Gynae Cancers

Question 1

What is the most common type of ovarian cancer?

Answer 1

Epithelial cell adenocarcinoma - mostly serous carcinomas

Accounts for 80-90% of all ovarian tumours

Question 2

Why does ovarian cancer have such low assocaited survival rates?

Answer 2

Late presentation due to vague symptoms

Question 3

What are the symptoms of ovarian cancer/

Answer 3

Abdominal pain
Bloating
Diarrhoea
Early satiety
Loss of appetite

Tends to mimic IBS

Question 4

What are some of the risk factors for ovarian cancer?

Answer 4

BRCA 1 and 2 genes
FHx
Many ovulations - Nulliparity, early menarche and late menopause
Lynch syndrome

Question 5

What are the appropriate investigations for ovarian cancer?

Answer 5

CA-125 (raised in 80% of epithelial cancers)
USS of pelvis
Staging CT or MRI
Transvaginal scan
Ascites / pleural effusion sample can be sent

Question 6

What staging system is used for ovarian cancer?

Answer 6

FIGO system

Question 7

If ovarian cancer is limited to the pelvis what stage is it?

Answer 7

Stage 2

Question 8

If ovarian cancer is described as stage 3 what does that mean

Answer 8

It is limited to the abdomen, which includes regional lymph node mets

Question 9

What stage is an ovarian cancer when it is limited to one or both ovaries, if peritoneal washouts are positive or tumour is present on the ovary surface?

Answer 9

Stage 1

Question 10

What stage of ovarian cancer involves distal mets?

Answer 10

Stage 4

Question 11

What type of incision in surgery carries the best progosis for ovarian cancer?

Answer 11

Midline incision for staging laparascopy

Question 12

What is involved in a staging laparascopy?

Answer 12

Midline laparotmy
HYsterectomy 
Bilateral salpingo oophorectomy
Omentectomy
Para-aortic lymph node and pelvic lymph node sampling
PEritoneal washouts and biopsies

Question 13

What type of chemotherapy agents are best for ovarian cancer?

Answer 13

Platinum based - e.g. carboplatin

+ paclitaxel for even better outcomes

Question 14

What malignancy can occur from gestational trophoblastic disease?

Answer 14

Choriocarcinoma

Question 15

What are some of the characteristics of borderline ovarian tumours?

Answer 15

Epithelial in nature
Not benign
Seen in premenopausal women
usually confined to one ovary
difficult to histologically diagnose 
Much better prognosis

Question 16

What is the name of an extremely rare tumour which can arise from a primary appendix tumour or a mucinous cystadenoma?

Answer 16

Pseudomyxoma peritonei

Question 17

List 8 differnt types of benign ovarian tumours:

Answer 17

Fibromas
Germ cell tumours
Sex cord tumours
Teratomas
Functional cysts
Endometriomas

Question 18

When is it appropraite to use the Risk of Malignancy scoring system?

Answer 18

In post-menopausal women who have ?benign ovarian cysts / tumours

Question 19

What are the three things seen inmeig’s syndrome?

Answer 19

Pleural effusion
Benign ovarian fibroma
Ascites

Question 20

Is endometrial cancer more common in pre or post menopausal women?

Answer 20

Post menopausal

Question 21

How does endometrial cancer tend to present?

Answer 21

Post menopausal vaginal bleeding

Question 22

List some risk factors for endometrial cancer?

Answer 22

Tamoxifen therapy
Obesity
Nulliparity
DM
PCOS
Anovulatory cycles
Early menarche and late menopause
HRT - unopposed oestrogen
Estrogen secreting tumours elsewhere
Endometrial hyperplasia
Genetics e.g. lynch syndrome

Question 23

Give two protective factors for endometrial carcinomas:

Answer 23

COCP

Multiparity

Question 24

What is the first line investigation for endometrial carcinoma?

Answer 24

Transvaginal scan for endometrial thickness

>4mm is abnormal

Question 25

95% of all endometrial cancers are _______?

Answer 25

Adenocarcinomas

Question 26

What is one form of investigation in post menopausal bleeding which can be done as an outpatient?

Answer 26

Endometrial sampling