Gyne

Question 1

Cervix staging figo

Answer 1

T1 - confined to uterus
T2 - invades beyond uterus but not pelvic wall or lower third of vagin; a-no parametrial invasion, b-parametrial invasion
T3 - invades structures above or kidney
t4 - invades bladder or rectum (a) OR distant mets (b)

Question 2

most common pathology for cervical ca

Answer 2

scc

adenoca (20%) more likely to have nodal involvement

Question 3

risk factors for cervical ca

Answer 3

hpv
early sex
history of stis
high number sex partners
tobacco
prolonged oral conceptive

Question 4

MC site of distant mets cervical

Answer 4

lung

Question 5

MC LN involved cervical

Answer 5

internal, external, presacral, common, paraaortic

Question 6

MC clin pres cervical and some others

Answer 6

abnormal vaginal bleeding**
postcoital spotting
abnormal vaginal discharge

Question 7

PAP smear guidlines

Answer 7

starting at 21 unless sexually active

every 3 years after

Question 8

most important prog factor cervical

Answer 8

nodal involvement

Question 9

when should brachy be initiatied for cervical

Answer 9

following EBRT

Question 10

when might brachy be the definitive tx for cervical

Answer 10

very early stage or non-surgical candidates

Question 11

why is hdr preferred over ldr for cervical

Answer 11

hdr allows for flexibility in dose distribution and decreased exposure to personnel

Question 12

point a placement cervical brachy

Answer 12

2cm sup to cervical os

2cm lat to tandem

Question 13

point b placement cervical brachy

Answer 13

2cm sup to cervical os

5cm lat to pt midline

Question 14

cervical contouring

whats included for ctv1, 2, 3

Answer 14

1 - gtv + cervic and entire uterus
2 - parametria, ovaries, vaginal tissue
3 - internal, external, common iliac chains

ptv 1.5 margin

Question 15

RT dose for stage 1a cervical

Answer 15

ebrt 45

brachy 6Gy x 4 (24)

Question 16

RT dose for cervical stage 1b-4 N0/1

Answer 16

EBRT 45-50Gy
brachy 5.5-6Gy x 5 (27.5)
with possible parametrial boost

concurrent chemo (disease greater than 4cm) warrants lower brachy

Question 17

risk factors for endometrial ca

Answer 17

unopposed estrogen exposure
tamoxifen use
older age
lynch syndrome
diabetes mellitus

Question 18

MC clin pres endometrium

Answer 18

vaginal bleeding or discharge

Question 19

MRI for endometrial ca is not helpful for detecting nodal or peritoneal spread but it is good at…??

Answer 19

demonstrating the depth of myometrial invasion

CT of abdopelv can detect nodal and peritoneal spread

Question 20

what tumor marker is associated with endometrial ca

Answer 20

ca-125

therefore one might test a pt for this through diagnostic evaluation

Question 21

figo staging for endometrial ca

Answer 21

Stage 1 – confined to uterus (a - <50% of myometrium, b - >50% of myometrium)
Stage 2 – spread to cervical stroma (not just cervical glandular tissues)
Stage 3 – spread to adjacent connective tissue, vagina, or regional lymphatics
Stage 4 – spread to other pelvic organs, distant lymphatics, and distant mets

Question 22

MC pathology of endo ca

Answer 22

adenoca

Question 23

most important prog indicator for endo ca

Answer 23

stage

Question 24

treatment for early stage endo ca

Answer 24

Surgery - TAH + BSO
adjuvant chemo for stage 2 g3 disease
adjuvant RT depending on histological factors and nodal involvement or residual
brachy may also be an option (stage 1a g3, 1b g1-3)

Question 25

treatment for advanced stage endo ca

Answer 25

TAH + BSO
pelvic ebrt (could be extended fields)
chemo

• hormonal therapy has not shown benefit for this ca
• for inoperable, definitive RT

Question 26

RT doses for endometrial ca

Answer 26

45-50Gy EBRT
brachy boost - 6Gy x 2-3fxs
brachy alone 21Gy/3