Gynae cancers

Question 1

What are the groups of ovarian cancers?

Answer 1

• Epithelial (70%)
• Germ cell (20%)
• Sex cord/ stomal cell (10%)

Question 1

What are the benign epithelial cancers?

Answer 1

• Serous cystadenoma
• Mucinous cystadenoma

Question 2

What are the malignant epithelial cancers?

Answer 2

• Endometriod
• Clear cell

Question 3

What are the benign germ cell tumous?

Answer 3

• Mature teratoma (dermoid cyst)
• Dysgerminoma

Question 4

What are the malignant germ cell tumours?

Answer 4

• Immature teratoma
• Choriocarcinoma

Question 5

What are the sex cord/ stomal tumours?

Answer 5

• Fibroma (Meig’s syndrome)
• Granulosa-theca cell tumour
• Leydig-sertoli cell tumour

Question 6

What is Meig’s syndrome?

Answer 6

• Right sided pleural effusion
• Fibroma
• Ascites

Question 7

What is a common tumour that metastasises to the ovaries?

Answer 7

Gastric/ colonic tumours, causing Krukenberg tumour formation in the ovary

Mucin-producing signet-ring cells

Question 8

What are the stages of ovarian cancer?

Answer 8

FIGO
1. In the ovaries
2. In the pelvis
3. In the abdominal cavity (including regional lymph nodes)
4. Metastases outside the abdomenal cavity

Question 9

What is the management for stage I ovarian cancer?

Answer 9

Hysterectomy and bilateral salpingo-oophorectomy + adjuvant chemo

(If fertility wishes to be preserved and they’re stage Ia, unilateral oophorectomy)

Question 10

What is the management for stage 2 ovarian cancer?

Answer 10

Debulking surgery + neo/adjuvant chemo

Question 11

What is the managment for stage 3 ovarian cancer?

Answer 11

Debulking surgery + neo/adjuvant chemo + Bevacizumab

If surgery can’t be performed, platinum based chemo and symptomatic management (eg. ascitic drainage, laxatives)

Question 12

What is the management for stage 4 ovarian cancer?

Answer 12

Same as stage 3, palliative care more likely

Question 13

What is the first line chemo regimen for ovarian cancer?

Answer 13

Combined carboplatin + paclitaxel every 3 weeks for 6 cycles

Question 14

What are the investigations once treatment for ovarian cancer is complete?

Answer 14

CT
CA125 - tends to rise in recurrence, if cancer recurs treat as palliative

Question 15

What is the mechanism of carboplatin?

Answer 15

Causes cross-linkage of DNA stands leading to cell cycle arrest

Calculated using GFR

Question 16

What is the mechanism of Paclitaxel?

Answer 16

Causes microtubular damage preventing replication and cell division

Pre-emptive steroids given to reduce hypersensitivity reactions and side effects

Causes total loss of body hair

Question 17

What is the mechanism of Bevacizumab?

Answer 17

Monoclonal antibody against VEG-F inhibiting angiogenesis

Question 18

What is the management of vulval cancer?

Answer 18

Excision
- 15mm margin
- Large lesions can be shrunk by neoadjuvant radiotherapy (often + chemotherapy)

Question 19

When is full inguinofemoral lymphadenectomy done in vulval cancers?

Answer 19

If the lesion has a depth of >4cm

Question 20

How can full iliofemoral lymphadenectomy be avoided in vulval cancers?

Answer 20

Sentinal node biopsy

• Dye and radioactive nucleotide injected into the vulval tumour to identify senital node
• If sential node positive, full IFL

Question 21

What can be used instead of surgery for vulval cancers?

Answer 21

If patient is unfit, radical radiotherapy

Question 22

What are the complications of inguinofemoral lymphadenectomy?

Answer 22

• Poor wound healing
• Infection
• VTE
• Chronic lymphoedema

Question 23

When is adjuvant radiotherapy indicated for vulval cancers?

Answer 23

If excision margins are close or in the presence of two or more groin node mets

Question 24

What is the risk of malignancy index for ovarian cancer?

Answer 24

RMI = UxMxCa125 U= ultrasound findings (0=0, 1=1, 2=>=2) M= menopause (1=pre, 2=post) Score of >250 = gynae referral

Question 25

What is the managment for endometrial hyperplasia without atypia?

Answer 25

1. Address risk factors 2. Levonogestrel IUS (3. If they don't want LNG-IUS, continuous oral progesterone) Surveillance and endometrial biopsy 6 months

Question 26

What is the management for endometrial hyperplasia with atypia?

Answer 26

Non-fertility preserving: - Hysterectomy with bilateral salpingo-oophorectomy Fertility-preserving: - LNG-IUS or continous oral progesterone - Surveillance and biopsy at 3 months

Question 27

What is the FIGO staging for endometrial cancer?

Answer 27

1. Confined to the uterus 2. Spread to the cervical stroma 3. Local/ regional spread (adnexa, upper 2/3 vagina, pelvic/ paraaortic lymph nodes) 4. Extension to the pelvic wall, lower 1/3 vagina, kidneys

Question 28

What is the managment of stage 1 endometrial cancer?

Answer 28

Total hysterectomy and bilateral salpingo-oophorectomy

Question 29

What is the managment of stage 2 endometrial cancer?

Answer 29

Radical hysterectomy and LN assessment (+ adjuvant chemo)

Question 30

What is the management of stage 3 endometrial cancer?

Answer 30

Maximal debulking surgery + chemo + radio

Question 31

What is the management of stage 4 endometrial cancer?

Answer 31

Maximal debulking surgery, may take a palliative approach with high dose progesterone

Question 32

What is the benefit of post-op radiotherapy?

Answer 32

Will reduce recurrance rates, but doesn't improve overall survival rates

Question 33

What is the risk with hormone treatment for endometrial hyperplasia?

Answer 33

High rates of relapse