Gyn-onc

Question 1

Which 2 subtypes of HPV are the most prevalent in cervical cancer?

Answer 1

16 and 18

Question 2

Screening for cervical cancer?

Answer 2

Pap smear, HPV DNA testing

Question 3

What does HPV vaccination do?

Answer 3

Reduces the incidence of premalignant lesion development in the cervix, vagina, and bulbs in women. Reduces genital warts and anal cancer in men.

Question 4

Treatment for FIGO stage IB1 cervical cancer (lesion

Answer 4

Radical hysterectomy and lymph node dissection. If positive lymph nodes, positive margins, positive parametria, consider adjuvant cisplatin-based chemoradiation.

Question 5

For metastatic cervical cancer, the addition of bev to chemo:

Answer 5

Improved OR by 4 months.

Question 6

Risk factors for cervical cancer?

Answer 6

HPV, smoking, immunocompromise, early coitarche, multiple sexual partners

Question 7

What are the 2 types of endometrial cancer?

Answer 7

Type I: endometrioid, due to unopposed estrogen exposure. Type II: non-endometrioid such as papillary serious or clear cell, higher mortality rate.

Question 8

Risk factors for endometrial cancer?

Answer 8

Unopposed estrogen, obesity, nulliparity, late menopause, complex atypical endometrial hyperplasia, and tamoxifen use, HNPCC. Combined OCP and smoking decrease the risk.

Question 9

How is endometrial cancer staged?

Answer 9

Surgically

Question 10

Treatment of endometrial cancer?

Answer 10

Surgery alone for early stage, low risk (stage IS, grade 1 or 2) endometrial cancer. Adjuvant therapy for high-intermediate risk. Adjuvant chemo for completely resected stage III and IV cancer. For low-grade, recurrent and metastatic endometrial cancer, progestin-based therapy. For high-grade metastatic disease, chemo (platinum, paclitaxel, doxorubicin, and bevacizumab)

Question 11

Treatment for uterine carcinosarcomas (mixed Mullerian rumors)?

Answer 11

Always adjuvant chemo after resection. Use a combination of two drugs (platinum, ifosfamide, paclitaxel)

Question 12

Treatment for uterine leiomyosarcoma?

Answer 12

Resection then observation for non-metastatic disease. No adjuvant therapy. For metastatic disease, gem plus docetaxel with RR about 30%. Doxorubicin with or without ifos is also OK.

Question 13

Risk factors ovarian cancer?

Answer 13

Advanced age, family history, BRCA1/2, HPNCC, white race, fatty diet, nulliparity, first birth after age 35, , involuntary infertility, late menopause, early menarche. OCP use is protective.

Question 14

Risk factors for ovarian cancer?

Answer 14

Increasing age, family history, BRCA1/2, HNPCC, white race, fatty diet, nulliparity, first birth after age 35, late menopause, early menarche. COPs are protective.

Question 15

Only 50% of patients with early stage ovarian cancer have elevated CA-125 levels. T or F?

Answer 15

True

Question 16

Neoadjuvant chemo followed by surgical cytoreduction yields equivalent outcomes to surgery followed by chemo for patients with clinically advanced epithelial ovarian cancer. T or F?

Answer 16

T

Question 17

Do patients with favorable-risk, early-stage ovarian cancer (stage IA or IB, grade 1-2) require adjuvant chemo after complete surgical staging?

Answer 17

No

Question 18

Chemo for advanced ovarian cancer?

Answer 18

Platinum plus taxane. The addition of bev increases PFS but not OS. Patients with optimally cytoreduced, stage III cancer have better OS when receiving IP chemo. Consolidation with paclitaxel has modest PFS benefit but also more alopecia and neuropathy.

Question 19

Data on second-look laparotomy at the completion of first-line chemo for advanced ovarian cancer?

Answer 19

Provides prognostic info but does not improve survival.

Question 20

Treatment for recurrent ovarian cancer?

Answer 20

If more than 12 months since last chemo, try platinum doublet again. Between 6 and 12 months, single agent platinum or non-platinum. Less than 6 months, nonplatinum single agent, with RR of 10-20%.

Question 21

Treatment for sex-cord stromal cell tumors of the ovary?

Answer 21

Often diagnosed at stage I. Surgical resection. No adjuvant chemo. Some patients have concurrent endometrial carcinomas.

Question 22

Treatment of germ cell tumors of the ovary?

Answer 22

Half are dysgerminomas. After staging surgery, stage I dysgerminomas and stage I, grade 1 immature teratomas need no adjuvant therapy. All other nondysgerminomas and higher-stage dysgerminomas need 3 or 4 cycles of cis/etop/bleo.

Question 23

Treatment of gestational trophoblastic disease?

Answer 23

Highly curable with chemo. Low risk: methotrexate. High risk: etop/methotrexate/dactinomycin alternating with cyclophosphamide/vincristine.

Question 24

Treatment for stage IB2 (lesion > 4 cm) cervical cancer and higher stages?

Answer 24

Cisplatin-based chemoradiation. Palliative chemo for stage IVB (distant mets).

Question 25

Small cell carcinoma of the ovary, hypercalcemic type, has been associated with which genomic alteration?

Answer 25

Mutation in the transcription activator BRG1 (SMARCA4)