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MRCOG Gynae Oncology > Gynae Oncology Busy SpR > Flashcards

Gynae Oncology Busy SpR Flashcards

1
Q

Diagram staging of endometrial cancer

A
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2
Q

Management stage 1a endometrial cancer?

A

Hysterectomy + BS0

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3
Q

Management stage 1b endometrial cancer

A

Hysterectomy + BSO + pelvic and peri-aortic node sampling should be performed.

Consider radiothapy

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4
Q

Management of stage 3 endometrial cancer that does not invade into pelvic side wall?

A

TAH + BSO + radiotherapy

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5
Q

Management of stage 3 endometrial cancer that does invade into pelvic side wall?

A

Radiotherapy with intra-cavitary and external-beam radiotherapy

or

chemotherapy

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6
Q

Overall survival for ovarian cancer at 5 years.

A

Ovarian cancer: 5 year survival rate 35-40%

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7
Q
A
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8
Q

FIGO staging for cervical cancer as diagram

A
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9
Q

Management of CGIN?

glandular neoplasia of endocervical type

A

Always surgical

Yonng/ TZ type 1 or 2 - 10mm Cone Bx

Older/ TZ 3 20-25mm Cone BX

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10
Q

How should stage 1a adenocarcinoma of the cervix be managed:
i) Fertility no desired
ii) Fertility disreed

A

Not desired - hysterectomy

Desired - Cone Bx 2.5cm and 5mm clear margins, otherwise repeat or hysterectomy

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11
Q

How is stage 1a squamous cell carcinoma of cervix managed? When can Lymph node dissection be avoided?

A

Cone Bx

If invasion <3mm and no lymph-vascular spread

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12
Q

When is chemo-radiation advised for cervical cancer based on FIGO stages

A

From stage 1 b (invasion >5mm) until stage 4a (Local mets)

Along side surgery

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13
Q

Surgical Management of stage 1b cervical cancer

Fertility not desired
Fertility desired

A

Not desired: Radical hysterectomy + BSO

Desired: Radical tracehelctoy

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14
Q

Draw FIGO diagram for ovarian cancer

A
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15
Q

Treatment ovarian cancer - Well / moderately well differentiated Stage Ia / Ib

A

TAH + BSO + omentectomy

Also Bx - pelvic/para-aortic LN, peritoneal washing, pelvic and peritoneal Bx + underside of diaphragm

(Involved one or both ovaries with no spill/spread)

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16
Q

Treatment for ovarian cancer - Poorly differentiated Stage Ia / Ib or Stage Ic – stage II

A

TAH + BSO + omentectomy ect

and

chemotherapy

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17
Q

Management of well/moderately well differentiated stage 1a + 1b ovarian cancer.

Fertility not desired

Fertility desired

A

Not desired: Hysterectomy + BSO + omentectomy

Desired: Unilateral SO + full staging (peritoneal washing, Bx para-aortic LN, omentectomy + endometrial Bx as 10-30% have endometrial Ca)

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18
Q

If cancer thought to isolated to ovary, how should staging procedure be conducted?

A

1.Midline laparotomy

2.Total abdominal hysterectomy + bilateral salpingo-oophorectomy + infracolic omentectomy

3.Biopsies of any peritoneal deposits

4.Random biopsies of the pelvic and abdominal peritoneum

5.Retroperitoneal lymph node sampling

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19
Q

If stage 1B1 or more (invasion >5mm) and > 16 weeks pregnant. How should this be managed?

A

CS once viability has been achieved, immediately followed by radical hysterectomy and pelvic lymphadenectomy

Can offer Neo-adjuvant chemotherapy until surgery

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20
Q

How are stage 1A1 cervcial cancers managed in pregnancy?

A

LLETZ or cold-knife cone alone, which should be undertaken early in the pregnancy (higher risk of preterm labour/PPROM as gestation increases)

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21
Q

When should pelvic Lymphadenectomy be performed in pregnancy to assess cervical cancer?

A

Cervical 1A2 and beyond, before 15 weeks

ie >3mm invasion

22
Q

How is VIN classificed?

A

1) Usual/typical
- Low grade squamous intraepithelial lesion (LSIL)/ VIN1
- High grade squamous intraepithelial lesion (HSIL) VIN 2-3

2) differentiated VIN (dVIN)

23
Q

Risk factors for VIN?

A

infection with the human papilloma virus (HPV)
smoking
having problems with your immune system such as HIV
long term skin problems such as lichen sclerosis

24
Q

How is vulvar intraepithelial neoplasia managed?

A

When occult invasion is not a concern, vulvar HSIL (VIN usual type) can be treated with excision, laser ablation, or topical imiquimod (off-label use).

LSIL/VIN 1 - can jut be monitored, unless there are symptomatic

25
Q

How should women with HSIL/VIN 2-3 be followed up following treatment?

A

6 months, 12 months then yearly

26
Q

What is transformation zone type 1, how much should be removed in cone Bx

A

TZ completely visible, on ectocervix 7-10mm

27
Q

What is transformation zone type 2, how much should be removed in cone Bx

A

TZ completely visible with manipulation, has ectocervix and endocervix component 10-15mm

28
Q

What is transformation zone type 3, how much should be removed in cone Bx

A

TZ not completely visible, has endocerivcal component
15-25mm

29
Q

What is the treatment for lichen sclerosus?

A

Ultra-potent topical steroids such as Clobetasol proprionate.

Various regimens are used one of the most common being
daily use for one month
alternate days for one month
twice weekly for one month with review at 3 months.

30
Q

What % of women with lichen sclerosis does not respond to topical steroids?

A

10 - 25% will not respond

31
Q

Management for simple ovarian cyst in pre-menopausal women?

A

<50mm - discharge
50-70mm - yearly scan
>70mm - remove surgically

32
Q

How to assess for metastasis in breast cancer when pregnancy

A

CXR and liver USS

33
Q

What % of endometrial cancers have Lynch syndrome?

A

1-3%

34
Q

Life time risk of endometrial cancer in those with Lynch syndrome?

A

1/400 to 1/2000

35
Q

1st line chemo for ovarian cancer?

A

Paclitaxel and cisplatin

36
Q

What % of those will ovarian cancer response to Paclitaxel and cisplatin?

What % relapse within 2 years

A

70-80%

55-75% relapse within 2 years

37
Q

What is define as partial and complete resonse to chemotherapy for ovarian cancer?

A

Partial - reduction 50% in 4 weeks

Total - not detectable for at least 4 weeks

38
Q

When should Neo-adjuvant chemotherapy for ovarian cancer, followed by debunking surgery be consider?

A

If bulky supra colic omental disease or extensive liver mets not suitable for resection

39
Q

What is definition of platinum resistance disease in ovarian cancer?

A

Recurrence within 6 months of stopping last dose of platinum

Partially resistant if recurrence within 6-12months

40
Q

If platinum sensitive, what is the response rate to second line chemotherapy

A

> 12 months to recurrence - 40-75%

41
Q

If partially platinum sensitive, what is the response rate to second line chemotherapy

A

6-12 months

25-30%

42
Q

If platinum resistant, what is the response rate to second line chemotherapy

A

<6 months

10-20%

43
Q

If platinum refectory, what is the response rate to second line chemotherapy

A

<10%

44
Q

Can HRT be used in the following ovarian cancers:
Epithelial
Germ cell
Sex cord stromal
Borerline

A

Epithelial: Limited Data
Germ cell: avoid
sex cord: Avoid
Borderline: Caution/avoid

45
Q

Can HRT be used in after the following endometrial cancers:

Type 1 Endometroid 1&2
Type Endometriod 3&4

Type 2

A

Type 1 Endometroid 1&2 → Can used combined, oestrogen only if possible occult foci

Type 1 Endometriod 3&4 → Avoid

Type 2 → Avoid

46
Q

Can HRT be used in following cervical cancer:

Squamous 1&2
Squamous 3&4
Adenocarcinoma

A

Squamous 1&2: Oestrogen only if hysterectomy, or cont combined

Squamous 3&4 Avoid/caution
Adenocarcinoma: Avoid/caution

47
Q

Can HRT be used in the following vulval cancers:
Squamous cell

Non squamous cell

A

Squamous cell: Oestrogen only if hysterectomy, or cont combined

Non squamous cell: Avoid

48
Q

Can HRT be used in the following vulval cancers:
Squamous cell

Non squamous cell

A

Squamous cell: Oestrogen only if hysterectomy, or cont combined

Non squamous cell: Avoid

49
Q

What medication can be given to those with Lynch syndrome as cancer prevention?

A

Aspirin from 18 years

From the age of menarche until natural age of menopause

50
Q

When should TAH and BSO be offered in Lynch Syndrome if

MLH1/MSH2 mutation

MSH6 mutation

Path_PMS2 mutation

A

For path_MLH1 and path_MSH2 at 35 years

For path_MSH6 at 40 years

For path_PMS2 at 50 years

MRCOG Gynae Oncology (21 decks)

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