Gynaeoncology

Question 1

RF for endometrial cancer

Answer 1

excessive exposure to unopposed oestrogen
Obesity, T2DM, HTN (increased peripheral oestrogen)
Nulliparity
PCOS
Early menarche/late menopause
Breast Ca
Oestrogen only HRT
genetics

Question 2

Protective factors for endometrial cancer

Answer 2

Parity

COCP

Question 3

Diagnosis of endometrial Ca

Answer 3

TVUSS- thickness >4cm
Hysteroscopy
Biopsy
CT/MRI- staging

Question 4

Treatment of endometrial Ca

Answer 4

Total hysterectomy with bilateral salpingo-oophrectomy
Pelvic lymphadenectomy
Radiotherapy
High dose progesterone- palliation of symptoms

Question 5

2ww referral guidelines endometrial Ca

Answer 5

> 55 with PMB

Question 6

consider 2ww referral (endometrial ca)

Answer 6

<55 with PMB

Question 7

Referral for direct access USS scan for endometrial Ca

Answer 7

> 55 with :
1. unexplained symptoms of vaginal discharge:
presenting for first time/ have thrombocytosis/ report haematuria

2. visible haematuria + low HB levels/thromobocytosis/high blood glucose levels`

Question 8

Ovarian torsion

Answer 8

severe lower abdominal pain and vomiting

Question 9

Presentation of ovarian tumours

Answer 9

Asymptomatic
Chronic pain- dull ache, dyspareynia, cyclical pain, pressure effects
Acute pain- bleeding into cyst, torsion
Irregular vaginal bleeding
Hormonal effects- androgenic features
Abdominal swelling or mass

Question 10

Investigation of ovarian tumour

Answer 10

FBC, tumour markers
<40- AFP, CA19-9, LDH, CEA and hCG
>40- CA125

Question 11

2ww referral for ovarian cancer

Answer 11

ascites and/or pelvic or abdominal mass

Question 12

Tests in primary care for ovarian Ca

Answer 12

> 50 with any of symptoms frequently/persistently
Persistent abdominal distension
Early satiety and/or loss of appetite
pelvic or abdominal pain
increased urinary urgency and/or frequency

Question 13

RF for ovarian cancer

Answer 13

Nulliparity
Early menarche and/or late menopause
Gene mutation- BRCA 1/2
HNPCC

Question 14

Protective factors for ovarian cancer

Answer 14

Pregnancy
Breastfeeding
COCP
Tubal ligation

Question 15

Presentation of ovarian ca

Answer 15

Vague symptoms- may be misinterpreted as IBS
Bloating
Unexplained weight loss, loss of appetite, early satiety
Fatigue
Urinary symptoms
change in bowel habit
abdominal/pelvic pain
vaginal bleeding
Palpable pelvic mass

Question 16

Investigations for ovarian Ca

Answer 16

FBC, U&Es, LFTs
Ca125 >40
<40- AFP, LDH, hCG
TVS
CXR
CT AP

Question 17

Types of ovarian tumours

Answer 17

Functional cysts
Endometriomas
Serous/ Mucinous cystadenomas
Fibromas
Teratomas
Germ cell tumours
Sex-cord tumours

Question 18

Peak incidence of cervical Ca

Answer 18

30-39y

>70s

Question 19

Signs and symptoms of cervical Ca

Answer 19

Smear
PCB/PMB, watery vaginal discharge
Advanced disease- heavy vaginal bleeding, ureteric obstruction, weight loss, bowel disturbance, vesicovaginal fistula, pain

Question 20

2ww referral for cervical ca

Answer 20

women, on examination, with appearance of cervix consistent with cervical cancer