Gyn Onc

Question 1

What are the most common chemo agents used in ovarian cancer?

Answer 1

Carboplatin and paclitaxel

Question 2

What proportion of ovarian tumours are secondary in origin?

Answer 2

10%

Question 3

From what tumour does a secondary ovarian tumour most commonly originate?

Answer 3

Endometrium

Question 4

A complex cyst is defined as having one or more of the following features:

Answer 4

1. Complete septation
2. Solid nodules
3. Papillary projections

Question 5

Which type of VIN is most likely to progress to vulval SCC?

Answer 5

Differentiated type

Question 6

In which patients would pipelle biopsy rarely give useful diagnostic information?

Answer 6

Women taking tamoxifen - due to tamoxifen-induced subepithelial stromal hypertrophy (so require hysteroscopy and targeted biopsy)

Question 7

Yearly risk reduction of ovarian cancer using the COCP?

Answer 7

7%

Question 8

Most common age group for malignant ovarian germ cell tumours?

Answer 8

0-20 years

Question 9

The most common types of ovarian germ cell tumours?

Answer 9

1. Dysgerminoma
2. Immature teratoma

Question 10

After risk reducing surgery for BRCA, what is the risk of primary peritoneal cancer?

Answer 10

2%

Question 11

How can radiotherapy be used in endometrial cancer?

Answer 11

As an adjuvant therapy postoperatively

Question 12

Brachytherapy choices for ovarian cancer:

Answer 12

1. Cobalt
2. Iridium

Question 13

What is the most common subtype of ovarian cancer?

Answer 13

Epithelial cancer

Question 14

Inhibin is a tumour marker for which type of tumours?

Answer 14

Granulosa cell tumours

Question 15

Where is oestRIOL produced?

Answer 15

The placenta

Question 16

LDH is a tumour marker for which type of tumours?

Answer 16

Ovarian dysgerminoma

Question 17

In which age group were cervical cancer rates highest in the UK?

Answer 17

25-29

Question 18

In which age group were ovarian cancer rates highest in the UK?

Answer 18

75-79

Question 19

In which age group were endometrial cancer rates highest in the UK?

Answer 19

70-74

Question 20

Management for RMI >/= 200?

Answer 20

Full laparotomy staging

Question 21

Management for RMI <200

Answer 21

Laparoscopic BSO

Question 22

What is the risk of endometrial cancer (at 20 years) of hyperplasia WITHOUT atypia?

Answer 22

<5%

Question 23

What is the risk of endometrial cancer (at 20 years) of hyperplasia WITH atypia?

Answer 23

> 25%

Question 24

What proportion of sexually active women will acquire HPV in their lifetime?

Answer 24

70-80%

Question 25

What age range are eligible for cervical screening?

Answer 25

25-64

Question 26

What age children are eligible for the HPV vaccine?

Answer 26

11-13 y/o

Question 27

Who is eligible for HPV catch-up scheme?

Answer 27

- All girls up to 25yo - Boys born after 1/9/2006 up to 25yo

Question 28

What is the HPV vaccine dosing?

Answer 28

<25yo - 1 dose 25 – 45yo - 2 doses, given 6/12–2 years apart Weakened immune system - 3 doses over 12/12

Question 29

When is the TOC smear after any CIN?

Answer 29

6/12

Question 30

What is the prognosis of CIN 1?

Answer 30

90% regress with two years 11% progress to CIN3 1% progress to invasive cancer

Question 31

What is the prognosis of CIN 2?

Answer 31

50% regress within two years 22% progress to CIN3 5% progress to invasive cancer

Question 32

What is the prognosis of CIN 3?

Answer 32

12% progress to invasive cancer

Question 33

What are the different types of cervical Ca?

Answer 33

SCC - 80% Adenocarcinoma - 20%

Question 34

How often are women screened for cervical cancer in the UK?

Answer 34

England and NI: - Every 3 years 25-49, Every 5 years 50-64. Wales and Scotland: Every 5 years 25-64

Question 35

What are the different 'solutions' (i.e. tests) performed at colposcopy?

Answer 35

Acetic acid 3% - turn areas of dysplasia white Iodine solution (Schillers test) – healthy cells appear very brown; dysplastic and metaplastic cells not good uptake and turn yellow/orange highly sensitive, but not specific

Question 36

How should women be followed up after CIN?

Answer 36

6/12 TOC smear - hrHPV negative -> 3 year recall - hrHPV positive -> cytology (CIN1) or colposcopy (CIN2,3)

Question 37

When should cervical screening be delayed?

Answer 37

1. Menstruating 2. <12/52 PP, after a TOP or miscarriage 3. Pregnant 4. Vaginal discharge or pelvic infection — treat the infection and take the sample on another occasion

Question 38

What modality is used for breast screening in the under 40s?

Answer 38

MRI

Question 39

Who are the higher risk populations that receive more frequent, and breast screening from a younger age?

Answer 39

TP53 mutation (Li-Fraumeni Syndrome) – annual scan from 20yo BRCA1, BRCA2 – annual scan from 30yo Significant family history - annual scans from 30s/40s

Question 40

Are people who take feminising hormones eligible for Breast Ca screening?

Answer 40

Yes

Question 41

Who gets bowel cancer screening?

Answer 41

England: 54 – 74yo, expanding to 50yo Wales, Scotland: 50 -74yo NI: 60 -74yo Every 2 years

Question 42

What are the key features of VaIN?

Answer 42

- 50-60 y/o - 85% have had previous VIN or CIN - often incidental finding at colp - Mostly in upper 1/3 vagina - Treat wit WLE or imiquimod - Low risk of progression to SCC

Question 43

What proportion of PIN develop into SCC if untreated?

Answer 43

10-30%

Question 44

Which type of HPV is responsible for 90% AIN?

Answer 44

HPV16

Question 45

What is the prognosis of AIN - high grade/low grade?

Answer 45

High grade AIN if untreated - 9-13% progress to anal Ca Low grade AIN -> 17% regress if untreated

Question 46

What are the 2ww features for colp?

Answer 46

1. ?invasion 2. High grade dyskaryosis 3. ?glandular neoplasia 4. Borderline changes in endocervical cells