Gyn Onc

Question 1

HPv infection persistence risks (2)

Answer 1

Immunocompromised and smoking

Question 2

Cervical staging

Answer 2

Figo
I:cervix only
A <5mm
A1<3mm
A2>3mm
B >5mm
II: beyond cervix
III: beyond uterus or pelvic nodes
IV: beyond true pelvis, bladder, rectum or distant met

Question 3

Ia1 cervical treatment and define stage

Answer 3

Simple hysterectomy or cone

Question 4

Stage ia2 treatment and define stage cervical

Answer 4

Radical hysterectomy or trachelectomy with LN dissection or chemorads

Question 5

Stage IB 1/2 treatment cervical and define stage

Answer 5

Radical hysterectomy or trachelectomy with LN dissection or chemorads
<4mm depth

Question 6

Locally advanced cervical define stage

Answer 6

Chemo rads (cisplatin)
Ib3 up to ivb

Question 7

Radical vs simple hysterectomy

Answer 7

Radical includes parametrium (tissue around uterus that contains ureters), increased risk

Question 8

Adjuvant therapy cervical indications

Answer 8

Positive surgical margins, pos nodes, parametria involved is chemorads
Intermediate risk sedlis criteria +/- rads

Question 9

Chemo rads includes 2 parts; chemo schedule cervical

Answer 9

External beam and brachytherapy, weekly cisplatin during rads (chemo adds sig survival benefit) 40 mg/m2 for 5-6 weeks

Question 10

Localized recurrent disease cervical

Answer 10

Surgery if had rads: pelvic exenteration cure rate 30-50%, but morbid (colostomy and illeal conduit, flaps)
Rads if had surgery

Question 11

Stage ivb disease and first line regimen cervical

Answer 11

Palliative chemo includes:
Cisplatin and taxol
Carbo and taxol no major difference in trial so this can and is often used instead
Stat sig benefit with addition of bevacizumab to above (17 vs 13 mo) higher 48% RR, fistula risk

Question 12

Second line options cervical

Answer 12

Check pdl1/ cps
15-18% RR
Pdl1+/ cps1

Tisotumab Vedotin ADC

Single agent chemo 5-10% RR

Question 13

Uterine staging

Answer 13

I uterus
II cervix
III local regional spread inc nodes
IV bowel bladder or Mets

Question 14

Stage I treatment

Answer 14

Surgery; then rads depending on invasion and grade of cancer

Question 15

Stage iiia/b uterine

Answer 15

Chemo +/- rads

Question 16

Stage iiic uterine treatment

Answer 16

Chemo/rt + tc x4

Question 17

Systemic therapy uterine first and subsequent lines

Answer 17

Carbo taxol standard of care first line
+/- herceptin (her2+)
Or hormonal if endometrioid

Second line
Msi testing then
Lenvatinib/pembro—> mss good responses
Pembro alone for msih

Then
Everolimus letrozole (endometrioid)
Bevacizumab alone (no benefit with chemo)
Second line chemo RR 15-20%

Question 18

Uterine carcinosarcoma management

Answer 18

Resect
Carbo taxol over ifos taxol
Rads helps with local recurrence not os
Then standard uterine other second lines

Question 19

Leiomyosarcoma management

Answer 19

Resect
1st line gem taxotere
Rads for local control not os
Then other sarcoma regimens

Question 20

Treatment of endometrial stromal sarcoma

Answer 20

Hormone responsive, megestrol acetate