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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%

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2
Q

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

A

<35%

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3
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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4
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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5
Q

CA125 above what value should trigger ultrasound for ovarian cancer?

A

35

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6
Q

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

A

AFP
BHCG

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7
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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8
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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9
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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10
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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11
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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12
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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13
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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14
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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15
Q

What does it indicate if MLH1 promoter hypermethylation is present?

A

The cancer is likely sporadic

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16
Q

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

A

Around 1,400

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17
Q

What is the incidence rate of vulval cancer?

A

3.9 per 100,000

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18
Q

What are the main risk factors for vulval SCC?

A

HrHPV
Vulval dermatosis (lichen sclerosus or lichen planus)

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19
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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20
Q

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

A

Annually

21
Q

Which are the high risk strains or HPV?

A

6, 11, 16, 18

22
Q

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

A

58%

23
Q

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

A

PET-CT

24
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

25
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

26
Q

What FIGO stage of cervical cancer is: Measured stromal invasion ≤3 mm in depth

A

Stage 1a1

27
Q

What FIGO stage of cervical cancer is: Measured stromal invasion >3 and ≤5 mm in depth

A

Stage 1a2

28
Q

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

A

Stage 1b

29
Q

What FIGO stage of cervical cancer is: Invasive carcinoma >5 mm depth of stromal invasion and ≤2 cm in greatest dimension

A

Stage 1b1

30
Q

What FIGO stage of cervical cancer is: Invasive carcinoma >2 and ≤4 cm in greatest dimension

A

Stage 1b2

31
Q

What FIGO stage of cervical cancer is: Invasive carcinoma >4 cm in greatest dimension

A

Stage 1b3

32
Q

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

A

Stage 2

33
Q

What FIGO stage of cervical cancer is: Involvement limited to the upper two-thirds of the vagina without parametrial involvement

A

Stage 2A

34
Q

What FIGO stage of cervical cancer is: Invasive carcinoma ≤4 cm in greatest dimension

A

Stage 2A1

35
Q

what FIGO stage of cervical cancer is: Invasive carcinoma >4 cm in greatest dimension

A

Stage 2A2

36
Q

what FIGO stage of cervical cancer is: invasive carcinoma with parametrial involvement but not up to the pelvic wall

A

Stage 2B

37
Q

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

A

Stage 3

38
Q

What FIGO stage of cervical cancer is: The carcinoma involves the lower third of the vagina, with no extension to the pelvic wall

A

Stage 3A

39
Q

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)

A

Stage 3B

40
Q

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)

A

Stage 3C

41
Q

What FIGO stage of cervical cancer is Pelvic lymph node metastasis only

A

Stage 3c1

42
Q

What FIGO stage of cervical cancer is Para-aortic lymph node metastasis

A

Stage 3c2

43
Q

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.

A

Stage 4

44
Q

what FIGO stage of cervical cancer is Spread of the growth to adjacent pelvic organs

A

Stage 4A

45
Q

What FIGO stage of cervical cancer is Spread to distant organs

A

Stage 4B

46
Q

Below what incidence can a country be considered to have eliminated cervical cancer?

A

4 per 100,000

47
Q

What is the global uptake of the HPV vaccine as of 2022?

A

21%

47
Q
A
47
Q
A

MRCOG Part 2 (11 decks)

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