Gynaecological Oncology

Question 1

In what circumstances would incomplete excision of CIN3 not justify a repeat excision?

Answer 1

All of:
1. No glandular abnormality
2. No invasive disease
3. Under 50 years old

Question 2

What proportion of CIN 1 & 2 regress spontaneously within 2 years?

Answer 2

50%

Question 3

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

Answer 3

1.4%

Question 4

What proportion of women experience long-term voiding difficulties requiring ISC after radical hysterectomy for cervical cancer?

Answer 4

2-3%

Question 5

How should women over 50 who have incomplete loop excision of CIN3 be managed?

Answer 5

Repeat excision

Question 6

What is FIGO stage 1 of vulval cancer?

Answer 6

Confined to vulva
1a ≤ 2cm with <1mm stromal invasion
1b >2cm or >1mm stromal invasion

Question 7

What is FIGO stage 2 of vulval cancer?

Answer 7

Extension to adjacent perineal structures:
Lower 1/3 urethra, vagina, anus
Negative nodes

Question 8

What is FIGO stage 3 of vulval cancer?

Answer 8

Positive inguinofemoral nodes
3a: 1 ≥ 5mm or 1-2 < 5mm
3b: 2+ ≥ 5mm or 3+ <5mm
3c: Extra-capsular spread

Question 9

What is FIGO stage 4 of vulval cancer?

Answer 9

Regional invasion or distant metastasis
4a: upper urethra &/or bladder, rectal or fixed to pelvic bone, or fixed/ulcerated inguinofemoral nodes
4b: distant mets inc pelvic LNs

Question 10

How should suspected vulval cancer be managed?

Answer 10

Biopsy without removing whole lesion

Question 11

What is the incidence of molar pregnancy in the UK?

Answer 11

1:1000

Question 12

How is a partial molar pregnancy formed?

Answer 12

Normal haploid egg
Fertilised by 2+ sperm
Resulting in triploid nucleus

Question 13

How is a complete molar pregnancy formed?

Answer 13

Sperm fertilises an empty egg
Abnormal diploid conceptus
No fetal tissue

Question 14

How long should patients wait after chemotherapy before breastfeeding?

Answer 14

14 days

Question 15

Which patients with ovarian cancer should be offered adjuvant radiotherapy followed by surgery?

Answer 15

Stage 1c

Question 16

What is the incidence of endometrial hyperplasia in patients with granulosa cell tumour?

Answer 16

1:3

Question 17

What proportion of patients with stage 1 ovarian cancer have elevated Ca125?

Answer 17

50-60%

Question 18

For which molar pregnancies is suction curettage indicated?

Answer 18

Complete molars
Partial molars up to 15/40

Question 19

What is the difference between differentiated & undifferentiated VIN?

Answer 19

Differentiated: associated with lichen sclerosus
Undifferentiated: associated with high-risk HPV, usually 16 or 18, may be multifocal

Question 20

In which patients are additional smears advised, and when?

Answer 20

1. HIV positive: annual
2. End-stage renal disease: at diagnosis
3. Renal transplant: within 1 year
4. Starting cytotoxic rheumatology drugs: at start of Tx

Question 21

What is the cure rate for patients with GTN, a) FIGO ≤ 6, b) ≥ 7

Answer 21

a) almost 100%
b) 95%

Question 22

What is the lifetime risk of endometrial cancer in obesity?

Answer 22

10%

Question 23

Following a uterine evacuation for molar pregnancy, when should patients be followed up?

Answer 23

1. 6 months from date of evac if hCG normalised within 56 days
2. 6 months from normalisation if >56 days

Question 24

What are the survival rates for vulval cancer?

Answer 24

1. No LNs: >80%
2. Inguinal LNs: <50%
3. Iliac & other pelvic LNs: 10-15%

Question 25

How should patients be followed up after treatment for CIN?

Answer 25

Cervical screening after 6 months

Question 26

What is the risk of molar pregnancy after a) 1 previous & b) >1 previous?

Answer 26

a) 1:80
b) > 1:10

Question 27

When should prenatal fetal karyotyping be carried out in GTD?

Answer 27

Abnormal placenta eg mesenchymal hyperplasia

Question 28

What is the incidence of vulval carcinoma in the UK?

Answer 28

3.7:100,000

Question 29

What is the incidence of endometrial cancer in granulosa cell tumour?

Answer 29

10-15%