Gyn Oncology

Question 1

What are risk factors for uterine sarcoma?

Answer 1

• Increasing age
  
  • Black women
  • Tamoxifen use
  • Previous pelvic radiation
  • History of hereditary retinoblastoma
  • Hereditary leiomyomatosis
  • Renal cell carcinoma

SOGC 371

Question 2

What is the best predictor of progression-free interval and survival rate of ovarian cancer?

Answer 2

Extent of residual disease

SOGC 230

Question 3

What is the percentage of patients with ovarian cancer thought to be confined to the ovaries who were upstaged at the time of their surgical staging?

Answer 3

30% were upstaged

SOGC 230

Question 4

What is stage 1A vulvar SCC?

Answer 4

<1mm DOI
<2cm mass

SOGC 376

Stage 1B if either one condition is not met

SOGC 370

Question 5

How do you treat stage 1A vulvar SCC?

Answer 5

WLE
No need for SLN
but if final pathology is +LN, need to go back within 3mo for LN assessment

SOGC 370

Question 6

What is stage 2 vulvar SCC?

Answer 6

involvement of

• perineum
• lower 1/3 of urethra, vagina

SOGC 370

Question 7

What is stage 3 vulvar SCC

Answer 7

LN involvement

EXCEPT fixed LN= 4A

mm micromets= <5mm
MM macromets= >5mm

3A= 1MM or 2mm
3B= 2MM or 3mm
3C= extracapsular

SOGC 370

Question 8

What is the treatment for stage 3 vulvar SCC?

Answer 8

after surgery:
adjuvant radiation
(with chemo to improve radiation effect= sensitization; no evidence of added benefit; idea extrapolated from other HPV cancers- cervix, anus)

SOGC 370

Question 9

What are the requirements for SLN rather than complete LND for vulvar ca?

Answer 9

Squamous pathology
1-2cm away from midline
only one lesion; no skipping 
lesion <4m
no grossly palpable node

technicium+ blue= 87% detection

SOGC 370

Question 10

Vulvar cancer represents what % of gyne cancers?

Answer 10

4%

SOGC 370

Question 11

A patient undergoing WLE for stage 1A vulvar ca. Final pathology is 1B. What is next step?

Answer 11

Return within 3 mo for LN assessment

SOGC 370

Question 12

A patient with fixed LN is stage

Answer 12

4A

SOGC 370

Question 13

Worse prognosis in vulvar SCC?

Answer 13

LN involvement

SOGC 370

Question 14

What is the 5yr survival for stage 2 vulvar SCC?

Answer 14

1= 80%
2=60%
3=40%
4=15%

SOGC 370

Question 15

A patient with history of vulvar SCC unfortunately has vLn recurrence. What does that mean?

Answer 15

LN recurrence is fatal.

SOGC 370

Question 16

A biopsy of the vulva has to have a width of at least

Answer 16

wide: 4mm
depth: down to subcutaneous fat

SOGC 370

Question 17

A patient would require adjuvant radiation if final pathology shows margins to be:

Answer 17

<8mm away on dry pathology (1cm wet)

SOGC 370

Question 18

What is the follow-up frequency for advanced vulvar SCC?

Answer 18

• q3mo x 2 years
• q6mo x 3 years
• annually

highest incidence of recurrence within 2yr

SOGC 370

Question 19

Pt has a history of stage 1B vulvar SCC, disease free for 5yr. What are the next steps?

Answer 19

annual visit
CERVICAL CYTOLOGY yearly
risk of HPV disease

SOGC 370