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MRCOG Part 2 > Gynae Oncology including TOG: Risk reducing surgery and GT12 Pregnancy and Breast Cancer > Flashcards

Gynae Oncology including TOG: Risk reducing surgery and GT12 Pregnancy and Breast Cancer Flashcards

1
Q

What is the risk of ovarian cancer in women who have brca 1 gene mutation

A

40% risk of developing ovarian cancer under the age of 70

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2
Q

What is the % risk of developing ovarian cancer with brca 2 mutation

A

11-17% by the age of 70

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3
Q

What percentage of general population will develop ovarian cancer by age 70

A

1.3%

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4
Q

What are Call-Exner bodies and where are they found?

A

Eosinophilic fluid filled spaces between granulosa cells

Pathognomonic for Granulosa cell tumours (produce oestrogen)

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5
Q

By how much does BSO reduce risk of ovarian cancer for BRCA1 and BRCA 2 carriers?

A

80-96%

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6
Q

By how much does BSO reduce risk of breast cancer in BRCA 1 carriers?
And for BRCA 2?

A

BRCA1 56%

BRCA2 46%

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7
Q

At what stage of cervical cancer diagnosed in pregnancy would early delivery be considered?

A

Greater than 1B

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8
Q

Up to which stage can a radical hysterectomy for cervical cancer be performed?

A

IIA

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9
Q

Which ovarian cancer is associated with endometriosis?

A

Clear cell carcinoma or endometrioid type epithelial
25% of these arise from endometriosis
Gene mutation - ARID1A

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10
Q

What is the follow up for completely excised CIN at hysterectomy?

A

Vault smear at 6 and 18 months

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11
Q

What is the 5 year survival for Stage 1 Cervical Ca?

A

96%

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12
Q

What is the 5 year survival for Stage 2 Cervical Ca?

A

54%

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13
Q

What is the 5 year survival for Stage 4 Cervical Ca?

A

5%

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14
Q

What % of ovarian tumours are epithelial?

A

80-90%

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15
Q

What % of ovarian tumours are germ cell tumours?

And what % are benign?

A

<20%

95% of them are benign

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16
Q

Which germ cell tumours are usually malignant?

What biochemistry is seen with these?

A

Dysgerminoma

Raised LDH normal HCG/AFP but may occarionally have bHCG if infiltrated with syncytiotrophoblastic giant cells

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17
Q

What % of patients found to have endometrial hyperplasia with atypia on Pipelle will be found to have Ca at hysterectomy?

A

40%

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18
Q

What is the risk of developing endometrial Ca compared to general population when taking Tamoxifen

A

3-6 times

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19
Q

What is the risk that a woman presenting with PMB will have endometrial cancer?

A

10-15%

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20
Q

Using a cut off of 5mm for ET what is the sensitivity and false positive rate for endometrial Ca?

A

96%

False pos 39%

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21
Q

What is the risk of ovarian cancer in a woman who has an RMI of 25-250?

A

20%

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22
Q

What is the risk of ovarian cancer in a woman who has an RMI of <25?

A

3%

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23
Q

What is the risk of ovarian cancer in a woman who has an RMI of >250?

A

75%

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24
Q

What are the histological features of borderline ovarian tumours?

A

Nuclear stratification
Hyperchromasia
Presence of mitotic figures
Prominent nucleoli

Lack of Stromal invasion - distinguishes from invasive

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25
What is the 5 year survival rate of stage 1 borderline ovarian tumour?
95-97%
26
What is the lifetime risk of ovarian cancer in the general population?
2%
27
What is the risk of developing ovarian cancer in HNPCC?
3-14%
28
What is the risk of developing endometrial cancer in HNPCC?
40-60%
29
What is systematic retroperitoneal lymphadenectomy?
Block dissection of lymph nodes from the pelvic side walls to the level of the renal veins
30
What is the definition of 'complete response' to chemotherapy?
Malignant disease not detectable for at least 4/52 | Partial response - tumour <50% reduced
31
What is the rate of LN involvement in women with stage 1a vulval Ca?
<1%
32
Which is the most common type of HPV in vaginal cancer?
HPV 16
33
What are the most common HPV serotypes in vulval cancers?
HPV 16 and 18
34
What are the types of epithelial ovarian cancer and what %?
Serous 68% Clear cell 13% Endometrioid 9% Mucinous 3%
35
What is the risk of endometrial Ca in a low risk woman in the UK?
2.7%
36
By how much does the OCP reduce the risk of endometrial cancer?
30-40% | 60% if 10 years use
37
What is the % of women found to have incidental ovarian Ca in risk reducing surgery in BRCA positive women?
4-8% | >45 yo increases to 20%
38
What is the risk of recurrence of borderline ovarian tumours?
0-58%
39
Which gene is associated with borderline ovarian tumours?
Braf/Kras pathway
40
What vulval disorder gives flat topped violaceous purpuric plaques?
Lichen planus
41
What % of women with vulval Ca present with lichen sclerosis?
25%
42
What % of untreated VIN will progress to Ca?
5%
43
What % of endometrial cancers are inherited?
<5%
44
What % of endometrial ca are linked with obesity?
40%
45
How many pregnancies are complicated by cancer?
1 in 1000 1 in 3000 breast ca
46
What % of all cervical Ca are adenocarcinomas?
20%
47
What % of endometrial Ca are picked up by Pipelle biopsies?
98%
48
What is the 5 year survival for Stage 1 endometrial Ca?
85-90%
49
What is the 5 year survival for Stage 2 endometrial Ca?
70-75%
50
What is the 5 year survival for Stage 3 endometrial Ca?
45%
51
What is the 5 year survival for Stage 4 endometrial Ca?
<30%
52
By how much is the lifetime risk of Breast Ca increased following CTPA?
13%
53
What is the risk of contralateral LN involvement in laterally placed vulval Ca?
<1%
54
Why are smokers more prone to cervical cancer?
Increased susceptibility to HPV
55
Which of the types of cervical cancer has the poorest prognosis?
Neuroendocrine
56
What is the most important prognostic factor of survival for cervical cancer?
Volume of tumour
57
What is the most common genetic mutation in type 2 endometrial cancer?
p53
58
In how many epithelial ovarian cancers is Ca125 raised?
80%
59
In which type of ovarian cancer is Ca125 often not raised?
Primary mucinous
60
What is involved in staging laparotomy?
Cytology - ascites or washings TAH, BSO, omentectomy Biopsies from suspicious areas May include bilateral selective pelvic and para-aortic lymphadenectomy
61
What are the chances of having co-existing endometrial Ca with a biopsy of complex atypical hyperplasia?
30-40%
62
What are the risk and protective factors for ovarian ca?
Risk factors: - Nulliparity - Early menarche - Late menopause - Increasing age - Infertility but ovulation induction not causal - Endometriosis - Malignant transformation 2.5% - PCO - Obesity Protective: - COCP - Pregnancy - Lactation - Tubal ligation - Hysterectomy (34% RR)
63
How many women with VIN3 progress to vulval Ca and which HPV types are associated?
9% | HPV 16 amd 18
64
What is the risk of lymph node metastasis if a vulval tumour shows <1mm depth invasion?
<1%
65
Which subtype of vulval squamous cell carcinoma have a low metastatic potential?
Verrucous carcinoma
66
What is the 5 year survival rate of vulval carcinoma?
Stage I - 86% Stage III - 53% Distant mets - 15%
67
In what % of stage 1 epithelial ovarian cancers is Ca125 raised?
50-60%
68
What are the 6 most common cancers in women in the UK?
1. Breast 2. Lung 3. Bowel 4. Uterus 5. Melanoma 6. Ovary (i.e. uterine most common gynae ca)
69
What are the 6 most common causes of cancer deaths in women in the UK?
1. Lung 2. Breast 3. Bowel 4. Pancreas 5. Ovary 6. Oesophagus (i.e. ovary most common gynae ca to die from)
70
What % of ovarian Ca arises from epithelial cells?
90%
71
What is the overall 5 year survival rate of ovarian Ca?
<45%
72
What % of patients have spread beyond the ovary at diagnosis of Ca?
75%
73
What is the most common subtype of ovarian Ca in BRCA carriers?
serous adenocarcinoma
74
What is the lifetime ovarian cancer risk with HNPCC (Lynch syn)?
3-14%
75
What is the lifetime risk of ovarian cancer with Peutz-Jeghers syn and what subtype is most common?
20% | Non-epithelial sex cord stromal tumours
76
What is the risk reduction of COCP on ovarian Ca?
RR 0.73 20% further each 5 years of use By 15 years risk halved Persists 30 years after cessation of pill
77
By what % will BSO reduce risk of breast Ca in BRCA mutations?
30-75%
78
What is the risk of developing primary peritoneal cancer in BRCA mutations?
2%
79
What is the lifetime risk of endometrial Ca in HNPCC (Lynch syn)?
40-60%
80
What is the overall 5 year survival rate for ovarian cancer?
< 35%
81
What stage ovarian cancer if offered adjuvant chemotherapy and what type?
Grade 3/Stage 1C or above 6x cycles of carboplatin if high risk stage 1 as above Stage II-IV have paclitaxel/platinum combination first line
82
Which blood tests should be requested if a woman <40yo has suspected ovarian cancer?
AFP and bHCG
83
What is the risk of developing breast cancer in the UK? What % are diagnosed <45yo
1 in 9 | 15% under 45 (approx 5000 women reproductive age)
84
What is the 5 year survival for breast cancer in women <50?
80%
85
When breast cancer is diagnosied < 30yo what % are cases associated with pregnancy or 1 year postpartum?
10-20%
86
What proportion of breast cancer survivors go on to have a subsequent prengnacy?
<10%
87
When is radiotherapy considered in breast cancer in pregnacy?
If life saving or organ sparing (e.g. spinal cord compression)
88
When is chemotherapy considered in breast cancer in pregnacy?
Contraindicated in T1 Can be used from T2 Ideally if delivery required - 2-3 weeks post last dose
89
Which breast cancer treaatments are contraindicated in pregnancy?
Tamoxifen and Trastuzamab
90
Can women breastfeed while being treated for breast Ca?
Depends on surgical excision Chemotherapy - BF contraindicated. Need >14/7 to clear from milk. Contraindicated on tamoxifen and herceptin
91
When should tamoxifen be stopped prior to pregnancy?
3/12 - teratogenic
92
How long after breast cancer should a woman avoid getting pregnant?
Individualised - but most 2 years as this is time of highest chance of recurrence Tamoxifen usually 5 years Rx with ER+ Ca No increased risk of malformation in children in subsequent pregnancy
93
What % of premenopausal women will subsequently be amenorrhoeic following treatment for breast cancer?
20-70%
94
What is the recommended treatment for a 38 year old woman with malignant cervical tumour measuring 2.5cm and no extracervical disease on imaging?
Radical hysterectomy and bilateral pelvic lymphadenectomy
95
From where do Krukenberg tumours metastasis to the ovaries?
Breast, stomach, gastrointestinal tract

MRCOG Part 2 (97 decks)

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