Gynaecological Cancers, Screening and Menopause

Question 1

What are the two stains used in colposcopy?

What show on abnormal areas?

Answer 1

Acetic acid - goes white

Iodine - doesn’t go brown

Question 2

What cellular abnormality is looked for on cervical screening?

Answer 2

Dyskariosis - abnormal nuclei

Question 3

What types of CIN require treatment?

Answer 3

CIN II + III

80% of CIN I regress

Question 4

What are the two treatments of CIN?

Answer 4

Loop excision and cold coagulation

Question 5

What follow up is required 6 months after CIN treatment?

Answer 5

Smear at 6 months - test of cure

Cytology + HPV test

Question 6

Which oestrogen decreases the most during menopause?

And why does this cause oestrogen deficiency?

Answer 6

E2 oestradiol

It is the most biologically active

Question 7

What happens to FSH levels perimenopausally and why?

Answer 7

It increases

Because ovaries are less responsive so more FSH is produced in an attempt to stimulate them

Question 8

How can menopause be diagnosed in younger women?

Answer 8

Two raised FSH readings 6 weeks apart

Question 9

At what ages should Sequential and Continuous HRT be used?

Answer 9

Over 54 or last menstruated period more than 1 year ago - continuous
Under 54 - use sequential for 2 years

Question 10

When can oestrogen only HRT be used?

Answer 10

In woman who have had a total hysterectomy

Question 11

At what age is menopause considered premature?

Answer 11

45

Question 12

What are the 3 benefits of HRT?

Answer 12

Relieves vasomotor symptoms
Decreases colorectal cancer risk
Protects against osteoporosis

Question 13

Which type of HRT has the highest Breast cancer risk?

Answer 13

Combined

Question 14

What are the 3 types of endometrial hyperplasia?
Which type has abnormal cytology?
Which has the highest malignancy risk?

Answer 14

Simple - normal cytology
Complex - normal cytology
Atypical - has atypical cytology - high malignancy risk

Question 15

What are the two commonest types of endometrial cancer and what are their precursor lesions?

Answer 15

80% -Endometrioid - atypical hyperplasia

Serious = serous intraepithelial carcinoma

Question 16

What is the biggest risk factor for endometrial carcinoma?

Answer 16

Obestiy

Question 17

Lynch syndrome
What cancers does it predispose to?
What is the faulty gene?
What is the mode of inheritance?

Answer 17

Colorectal, endometrial and ovarian

Inheritance of DNA mismatch repair gene
Autosomal Dominant

Question 18

What type of endometrial cancer is related to unopposed oestrogen?

Answer 18

Endometrioid (type 1)

Question 19

Which is more aggressive - endometrioid or serous endometrial cancer?

Answer 19

Serous

Question 20

How is endometrial cancer graded?

Answer 20

Grade 1 - 5% or less solid growth
Grade 2 - 6-50% solid growth
Grade 3 - >50% solid growth

Question 21

What the name for a fibroid?
What are fibroids?
What are they called if they become malignant?

Answer 21

Leiomyoma
Tumours of smooth muscle
Leiomyosarcoma

Question 22

Where does endometrial cancer commonly spread?

Answer 22

Myometrium

Cervix

Question 23

What are the 3 types of Ovarian tumours?

Answer 23

Epithelial
Germ Cell
Sex cord - stromal

Question 24

Name 3 germ cell ovarian tumours?

Answer 24

Teratoma
Dysgerminoma
Yolk sac tumour
Choriocarcinoma

Question 25

Name 2 sex cord ovarian tumours?

Answer 25

Fibroma Granulosa Sertoli leydig

Question 26

What are the 4 commonest sites for ovarian metastases?

Answer 26

Stomach Colon Breast Pancreas

Question 27

What are the 3 categories of epithelial ovarian tumours? | And describe the cytological appearance and stomal invasion?

Answer 27

Benign - normal, no invasion Borderline - abnormal, no invasion Invasie - abnormal, invasion

Question 28

What are the two commonest types of epithelial ovarian tumour?

Answer 28

Serous (2 types - high grade serous carcinoma, low grade serous carcinoma) Endometrioid (associated with lynch syndrome)

Question 29

What is the normal lining of the endometrium?

Answer 29

Pseudo stratified columnar epithelium with tubular glands

Question 30

What type of epithelium is found on the cervix?

Answer 30

Stratified squamous

Question 31

What drug may be used for stress incontinence?

Answer 31

Duloxetine

Question 32

What drug may be used for over active bladder?

Answer 32

Anti muscarinic - oxybutinin

Question 33

What are the 4 levels of uterovaginal prolapse?

Answer 33

1st degree - in vagina 2nd degree - at introits 3rd degree - outside vagina Procidentia - entirely outside vagina

Question 34

What is the most common type of vulval cancer?

Answer 34

Squamous cells

Question 35

Name 2 risk factors for vulval cancer?

Answer 35

Smokers and immunocompromised women

Question 36

What is the 5 year survival for vulval cancer is node negative?

Answer 36

70-80%

Question 37

To which lymph nodes does endometrial cancer spread first?

Answer 37

Para aortic

Question 38

To which lymph nodes does cervical cancer spread first?

Answer 38

Pelvic lymph nodes

Question 39

To which lymph nodes doe ovarian cancer spread first?

Answer 39

Para aortic

Question 40

What is the most common type of cervical cancer?

Answer 40

Squamous cell

Question 41

What is Meig's syndrome?

Answer 41

Benign ovarian tumour, ascities, pleural effusion.