin D, cyclophosphamide and vincristine

Question 23

Causes of cancer death in US women

Answer 23

Lung
Breast
Colon 
Pancreas
Ovary

Question 24

Histopathology
Ovarian tumors
1. Brenner
2. 
Dysgerminoma
3. Struma ovarii 
4. Granulosa cell tumor
5. Krukenburg tumor
6. Endodermal sinus/yolk sac tumor
7. Serous tumors, low malignant potential tumors

Answer 24

1. Coffee bean nuclei, island of transitional epithelium
2. Lymphocytes
3. Single germ cell layer containing thyroid tissue
4. Call Exner bodies (Starry sky appearance), coffee bean nuclei
5. Signet ring cells
6. Schiller Duvall bodies
7. Psammoma bodies

Question 25

Subtypes of epithelial ovarian cancer

Answer 25

Serous High grade or a low-grade
Clear cell
Endometrioid
Mucinous

Question 26

Risk of breast and ovarian cancer in BRCA1

BRCA2

Answer 26

BRCA 1
Breast 60%
Ovarian 40%

BRCA 2
Breast 50%
Ovarian 15%

Question 27

Which genes warrant risk reducing BSO?

Answer 27

BRCA 1&2
Lynch syndrome
BRIP1
RAD 51C&D

Question 28

Screening for BRCA carriers age 25-29

>30

Answer 28

Clinical breast exam q6mo
Breast MRI annually

Annual mammo and annual breast MRI staggered q6mo

Question 29

Chemoprohylaxis in breast cancer

Answer 29

Tamoxifen for BRCA2. Doesn’t work for a BRCA1 (likely because of negative receptor status)

Question 30

Side effects of tamoxifen

Raloxifene

Answer 30

VMS
vaginal dryness
VTE
endometrial cancer

VTE
LEG cramps
Dyspareunia
Weight gain

Question 31

Type 2 endometrial cancers

Answer 31

Clear cell

Papillary serous

Question 32

Risk factors for endometrial cancer

Answer 32

DM
OBESITY
HTN
Smoking increases risk for type 2 only

Question 33

Pelvic LNs

Para-aortic LNs

Answer 33

Removal of nodal tissue from distal half of common iliac

Distal IVC from level of IMA to right common iliac artery