Gynecology- Oncology (not breast)

Question 1

Use of CA-125 testing in premenopausal women.

Answer 1

In premenopausal women CA125 has low sensitivity and specificity. Not indicated

Question 2

Signs and symptoms of vaginal squamous cell carcinoma

Answer 2

Vaginal bleeding
Malodorous Discharge
Ulcerated Vaginal Lesion 
Pelvic Pain
Urinary or Mass Symptoms

Question 3

Vaginal squamous cell carcinoma topical lesion

Answer 3

irregular plaque or ulcer located in the upper 1/3 posterior vagina

Question 4

Vaginal squamous cell carcinoma risk factors

Answer 4

Chronic tobacco use
HPV
Age >60
Exposure to DES inutero

Question 5

Best next step for ulcerative lesions on posterior vaginal wall

Answer 5

BIOPSY of lesion.

Evaluated depth is innovations and diagnosis invasive v non invasive neoplasia.

Question 6

Indications for endometrial biopsy

Answer 6

Biopsy to evaluate for endometrial cancer is indicated with:

Postmenopausal bleeding
Endometrial lining >4mm

Question 7

Presence of Endometrial cells on Pap

Answer 7

< 45- common benign finding

≥45- concern for abnormality particularly in post menopausal woman

Question 8

Endometrial cell on Pap in postmenopausal woman

Answer 8

endometrial shedding may be due to endometrial hyperplasia/ cancer.

Especially risk factors: obesity, prior chronic anovulation

Question 9

Management of endometrial cells on Pap

Answer 9

<45 not reported.

>45 require further evaluation with endometrial biopsy

Question 10

surgical Tx endometrial cancer

Answer 10

hysterectomy with bilateral sapling-oophrectomy

Question 11

Choriocarcinoma

Answer 11

Aggressive type of gestational trophoblastic neoplasia, a malignancy that arrises from the placental trophoblastic tissue and secretes B-hCG.
Most common after hydatidiform mole, can occur <6months after normal gestation or spontaneous aborition.

Question 12

Presentation of choriocarcinoma

Answer 12

Irregular vaginal bleeding
Enlarged uterus
Pelvic pain/ pressure
Elevated B-hCG

Question 13

Metastasis of choriocarcinoma and symptoms

Answer 13

Pulmonary mets
Chest pain
Hemoptysis 
Dyspnea 
Irregular infiltrates

Question 14

Assessment of adnexal mass

Answer 14

Adnexal masses are common and typically benign in premenopausal but require evaluation for malignancy.

1. Initial eval: pelvic ultrasound
2. Suspicious mass: Additional imaging or surgery

Question 15

S&S epithelial ovarian carcinoma

Answer 15

Asymptomatic: incidental adnexal mass
Subacute: pelvic/ abdominal pain, bloating, early satiety
Acute: Dyspnea, obstipation/ constipation, abdominal distention

Question 16

Risk factors for epithelial ovarian carcinoma

Answer 16

Family History 
Genetic mutations (BRCA1, BRCA2)
Age >50
Endometriosis 
Infertility
Early menarche/ Late menopause

Question 17

Protective factors of epithelial ovarian carcinoma

Answer 17

Oral contraceptive pills
Multiparty
Breastfeeding

Question 18

U/S findings of malignant adnexal masses

Answer 18

Disorder uncontrolled tissue proliferation
Complex appearance (cystic and solid)
Abnormal internal features (irregular thickened separations/ papillary projections)
Ascites

Question 19

Management of cervical intraepithelial neoplasia 3

Answer 19

All non pregnant patients age>25 with CIN3 require cone biopsy (cervical conization) due to high risk of progression to invasive squamous cell cervical carcinoma

Question 20

Cervical conization

Answer 20

Diagnostic and therapeutic for cervical intraepithelial neoplasia

Question 21

Risks for Cervical cancer:

Answer 21

early onset sexual activity
Oral contraceptive
multiple sexual partners

Question 22

presentation cervical cancer

Answer 22

Vaginal bleeding particular postcoital
Increased bleeding risk with pregnancy
Raised exophytic mass
Cervical friability

Question 23

Management of suspected cervical cancer during pregnancy

Answer 23

Cervical biopsy can be preformed safely during pregnancy.

Specialized oncologic and obstetric treatment