Gynae Onc

Question 1

Endometrial ca - Incidence

Answer 1

2.5% lifetime risk

Most common gynae malignancy in developed countries (second to cervix in developing countries)

Question 2

Endometrial cancer - Risk factors (Type I)

Answer 2

Endometrioid (80%)

• Obesity
• Increased oestrogen exposure
• Tamoxifen
• HNPCC
• PCOS

Question 3

Endometrial cancer - Risk factors (Type II)

Answer 3

Serous/clear cell/mucinous (20%)

• Age
• Tumour mutations and aneuploidy
• Possibly obesity

Question 4

Endometrial cancer - Symptoms

Answer 4

90% PMB (10% of PMB is ca)
Pelvic pressure secondary to enlarging uterus
Haematometra/pyometra
Asymptomatic <5% - pap smear, conincidental imaging finding, hysterectomy for other cause

Question 5

Endometrial cancer - Survival

Answer 5

Overall 75%

75% are stage 1

Question 6

Endometrial cancer - Role of screening

Answer 6

No role in women without HNPCC
Most women have symptoms at an early stage
With HNPCC - ~50% lifetime risk endo ca (and 10% ov), so yearly TV USS and endo sampling from 30 or 5y younger than youngest affected relative

Question 7

Endometrial hyperplasia and progression to malignancy

Answer 7

Simple 1%
Complex 3%
Simple w atypia 8%
Complex w atypia 30%
- if ca coexistent risk coexistent ov ca (5%PM, 25% preteen)

Question 8

Endometrial cancer types

Answer 8

Endometrioid 80%
Mucinous 5%
Clear cell 5%
Papp serous 3%
Squamous Rare
Simulatenous w ovary 1-3% (most well differentiated with good prognosis)

Question 9

FIGO Staging Endometrial Ca

Answer 9

1a 50% myometrial invasion

2 cx stroma but not beyond uterus

30% 5y
3a/b local spread
3c nodal spread (pelvic or paraaortic)

10% 5y
4a bladder/bowel
4b distant mets or inguinal LN

Question 10

Endometrial cancer - Prognostic factors

Answer 10

Good prognosis:

• Young age
• Endometrioid type
• Low grade
• Small size
• ER/PR +
• Diploid
• No myometrial invasion

Question 11

Difference complete vs partial molar pregnancy

Answer 11

COMPLETE:
- Usually diploid (usually all paternal 46XX)
- 25% chance persistent trophoblastic disease
- usually no foetal parts
PARTIAL:
- Usually triploid (69XXY, 69XXX)
- May have foetal parts
- 1-2% risk persistent trophoblastic disease

Question 12

Types of persistent trophoblastic disease

Answer 12

Choreocarcinoma = malignant transformtation of molar tissue or de novo after normal pregnancy
Palcental site tumour = increasedhumal placental lactogen
Epithelioid trophoblastic tumour

Question 13

Vulval cancer

• Incidence
• Age group
• Type

Answer 13

2/100 000
Bimodal distribution - older w LS, younger w HPV
Types: (90% are primary, 10% mets)
- 90% Squamous
- 5% Melanoma
- 3% adenocarcinoma (Bart’s and Bechet’s)
- Other BCC and sarcoma

Question 14

Vulval cancer - Risk factors

Answer 14

Age
Lichen sclerosis
Smoking
HPV
Previous gynaecological malignancy
VIN
Paget’s disease

Question 15

Vulvar cancer - metastatic pattern

Answer 15

30 % metastatic at the time of diagnosis
Nodes: inguinofemoral > pelvic
Local
Haematogenous

Question 16

Vulval cancer - Rx

Answer 16

Individualised
1mm depth of invasion then LN assessment (if 4cm groin dissection)
2cm rule:
- cut a 2cm margin
- if >2cm then consider bilateral nodes
- with within 2cm of the midline consider bilateral nodes

Question 17

VIN - Types

Answer 17

1. Usual type
   - HPV related
   - <30y
   - 95%
   - warty/basaloid
2. Differentiated type
   - LS
   - 5%
   - High rate of progression to ca (?100%)
   - older women

Question 18

Vulval melanoma

Answer 18

Staged with Clark levels and Breslow thickness
Most > 50y
Worse prognosis than other types
No role for CTx
? role of interferon

Question 19

Vulval adenocarcinoma

Answer 19

Majority arise in Bartholin’s gland 
Homan’s criteria for diagnosis
- Correct anatomical location
- deep to labia major
- overlying skin is intact
- Recognisable residual gland
Rx:
- Radical excision and LN (inguinofemoral)
- primary RTx if fixed to underlying structure