Gynecologic Oncology

Question 1

First line chemo in uterine cancer

Answer 1

Carboplatin + paclitaxel (+trastuzumab in HER2 positive serous carcinoma)

Question 2

What non-chemotherapy regimen may be superior to tamoxifen/megace in endometrial cancer?

Answer 2

everolimus/letrozole

Question 3

What defines high-risk early stage ovarian cancer?

Answer 3

Stage IC or II; clear cell histology (any stage); Grade 3 tumors (any histology)

Question 4

Which gene is thought to play a role in small-cell carcinoma hypercalemia-type ovarian cancer?

Answer 4

SMARCA4 (occ SMARCA2 as well)

Question 5

How are Stage IA, IB, and IC ovarian cancer defined?

Answer 5

IA = Tumor limited to one ovary with capsule intact; IB = Tumor involves both ovaries, but capsules are intact; IC = tumor involves one or both ovaries with either surgical spill, capsule ruptured before surgery or tumor on ovarian or fallopain tube surface, or malignant cells in ascites or peritoneal washing

Question 6

How is platinum sensitive vs. insensitive defined in ovarian cancer?

Answer 6

Recurrence in less than or greater than 6 months

Question 7

What are genetic changes characteristic of Type 1 endometrial cancer?

Answer 7

K-Ras, PTEN, beta-catenin mutations

Question 8

What are genetic changes characteristic of Type 2 endometrial cancer?

Answer 8

p53, HER2 amplificaiton, Bcl2 amplification

Question 9

What is chemotherapy choice for platinum-resistant ovarian cancer?

Answer 9

Doxil + bevacizumab

Question 10

How are borderline ovarian tumors (tumors of low malignant potential) defined?

Answer 10

Epithelial proliferation with absence of stromal invasion

Question 11

What stages of dysgerminoma is chemotherapy recommended?

Answer 11

Stages II-IV

Question 12

What stages of granulosa cell tumors should receive chemotherapy?

Answer 12

Stage IC-IV (Carbo/taxol or BEP)

Question 13

Which type of endometrial cancer is estrogen dependant?

Answer 13

Type 1

Question 14

What is stage IA ovarian cancer?

Answer 14

cancer only within one ovary and no cancer on surface

Question 15

What is stage IB ovarian cancer?

Answer 15

Cancer in both ovaries, but no cancer on the surface

Question 16

What is stage IC ovarian cancer?

Answer 16

Cancer in on or both ovaries, plus cancer has spread to surface of one or both ovaries or cancer cells are in abdominal fluid

Question 17

What is stage II ovarian cancer?

Answer 17

Cancer has spread to nearby organs in the pelvis

Question 18

What is stage III ovarian cancer?

Answer 18

Cancer has spread to the peritoneum

Question 19

What is stage IV ovarian cancer?

Answer 19

Cancer has spread outside the pelvis and peritoneum

Question 20

When can you observe ovarian cancer after surgery?

Answer 20

IA or IB if grade 2 endometroid (NOT high grade serous or grade 3 endometrois)

Question 21

What is stage IA endometrial cancer?

Answer 21

Less than half myometrial invasion

Question 22

What is stage IB endometrial cancer?

Answer 22

More than half myometrial invasion but does not extend past the uterus

Question 23

What is stage II endometrial cancer?

Answer 23

Invades cervical stroma

Question 24

Adjuvant treatment for Stage I endometrial cancer?

Answer 24

Observation for G1/G2 stage IA. RT +/- systemic therapy for IB G3. Otherwise vaginal bracytherapy.

Question 25

Adjuvant treatment for Stage II endometrial cancer?

Answer 25

EBRT and/or vaginal brachytherapy +/- systemic therapy

Question 26

Adjuvant treatment for Stage III/IV endometrial cancer?

Answer 26

Systemic therapy +/- EBRT +/- vaginal brachytherapy

Question 27

What is stage IIIA endometrial cancer?

Answer 27

Tumor invades the serosa of the uterus and/or adnexae

Question 28

What is Stage IIIB endometrial cancer?

Answer 28

Vaginal and/or parametrial involvement

Question 29

What is Stage IIIC endometrial cancer?

Answer 29

Metastases to pelvic and/or para-aortic lymph nodes

Question 30

What are risk factors of uterine carcinosarcomas?

Answer 30

Similar to type 1- unopposed estrogen exposure

Question 31

What treatment is recommended to women with resected uterine carcinosarcoma?

Answer 31

Ifosfamide, msna, and cisplatin

Question 32

What is the treatment for low-risk gestational trophoblastic neoplasia?

Answer 32

Single agent methotrexate or dactinomcyin

Question 33

What is the treatment for high-risk gestational trophoblastic neoplasia?

Answer 33

Combination chemotherapy with methotrexate and etoposide and actinomycin alternating with cyclophosophamide and vincristine

Question 34

What is the criteria for high-risk gestational trophoblastic neoplasia?

Answer 34

hcg >40,000, non-pulmonary visceral metastases, and >4 months to the diagnosis of malignant transformation

Question 35

When is chemotherapy not required for ovarian germ cell tumors?

Answer 35

Stage 1 dysgerminomas, or grade 1, stage IA immature teratomas