Gynae cancer

Question 1

What is wertheims hysterectomy?

Answer 1

Pelvic node clearance, hysterectomy, removal of parametrium and upper third of the vagina

Question 2

What in meigs syndrome?

Answer 2

Benign ovarian tumour (usually a fibroma) associated with ascites and a pleural effusion

Question 3

What is the most common benign ovarian tumour in women under 25?

Answer 3

Dermoid cyst (teratoma)

Question 4

Which ovarian tumours are associated with lynch syndrome?

Answer 4

Endometriod

Clear cell

Question 5

What kind of ovarian tumours do children get?

Answer 5

Dysgerminoa - malignant primitive germ cell tumour

Question 6

What hormone may be secreted if there is a granulosa cell tumour?

Answer 6

Oestrogen

Question 7

What hormone may be secreted if there is a theac/leydig cell tumour?

Answer 7

Androgens

Question 8

What genes are associated with ovarian cancer?

Answer 8

BRCA 1 & 2

HNPCC (Lynch syndrome)

Question 9

How do you investigate suspected ovarian cancer?

Answer 9

CA 125. If this is greater than 35 then arrange an ultrasound scan

Question 10

What is the most common type of ovarian carcinoma?

Answer 10

High grade serous carcinoma

Question 11

What does the risk of malignancy index include for ovarian cancer?

Answer 11

Ultrasound score x menopausal status x serum CA125

1 point for premenopausal and 3 points for postmenopausal

Question 12

What are the 4 types of epithelial ovarian cancer?

Answer 12

Serous
Endometriod
Transitional
Mucinous

Question 13

What is a sister mary joseph nodule? What does it mean?

Answer 13

A palpable nodule bulging into the umbilicus which is a sign of metastatic disease to the umbilicus . This can be a sign of ovarian cancer

Question 14

Describe the cervical smear programme

Answer 14

25 - 50 (3 yearly smears)

50 - 65 (5 yearly)

Question 15

What do you do if the smear result is inflammatory?

Answer 15

repeat smear in 3 months

Question 16

What do you do if the smear result is borderline?

Answer 16

Repeat smear in 6 months

Question 17

What do you do if the smear result is mild dyskaryosis?

Answer 17

repeat smear in 6 months

Question 18

What do you do if the smear result is moderate dyskarosis?

Answer 18

Refer to colposcopy

Question 19

What do you do if the smear result is severe dyskarosis?

Answer 19

refer to colposcopy

Question 20

What do you do if the smear result shows glandular abnormalitis

Answer 20

refer to colposcopy

Question 21

What do you do if the smear result shows invasive cancer?

Answer 21

Urgent (within 2 week) referral

Question 22

How is acetic acid used in colposcopy?

Answer 22

Goes white with any abnormality and shows the extent of the lesion

Question 23

How is iodine used in colposcopy?

Answer 23

Goes brown in a normal cervix. If there is an absence of a stain it is abnormal

Question 24

What is cold coagulation of the cervix?

Answer 24

A hot probe which causes cells to burst

Question 25

What is LLETZ?

Answer 25

An electrosurgical technique where wire can cut through the loop of tissue

Question 26

How are people who have had a LLETZ/cold coagulation followed up after?

Answer 26

Test of cure which is a combined smear and HPV test after 6 months. If they are both negative then it is just 3 yearly repeat smears. If positive need further colposcopy

Question 27

What is the most common type of cervical cancer?

Answer 27

Squamous cell carcinoma

Question 28

How long does it take to go from HPV infection to high grade CIN to invasive cancer?

Answer 28

HPV –> High grade CIN: 6 months - 3 years

High grade CIN –> Invasive cancer: 5 - 20 years

Question 29

What part of the cervix does cervical cancer occur?

Answer 29

Transformational zone

Question 30

What does koilocytosis indicate on a cervical smear?

Answer 30

HPV infection

Question 31

What does CIN look like histologically?

Answer 31

Immature basal cells occupy more of the epithelium
Nuclear abnormalities
Excess mitotic activity

Question 32

What is meant by CIN1?

Answer 32

Basal 1/3rd of epithelium occupied by abnormal cells

Question 33

What is meant by CIN2?

Answer 33

Abnormal cells extend to middle 1/3rd

Question 34

What is meant by CIN3?

Answer 34

Abnormal cells occupy full thickness of the epithelium.

Question 35

Where does cervical glandular neoplasia originate from?

Answer 35

Endocervical epithelium

Question 36

Which type of HPV is particularly associated with adenocarcinoma?

Answer 36

HPV 18

Question 37

What is the most important prognostic factor for vulval squamous carcinoma?

Answer 37

Spread to inguinal lymph nodes

Question 38

What are the main two types of endometrial carcinoma? What are the main differences?

Answer 38

Endometriod adenocarcinoma (Type 1) 
- Oestrogen dependant 
- Younger women 
- Good prognosis 
Serous papillary carcinoma ( Type 2) 
- Non oesterogen dependent 
- Elderly women 
-   Poorer prognosis

Question 39

What endometrial thickness on biopsy is suggestive of endometrial cancer?

Answer 39

Over 4mm

Question 40

What is the main precursos for endometriod carcinoma?

Answer 40

Atypical hyperplasia

Question 41

What is the precursos for serous carcinoma?

Answer 41

Serous intraepithelial carcinoma

Question 42

What mutations are associated with endometrial type 1 tumours?

Answer 42

Atypical hyperplasia is the precursor
Microsatellite instability
Lynch syndrome - germline mutation of mismatch repair genes

Question 43

What does obesity cause endometrial cancer?

Answer 43

Adipocytes convert ovarian androgens into oestrogens with cause endometrial proliferation
SHBg is lower in obese women so free levels of the hormones are higher

Question 44

What gene mutation is associated with serous and clear cell cancer?

Answer 44

TP53 mutation and over expression