Gyn Onc

Question 1

Point A for Radiotherapy for carcinoma of the cervix. How much Rads for local advanced disease?

Answer 1

2 cm above level of external os and 2cm lateral to the midline (point of crossover of artery over ureter)

Question 2

Point B for Radiotherapy for carcinoma of the cervix. How much Rads?

Answer 2

3 cm lateral to point A (position of obturator nodes) Aim to deliver 5500 to 6500. Rads to Point B depending on the extent of parametrial/sidewall disease

Question 3

High risk HPV subtypes

Answer 3

16, 18, 31, 33, 35, 45

Question 4

Describe the histological architecture of Endometrial Intraepithelial Neoplasia (EIN)

Answer 4

Increased glandular density w/ atypia

Question 5

Risk of malignancy w/ Endometrial Intraepithelial Neoplasia (EIN)

Answer 5

formerly simple/complex hyperplasia w/ atypia (formerly 10/30%)

30-50%

Question 6

Types of Endometrial Cancer

Answer 6

Type I- Endometriod, 75% of endometrial cancer, global process, unopposed estrogen, better prognosis

Type II- Clear Cell, Papillary Serous. High grade, poorer prognosis, more focal in origination

Question 7

How is staging for uterine cancer performed?

Answer 7

Surgical staging-remove uterus, cvx, adnexa, pelvic and para aortic nodes and pelvic washings

Question 8

One of most important prognostic factors for endometrial carcinoma?

Answer 8

Presence of extra uterine disease

Question 9

What percent of patients w/ surgery for an atypical endometrial hyperplasia will have an endometrial cancer at final pathology?

Answer 9

40% of patients

Question 10

Criteria for patient selection for Medical Management of Endometrial Carcinoma?

Answer 10

1. Pre-menopausal w/ strong desire to preserve uterus for fertility
2. Poor candidate for major operation due to medical co-morbidities

Question 11

Medical Management of Endometrial Cancer

Answer 11

1. Medroxyprogesterone or Megestrol
2. Progesterone-containing IUD

Should be prescribed by Gyn Onc

Question 12

Differential Dx of Solid Ovarian Tumor

Answer 12

Fibroid
Thecoma
Fibroma
Fibrothecoma
Brenner
Granulosa Cell Tumor
Dysgerminoma

Question 13

Differential Dx of Cystic Tumors

Answer 13

Fx Cysts
Serous Cysts
Mucinous Cysts
Mature cystic teratoma

Question 14

Bilaterality of Germ cell tumors

Answer 14

5-10% (teratoma)

Exception=gonadoblastoma (40%)

Question 15

Bilaterality of Fibroma

Answer 15

10%

Question 16

B/L of Serous carcinoma

Answer 16

66%

Question 17

B/L of Mucinous carcinoma

Answer 17

20%

Question 18

B/L of Krukenburg

Answer 18

100% ( from GI tract )

Question 19

B/l of Mucinous adenoma

Answer 19

0% (virtually)

Question 20

B/l of Serous adenoma

Answer 20

10%

Question 21

CA-125

Answer 21

Serous epithelial tumors

Question 22

False + CA-125

Answer 22

Appendicitis
Cholecystitis
PID
Fiborids
Endometriosis
Diverticulosis

Question 23

CEA

Answer 23

Mucinous epithelial tumors

Question 24

AFP

Answer 24

Endodermal sinus tumors
Embryonal tumors
Germ Cell Tumors

Question 25

HCG

Answer 25

Choriocarcinoma
Embryonal Sinus tumor
Germ cell tumors

Question 26

Estrogens

Answer 26

Granulosa Cell tumor

Question 27

Androgens

Answer 27

Thecoma
Fibroma
Sertoli-Leydig cell tumor

Question 28

Inhibin

Answer 28

Granulosa cell tumor

Question 29

LDH

Answer 29

Dysgerminoma

Question 30

Criteria for borderline tumors

Answer 30

Epithelial stratification
Papillations
Nuclear atypia
No stromal invasion

Question 31

Dysgerminoma

Answer 31

Typically young, nullip

Treat with USO, limited staging, conserve contralateral Ov and uterus, Follow with LDH, HCG tumor markers.