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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
Q

What is the 5 year survival rate of stage 1 borderline ovarian tumour?

A

95-97%

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26
Q

What is the lifetime risk of ovarian cancer in the general population?

A

2%

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27
Q

What is the risk of developing ovarian cancer in HNPCC?

A

3-14%

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28
Q

What is the risk of developing endometrial cancer in HNPCC?

A

40-60%

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29
Q

What is systematic retroperitoneal lymphadenectomy?

A

Block dissection of lymph nodes from the pelvic side walls to the level of the renal veins

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30
Q

What is the definition of ‘complete response’ to chemotherapy?

A

Malignant disease not detectable for at least 4/52

Partial response - tumour <50% reduced

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31
Q

What is the rate of LN involvement in women with stage 1a vulval Ca?

A

<1%

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32
Q

Which is the most common type of HPV in vaginal cancer?

A

HPV 16

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33
Q

What are the most common HPV serotypes in vulval cancers?

A

HPV 16 and 18

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34
Q

What are the types of epithelial ovarian cancer and what %?

A

Serous 68%
Clear cell 13%
Endometrioid 9%
Mucinous 3%

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35
Q

What is the risk of endometrial Ca in a low risk woman in the UK?

A

2.7%

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36
Q

By how much does the OCP reduce the risk of endometrial cancer?

A

30-40%

60% if 10 years use

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37
Q

What is the % of women found to have incidental ovarian Ca in risk reducing surgery in BRCA positive women?

A

4-8%

>45 yo increases to 20%

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38
Q

What is the risk of recurrence of borderline ovarian tumours?

A

0-58%

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39
Q

Which gene is associated with borderline ovarian tumours?

A

Braf/Kras pathway

40
Q

What vulval disorder gives flat topped violaceous purpuric plaques?

A

Lichen planus

41
Q

What % of women with vulval Ca present with lichen sclerosis?

A

25%

42
Q

What % of untreated VIN will progress to Ca?

A

5%

43
Q

What % of endometrial cancers are inherited?

A

<5%

44
Q

What % of endometrial ca are linked with obesity?

A

40%

45
Q

How many pregnancies are complicated by cancer?

A

1 in 1000

1 in 3000 breast ca

46
Q

What % of all cervical Ca are adenocarcinomas?

A

20%

47
Q

What % of endometrial Ca are picked up by Pipelle biopsies?

A

98%

48
Q

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

A

85-90%

49
Q

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

A

70-75%

50
Q

What is the 5 year survival for Stage 3 endometrial Ca?

A

45%

51
Q

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

A

<30%

52
Q

By how much is the lifetime risk of Breast Ca increased following CTPA?

A

13%

53
Q

What is the risk of contralateral LN involvement in laterally placed vulval Ca?

A

<1%

54
Q

Why are smokers more prone to cervical cancer?

A

Increased susceptibility to HPV

55
Q

Which of the types of cervical cancer has the poorest prognosis?

A

Neuroendocrine

56
Q

What is the most important prognostic factor of survival for cervical cancer?

A

Volume of tumour

57
Q

What is the most common genetic mutation in type 2 endometrial cancer?

A

p53

58
Q

In how many epithelial ovarian cancers is Ca125 raised?

A

80%

59
Q

In which type of ovarian cancer is Ca125 often not raised?

A

Primary mucinous

60
Q

What is involved in staging laparotomy?

A

Cytology - ascites or washings
TAH, BSO, omentectomy
Biopsies from suspicious areas
May include bilateral selective pelvic and para-aortic lymphadenectomy

61
Q

What are the chances of having co-existing endometrial Ca with a biopsy of complex atypical hyperplasia?

A

30-40%

62
Q

What are the risk and protective factors for ovarian ca?

A

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
Q

How many women with VIN3 progress to vulval Ca and which HPV types are associated?

A

9%

HPV 16 amd 18

64
Q

What is the risk of lymph node metastasis if a vulval tumour shows <1mm depth invasion?

A

<1%

65
Q

Which subtype of vulval squamous cell carcinoma have a low metastatic potential?

A

Verrucous carcinoma

66
Q

What is the 5 year survival rate of vulval carcinoma?

A

Stage I - 86%
Stage III - 53%
Distant mets - 15%

67
Q

In what % of stage 1 epithelial ovarian cancers is Ca125 raised?

A

50-60%

68
Q

What are the 6 most common cancers in women in the UK?

A
  1. Breast
  2. Lung
  3. Bowel
  4. Uterus
  5. Melanoma
  6. Ovary

(i.e. uterine most common gynae ca)

69
Q

What are the 6 most common causes of cancer deaths in women in the UK?

A
  1. Lung
  2. Breast
  3. Bowel
  4. Pancreas
  5. Ovary
  6. Oesophagus

(i.e. ovary most common gynae ca to die from)

70
Q

What % of ovarian Ca arises from epithelial cells?

A

90%

71
Q

What is the overall 5 year survival rate of ovarian Ca?

A

<45%

72
Q

What % of patients have spread beyond the ovary at diagnosis of Ca?

A

75%

73
Q

What is the most common subtype of ovarian Ca in BRCA carriers?

A

serous adenocarcinoma

74
Q

What is the lifetime ovarian cancer risk with HNPCC (Lynch syn)?

A

3-14%

75
Q

What is the lifetime risk of ovarian cancer with Peutz-Jeghers syn and what subtype is most common?

A

20%

Non-epithelial sex cord stromal tumours

76
Q

What is the risk reduction of COCP on ovarian Ca?

A

RR 0.73
20% further each 5 years of use
By 15 years risk halved
Persists 30 years after cessation of pill

77
Q

By what % will BSO reduce risk of breast Ca in BRCA mutations?

A

30-75%

78
Q

What is the risk of developing primary peritoneal cancer in BRCA mutations?

A

2%

79
Q

What is the lifetime risk of endometrial Ca in HNPCC (Lynch syn)?

A

40-60%

80
Q

What is the overall 5 year survival rate for ovarian cancer?

A

< 35%

81
Q

What stage ovarian cancer if offered adjuvant chemotherapy and what type?

A

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
Q

Which blood tests should be requested if a woman <40yo has suspected ovarian cancer?

A

AFP and bHCG

83
Q

What is the risk of developing breast cancer in the UK?

What % are diagnosed <45yo

A

1 in 9

15% under 45 (approx 5000 women reproductive age)

84
Q

What is the 5 year survival for breast cancer in women <50?

A

80%

85
Q

When breast cancer is diagnosied < 30yo what % are cases associated with pregnancy or 1 year postpartum?

A

10-20%

86
Q

What proportion of breast cancer survivors go on to have a subsequent prengnacy?

A

<10%

87
Q

When is radiotherapy considered in breast cancer in pregnacy?

A

If life saving or organ sparing (e.g. spinal cord compression)

88
Q

When is chemotherapy considered in breast cancer in pregnacy?

A

Contraindicated in T1
Can be used from T2
Ideally if delivery required - 2-3 weeks post last dose

89
Q

Which breast cancer treaatments are contraindicated in pregnancy?

A

Tamoxifen and Trastuzamab

90
Q

Can women breastfeed while being treated for breast Ca?

A

Depends on surgical excision
Chemotherapy - BF contraindicated. Need >14/7 to clear from milk.
Contraindicated on tamoxifen and herceptin

91
Q

When should tamoxifen be stopped prior to pregnancy?

A

3/12 - teratogenic

92
Q

How long after breast cancer should a woman avoid getting pregnant?

A

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
Q

What % of premenopausal women will subsequently be amenorrhoeic following treatment for breast cancer?

A

20-70%

94
Q

What is the recommended treatment for a 38 year old woman with malignant cervical tumour measuring 2.5cm and no extracervical disease on imaging?

A

Radical hysterectomy and bilateral pelvic lymphadenectomy

95
Q

From where do Krukenberg tumours metastasis to the ovaries?

A

Breast, stomach, gastrointestinal tract

MRCOG Part 2 (97 decks)

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