Gynaecological oncology

Question 1

What is the lifetime risk of ovarian cancer?

Answer 1

2%

Question 2

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

Answer 2

<35%

Question 3

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

Answer 3

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

Question 4

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

Answer 4

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

Question 5

CA125 above what value should trigger ultrasound for ovarian cancer?

Answer 5

35

Question 6

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

Answer 6

AFP
BHCG

Question 7

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

Answer 7

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)

Question 8

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

Answer 8

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)

Question 9

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

Answer 9

6 cycles of Carboplatin

Question 10

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

Answer 10

28 days

Question 11

What elements give an ultrasound score for RMI?

Answer 11

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

Germline genetic testing to confirm Lynch syndrome

Question 15

What does it indicate if MLH1 promoter hypermethylation is present?

Answer 15

The cancer is likely sporadic

Question 16

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

Answer 16

Around 1,400

Question 17

What is the incidence rate of vulval cancer?

Answer 17

3.9 per 100,000

Question 18

What are the main risk factors for vulval SCC?

Answer 18

HrHPV
Vulval dermatosis (lichen sclerosus or lichen planus)

Question 19

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

Answer 19

Colposcopy
Ano-rectal examination
HIV testing

Question 20

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

Answer 20

Annually

Question 21

Which are the high risk strains or HPV?

Answer 21

6, 11, 16, 18

Question 22

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

Answer 22

58%