Gynaecology Oncology Flashcards
A 59 year old nulliparous woman undergoes a hysteroscopy and endometrial biopsy after an episode of post-menopausal bleeding. This demonstrates invasive endometrial malignancy confirmed as stage I on imaging. What is the 5 year survival associated with stage I endometrial cancer?
a. 45%
b. 60%
c. 75%
d. 80%
e. 95%
E - 95%
Five year survival in endometrial cancer by stage is as follows:
- Stage I: 95%
- Stage II: 77%
- Stage III: 39%
- Stage IV: 14%
A 69 year old woman with a body mass index of 42 is referred on the 2-week-wait pathway with post-menopausal bleeding. After investigation, she is diagnosed with stage II endometrial cancer. What is the 5 year survival associated with stage II endometrial cancer?
a. 30%
b. 45%
c. 56%
d. 77%
e. 89%
D - 77%
Five year survival in endometrial cancer by stage is as follows:
- Stage I: 95%
- Stage II: 77%
- Stage III: 39%
- Stage IV: 14%
A patient is admitted for total abdominal hysterectomy following a diagnosis of endometrial cancer. On initial imaging it was believed her cancer was confined to the uterine body, though at laparotomy, serosal breech is identified and there is evidence of spread histologically to the internal iliac lymph nodes. Based on this, her cancer is re-staged to stage III and you are asked to counsel her regarding her prognosis. What is the 5 year survival associated with stage III endometrial cancer?
a. 23%
b. 39%
c. 46%
d. 67%
e. 73%
B - 39%
Five year survival in endometrial cancer by stage is as follows:
- Stage I: 95%
- Stage II: 77%
- Stage III: 39%
- Stage IV: 14%
After originally being referred to the urologists with frank haematuria, a 77 year old patient with known vascular dementia is found to have endometrial cancer with bladder metastasis (Stage IV). What is the 5 year survival associated with stage IV endometrial cancer?
a. 14%
b. 23%
c. 35%
d. 41%
e. 67%
A - 14%
Five year survival in endometrial cancer by stage is as follows:
- Stage I: 95%
- Stage II: 77%
- Stage III: 39%
- Stage IV: 14%
What is the optimum imaging modality to assess depth of myometrial invasion in patients with endometrial cancer?
a. CT
b. PET-CT
c. Ultrasound
d. MRI
e. Hysteroscopy
D - MRI
MRI is the optimum means of assessing myometrial depth of invasion. Stage I tumours are divided into IA (up to 50% myometrial invasion) and IB (50% or greater myometrial invasion)
A patient is referred as a 2 week wait after the incidental discovery of a large ovarian mass on an ultrasound to investigate bloating. A diagnosis of stage I epithelial ovarian cancer is made. What is the 5-year survival of patients with stage I ovarian cancer?
a. 45%
b. 60%
c. 75%
d. 80%
e. 90%
E - 90%
Five year survival in ovarian cancer by stage is as follows:
- Stage I: 90%
- Stage II: 42%
- Stage III: 18%
- Stage IV: 3%
A 78 year old woman is commenced on a course of chemotherapy after she is diagnosed is with stage II ovarian cancer. What is the 5-year survival for patients with stage II ovarian cancer?
a. 42%
b. 58%
c. 65%
d. 75%
e. 85%
A - 42%
Five year survival in ovarian cancer by stage is as follows:
- Stage I: 90%
- Stage II: 42%
- Stage III: 18%
- Stage IV: 3%
A 65 year old with a known BRCA mutation is diagnosed with stage III ovarian cancer. You are asked to counsel her regarding her prognosis. What is the 5-year survival amongst patients with stage III ovarian cancer?
a. 10%
b. 18%
c. 32%
d. 40%
e. 65%
B - 18%
Five year survival in ovarian cancer by stage is as follows:
- Stage I: 90%
- Stage II: 42%
- Stage III: 18%
- Stage IV: 3%
At an emergency laparotomy under the care of the general surgeons, widespread metastatic disease is found – later revealed to be from an ovarian primary and stage IV ovarian cancer is diagnosed. What is the 5-year survival for patients with stage IV ovarian cancer?
a. 3%
b. 12%
c. 24%
d. 36%
e. 45%
A - 3%
Five year survival in ovarian cancer by stage is as follows:
- Stage I: 90%
- Stage II: 42%
- Stage III: 18%
- Stage IV: 3%
What is the lifetime risk of breast cancer amongst women in the general population?
a. 3%
b. 8%
c. 12%
d. 15%
e. 20%
C - 12%
The prevalence of breast cancer in the general population is 12%.
Amongst carriers of the BRCA mutations is is nearer 70% (72% BRCA1; 69% BRCA2)
What is the lifetime prevalence of ovarian cancer in the general population?
a. 0.1%
b. 0.5%
c. 1.3%
d. 3.1%
e. 5.4%
C - 1%
The lifetime risk of ovarian cancer in the general population is 1.3%
Amongst carriers of a BRCA mutation rates are much higher:
- BRCA1: 39%
- BRCA2: 10%
These are the numbers quoted in the RCOG’s own SBA question bank
A woman with a strong family history undergoes genetic counselling regarding her risk of ovarian cancer and is found to carry the BRCA1 mutation. What is her lifetime risk of developing ovarian cancer?
a. 5-10%
b. 20-25%
c. 30-35%
d. 40-45%
e. 60-65%
D - 40-45%
The lifetime risk of ovarian cancer in the general population is 1.3%
Amongst carriers of a BRCA mutation rates are much higher:
- BRCA1: 39%
- BRCA2: 10%
A woman with a strong family history undergoes genetic counselling regarding her risk of ovarian cancer and is found to carry the BRCA2 mutation. What is her lifetime risk of developing ovarian cancer?
a. 10-15%
b. 15-20%
c. 30-35%
d. 40-45%
e. 60-65%
A - 10-15%
The lifetime risk of ovarian cancer in the general population is 1.3%
Amongst carriers of a BRCA mutation rates are much higher:
- BRCA1: 39%
- BRCA2: 10%
Tamoxifen is used in the treatment of patients with known oestrogen-receptor positive breast cancers as it has an anti-oestrogenic effect on breast tissue. It has a weakly oestrogen-agonist effect on the endometrium however. What, if any, is the increased risk of endometrial cancer amongst tamoxifen users?
a. No increased risk
b. 2x
c. 3-6x
d. 8-10x
e. 15-20x
C - 3-6x
What is the risk of malignancy amongst women with an RMI of 25-250?
a. 5%
b. 10%
c. 20%
d. 25%
e. 40%
C - 20%
Patient with an RMI of 25-250 are deemed to have an ‘intermediate’ or moderate risk of ovarian malignancy. In triaging who operates on such patients, it is advised that they be managed by the lead clinician in a cancer unit (i.e. not specifically an gynae-oncologist)
HNPCC – also known as Lynch Syndrome – is known to increase the likelihood of an individual developing numerous malignancies during their lifetime. In respect of risk reduction of gynaecological cancers, what is the recommended management of a 35 year old woman with HNPCC who has completed her family?
a. 6 monthly Ca125 and TVUSS
b. 12 monthly Ca125 and TVUSS
c. Hysterectomy and BSO
d. Laparoscopic BSO
e. Regular use of the combined pill
C - Hysterectomy and BSO
Lynch syndrome/HNPCC is known to increase both endometrial and ovarian cancers. The lifetime risk of ovarian cancer is 3-14% in such individuals.
In the context of ovarian cancer, what is defined as a complete response to chemotherapy?
a. Malignant disease not detectable for 4 weeks
b. Malignant disease not detectable for 8 weeks
c. Malignant disease not detectable for 12 weeks
d. Malignant disease not detectable for 6 months
e. Malignant disease not detectable for 12 months
A - Malignant disease not detectable for 4 weeks
A complete response to chemotherapy is defined as malignant disease not detectable for 4 weeks.
A partial response is a reduction in tumour size of >50% for at least 4 weeks.
Primary vaginal cancer is the least common of all gynaecological malignancies. The most common causes are known to be HPV and irradiation. What is the most common HPV subtype found in vaginal cancer?
a. HPV 6
b. HPV 11
c. HPV 16
d. HPV 18
e. HPV 31
C - HPV 16
What are the most common HPV subtypes found in vulval cancers?
a. HPV 5 and 8
b. HPV 6 and 11
c. HPV 16 and 18
d. HPV 31 and 33
e. HPV 58 and 59
B - HPV 6 and 11
What are the most common HPV subtypes found in cervical cancer?
a. HPV 5 and 8
b. HPV 6 and 11
c. HPV 16 and 18
d. HPV 31 and 33
e. HPV 58 and 59
C - HPV 16 and 18
HPV 16 and 18 cause >70% of cervical cancers.
A 65 year old patient is reviewed in the 2WW clinic with bilateral ovarian masses and a raised Ca-125. Calculation of the RMI returns a score of >200. What is the most appropriate next stage in management?
a. Refer to MDT
b. CT abdomen and pelvis
c. MRI abdomen and pelvis
d. List for open TAH+BSO
e. Arrange other tumour markers – CEA, hCG and AFP
B - CT Abdomen and Pelvis
All patients with an RMI >200 should undergo a CT scan of the abdomen and pelvis. While referral to MDT is also prudent, knowledge of the CT scan is required to facilitate that discussion and thus should occur first. MRI is useful in the context of equivocal ultrasound findings though has little role here. Ca125 is the only tumour marker indicated in assessment of the post-menopausal woman. While in all likelihood the patient will require a laparotomy (inclusive of TAH and BSO), further workup is required first.
A 72 year old woman is referred to the 2WW clinic after an ultrasound scan performed in primary care has highlighted the presence of a 6cm cyst on the right ovary. Ca125 is marginally elevated at 42. The USS report is somewhat vague regarding the precise nature of the cyst. What is the next step?
a. Repeat USS
b. CT pelvis
c. MRI pelvis
d. Additional tumour markers – CEA, hCG and AFP
e. MDT discussion
C - MRI Pelvis
Where there is diagnostic uncertainty on ultrasound scanning, an MRI of the pelvis may prove useful in assessment of an indeterminate ovarian mass.
A patient is seen in the GOPD clinic with an ultrasound report from primary care. She is 51 years old and last had a menstrual period over 2 years ago. The ultrasound reports the presence of a 6cm right sided ovarian mass with ‘a heterogeneous appearance, septations and solid components’. The Ca125 is elevated at 45. What is this patient’s RMI score?
a. 90
b. 135
c. 270
d. 405
e. 435
D - 405
Calculation of the RMI is based upon 3 variables:
Menopausal status
o 1 if pre-menopausal
o 3 if post-menopausal
Ca125
Ultrasound findings (where 0 scores 0, 1 scores 1 and 2 or more scores 3): o Bilateral cysts/masses o Ascites o Metastatic disease o Solid components o Multilocular
The score for each should then be multiplied to give the total RMI. In the scenario here, the patient is post-menopasual (3), Ca125 is elevated (45) and she has 2 concerning features on USS, solid and multi-cystic lesion (3) – 3x3x45 = 415. The next step in management is thus to arrange a CT of the abdomen and pelvis and discussion in MDT.
A 62 year old patient is referred to the 2WW clinic after seeing her GP with unexplained weight loss and bloating. A scan in clinic demonstrates a 3cm left ovarian cyst – apparently simple with a larger 9cm cyst on the right which is reported as containing solid components. A transabdominal scan has also been performed which demonstrates suspected ascites. The Ca125 is within normal limits at 16. What is this patient’s RMI score?
a. 48
b. 96
c. 144
d. 288
e. 496
C - 144
In the scenario here, the patient is post-menopausal (3), Ca125 is normal (16) and there are 3 concerning ultrasound features, bilateral lesions, solid components and ascites (3). 3x3x16 = 144.