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MRCOG Part 2 > Gynaecological oncology > Flashcards

Gynaecological oncology Flashcards

1
Q

What is the lifetime risk of ovarian cancer?

A

2%
or 1 in 50

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2
Q

What are the red flag symptoms for ovarian cancer? (4 of them)

A

Persistent abdominal distension
Early satiety or loss of appetite
Pelvic pain
Increased urinary urgency or frequency

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3
Q

How should suspected IBS in a woman over 50 be managed?

A

As concerning for ovarian cancer (IBS rarely presentsfor the first time >50)

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4
Q

CA125 above what value should trigger ultrasound for ovarian cancer?

A

35

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5
Q

Which tumour markers should be added for women aged <40 with suspected ovarian cancer?

A

AFP
BHCG

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6
Q

What are the constituents of optimum surgical staging for ovarian cancer?

A

Laparotomy
TAH BSO
infracolic omentectomy
Biopsies of peritoneal deposits
Random biopsies of pelvic and abdominal peritoneum
Retroperitoneal lymph node assessment (para-aortic and pelvic sidewall)

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7
Q

What is the role of adjuvant chemotherapy in stage 1 ovarian disease?

A

Do not offer adjuvant chemotherapy to women with low risk stage 1 disease (grade 1 or 2, stage 1a or 1b)
Offer 6 cycles of Carboplatin to women with high-risk stage 1 disease (grade 3 or stage 1c)

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8
Q

What adjuvant chemotherapy regime should be used for women with high risk stage 1 ovarian disease?

A

6 cycles of Carboplatin

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9
Q

Within how long should women have a diagnosis or a ruling out of cancer after a 2ww referral by their GP?

A

28 days

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10
Q

What elements give an ultrasound score for RMI?

A

Multilocular cysts
Solid areas
Metastases
Ascites
Bilateral lesions
(U=3 for score of 2-5)

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11
Q

How is a woman classified as post-menopausal for RMI caluclation?

A

A woman who has had no period for more than 12 months or a woman over 50 who has had a hysterectomy

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12
Q

What test should be performed if immunohistochemistry is abnormal with loss of MLH1 or loss of both MLH1 and PMS2 protein expression?

A

MLH1 promoter hypermethylation testing of tumour DNA.
If MLH1 promoter hypermethylation not detected, offer germline genetic testing

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13
Q

What test should be performed if immunohistochemistry is abnormal with loss of MSH2, MSH6 or isolated PMS2 protein expression?

A

Germline genetic testing to confirm Lynch syndrome

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14
Q

What does it indicate if MLH1 promoter hypermethylation is present?

A

The cancer is likely sporadic

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15
Q

How many new cases of vulval cancer are diagnosed per year?

A

Around 1,400

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16
Q

What is the incidence rate of vulval cancer?

A

3.9 per 100,000

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17
Q

What are the main risk factors for vulval SCC?

A

HrHPV
Vulval dermatosis (lichen sclerosus or lichen planus)

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18
Q

What additional testing should be performed for women with multi-focal HPV related disease?

A

Colposcopy
Ano-rectal examination
HIV testing

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19
Q

How often should women with uncomplicated lichen sclerosus or lichen planus be followed up?

A

Annually

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20
Q

Which are the high risk strains or HPV?

A

6, 11, 16, 18

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21
Q

A complete response to uVIN occurs in what percentage of women receiving topical Imiquimod therapy?

A

58%

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22
Q

What imaging modality is most sensitive for identifying nodal involvement in locally advanced cervical cancer?

A

PET-CT

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23
Q

What FIGO stage of cervical cancer is: The carcinoma is strictly confined to the cervix (extension to the uterine corpus should be disregarded)

A

Stage 1

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24
Q

What FIGO stage of cervical cancer is: Invasive carcinoma that can be diagnosed only by microscopy, with maximum depth of invasion ≤5 mm

A

Stage 1a

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25
What FIGO stage of cervical cancer is: Measured stromal invasion ≤3 mm in depth
Stage 1a1
26
What FIGO stage of cervical cancer is: Measured stromal invasion >3 and ≤5 mm in depth
Stage 1a2
27
What FIGO stage of cervical cancer is: Invasive carcinoma with measured deepest invasion >5 mm; lesion limited to the cervix uteri with size measured by maximum tumor diameter
Stage 1b
28
What FIGO stage of cervical cancer is: Invasive carcinoma >5 mm depth of stromal invasion and ≤2 cm in greatest dimension
Stage 1b1
29
What FIGO stage of cervical cancer is: Invasive carcinoma >2 and ≤4 cm in greatest dimension
Stage 1b2
30
What FIGO stage of cervical cancer is: Invasive carcinoma >4 cm in greatest dimension
Stage 1b3
31
What FIGO stage of cervical cancer is: The carcinoma invades beyond the uterus, but has not extended onto the lower third of the vagina or to the pelvic wall
Stage 2
32
What FIGO stage of cervical cancer is: Involvement limited to the upper two-thirds of the vagina without parametrial involvement
Stage 2A
33
What FIGO stage of cervical cancer is: Invasive carcinoma ≤4 cm in greatest dimension
Stage 2A1
34
what FIGO stage of cervical cancer is: Invasive carcinoma >4 cm in greatest dimension
Stage 2A2
35
what FIGO stage of cervical cancer is: invasive carcinoma with parametrial involvement but not up to the pelvic wall
Stage 2B
36
What FIGO stage of cervical cancer is: The carcinoma involves the lower third of the vagina and/or extends to the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney and/or involves pelvic and/or para-aortic lymph nodes
Stage 3
37
What FIGO stage of cervical cancer is: The carcinoma involves the lower third of the vagina, with no extension to the pelvic wall
Stage 3A
38
What FIGO stage of cervical cancer is: Extension to the pelvic wall and/or hydronephrosis or nonfunctioning kidney (unless known to be due to another cause)
Stage 3B
39
What FIGO stage of cervical cancer is Involvement of pelvic and/or para-aortic lymph nodes (including micrometastases), irrespective of tumor size and extent (with r and p notations)
Stage 3C
40
What FIGO stage of cervical cancer is Pelvic lymph node metastasis only
Stage 3c1
41
What FIGO stage of cervical cancer is Para-aortic lymph node metastasis
Stage 3c2
42
what FIGO stage of cervical cancer is The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum.
Stage 4
43
what FIGO stage of cervical cancer is Spread of the growth to adjacent pelvic organs
Stage 4A
44
What FIGO stage of cervical cancer is Spread to distant organs
Stage 4B
45
Below what incidence can a country be considered to have eliminated cervical cancer?
4 per 100,000
46
What is the global uptake of the HPV vaccine as of 2022?
21%
46
What is the cure rate for female malignant germ cell tumours with early recognition and multi-agent chemotherapy?
85.6%
46
Malignant ovarian germ cell tumours account for what percentage of ovarian cancers?
1.5%
49
On what Chromosome is p53 located?
Chromosome 17
50
What are the 4 molecular subgroups of Endometrial Cancer?
DNA Polymerase epsilon catalytic subunit mutants (POLE) Mismatch Repair Deficient (MMRd) Copy number low Copy number high
51
What percentage of pure dysgerminomas are bilateral?
10-15%
52
What operation should be performed for women with suspected malignant ovarian germ cell tumour?
Open unilateral oophorectomy, peritoneal washings, omental biopsy and removal of enlarged lymph nodes
53
What neoadjuvant chemotherapy regime should be considered for women with stage II or greater malignant ovarian germ cell tumours?
Cisplatin-based chemotherapy
54
When should cisplatin be replaced by carboplatin?
When there are renal function abnormalities, peripheral neuropathy or ototoxicity
55
A first degree relative with epithelial ovarian cancer increases the lifetime ovarian cancer risk by a factor of what?
3 fold increase
56
What is the ovarian cancer risk for a woman with BRCA1?
44%
57
What is the ovarian cancer risk for a woman with BRCA2?
17%
58
What are the environmental risk factors for ovarian cancer?
Nulliparity Early menarche Late menopause
59
What are the protective factors against ovarian cancer?
Oral contraceptives increasing parity Breastfeeding Later age at births
60
What type of ovarian cancer has increased risk in smokers?
Invasive mucinous ovarian cancer
61
Which risk assessment tool can be used to evaluate a woman's risk of carrying the BRCA gene?
The Manchester scoring system Women with a score 15 or more should be offered germline testing
62
What percentage of high risk women will have serous tubal intraepithelial carcinoma identified following risk reducing BSO?
5%
63
How should women with STIC lesions identified at risk reducing BSO be managed?
Staging CTCAP Surgical staging if positive cytology or microscopic invasive cancer
64
What is the overall 5 year survival of ovarian cancer in the UK?
45%
65
What is the 5 year survival of stage 1 ovarian cancer?
90%
66
What is the 5 year survival of stage 4 ovarian cancer?
15%
67
Which cancers have an elevated risk in women with endometriosis?
Low grade serous Endometrioid Clear cell
68
In women choosing to avoid risk-reducing surgery for ovarian cancer, how should surveillance be carried out?
4 monthly CA125
69
Risk reducing salpingo-oophorectomy should be offered to women with what lifetime risk of ovarian cancer?
4-5%
70
CA125 is elevated in what percentage of stage 1 ovarian cancers?
50%
71
Women with IOTA-ADNEX score above what threshold should be referred for further investigation?
10%
72
What is the limitation of PET-CT in assessment of ovarian cancer?
PET-CT is limited in ability to identify <10mm peritoneal disease
73
Homologous recombinant deficient tumours show increased sensitivity to which chemotherapeutic agents?
Platinum PARP inhibitors
74
What element of the interval debulking specimen is used to give the chemotherapy response score?
Omentum
75
Which genetic change is usually seen in ovarian clear cell carcinoma?
PAX8 positive
76
What is the rate of dyspareunia following radiotherapy for cervical cancer?
55%
77
Bowel fistulae occur in what percentage of women having radiotherapy for cervical cancer?
5-10%
78
Gardasil protects against which strains of HPV?
6, 11, 16, 18
79
What is the risk of radiation cystitis in women surviving beyond 5 years of radiotherapy for cervical cancer?
26%
80
What percentage of women having radical hysterectomy will need intermittent self catheterisation long term?
2-3%
81
In what circumstances should cervical screening be delayed?
Menstruating <12 weeks postpartum <12 weeks post miscarriage or TOP Currently pregnant Vaginal discharge or pelvic infection
82
How should you manage an unavailable hrHPV result or inadequate cytology?
Repeat the sample within 3 months
83
How much more likely are women with CIN to go on to develop cervical cancer?
2-5 times more likely
84
What is the chance of vulval lichen sclerosus progressing to invasive disease?
4%
85

MRCOG Part 2 (13 decks)

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