Gynaecological Cancers

Question 1

What is the most common gynaecological cancer?

Answer 1

Endometrial cancer

Question 2

Between what ages does endometrial cancer peak?

Answer 2

64-74 years

Question 3

Why is endometrial cancer commoner in the western world?

Answer 3

Due to higher rates of obesity which is a risk factor

Question 4

What are the two main risk factors for endometrial cancer?

Answer 4

Obesity and Tamoxifen

Question 5

Name four risk factors for endometrial cancer other than obesity and Tamoxifen

Answer 5

Nulliparity, early menarche, late menopause, diabetes, PCOS, oestrogen producing tumours, HNPCC

Question 6

What is HNPCC?

Answer 6

Hereditary Nonpolyposis Colorectal Cancer

Question 7

What is HNPCC also known as?

Answer 7

Lynch syndrome

Question 8

How is HNPCC inherited?

Answer 8

Autosomal dominant

Question 9

What are the three classifications of endometrial hyperplasia?

Answer 9

Simple, complicated, atypical

Question 10

What percentage of endometrial cancers are type 1?

Answer 10

80%

Question 11

What type of cancer is type 1 endometrial cancer?

Answer 11

Adenocarcinoma

Question 12

What percentage of endometrial cancers are type 2?

Answer 12

20%

Question 13

What is the gold standard diagnostic investigation for endometrial cancer?

Answer 13

Hysteroscopy

Question 14

Are mets rare in type 1 or type 2 endometrial cancer?

Answer 14

Type 1

Question 15

What are two methods for endometrial biopsy?

Answer 15

Pipelle, Dilation and Curettage

Question 16

What is the most common symptom of endometrial cancer?

Answer 16

Post menopausal bleeding

Question 17

What is the mainstay of investigation for endometrial cancer?

Answer 17

Hysteroscopy and D&C

Question 18

What does a transvaginal ultrasound assess?

Answer 18

Endometrial thickness

Question 19

Endometrial thickness can be measured by what investigation?

Answer 19

Transvaginal ultrasound

Question 20

How many millimetres is the cut off of endometrial thickness for the indication of endometrial cancer?

Answer 20

5mm

Question 21

Why is a transvaginal ultrasound not very useful in women who are not post-menopausal?

Answer 21

Endometrial thickness varies during the menstrual cycle

Question 22

What is the 5 year survival of stage 1 endometrial cancer?

Answer 22

80%

Question 23

What is the 5 year survival of stage 2 endometrial cancer?

Answer 23

60%

Question 24

What is the 5 year survival of stage 3 endometrial cancer?

Answer 24

40%

Question 25

What is the 5 yr survival of stage 4 endometrial cancer?

Answer 25

20%

Question 26

Involvement of the pelvic or para-aortic lymph nodes is what stage of endometrial cancer?

Answer 26

Stage three

Question 27

In what stage of endometrial cancer do you get bladder/bowel involvement?

Answer 27

Stage four

Question 28

Bladder/bowel involvement indicates which stage of endometrial cancer?

Answer 28

Stage 4

Question 29

What structures can be involved in stage 3 endometrial cancer?

Answer 29

Uterine serosa, vagina, tubes, ovaries, lymph nodes

Question 30

When is adjuvant radiotherapy used for endometrial cancer?

Answer 30

When there is a high risk of recurrence

Question 31

What is the primary curative procedure for endometrial cancer?

Answer 31

Hysterectomy and bilateral salpingo-oophrectomy (BOS)

Question 32

Name three endogenous sources of oestrogen

Answer 32

Obesity Tumours PCOS

Question 33

Name two exogenous sources of oestrogen.

Answer 33

Tamoxifen | HRT

Question 34

Name four causes of reduced endogenous progesterone production

Answer 34

Nulliparity, early menarche, late menopause, PCOS

Question 35

Why does pregnancy act as a protective factor against endometrial cancer?

Answer 35

High levels of progesterone during pregnancy

Question 36

What is the most common type of ovarian cancer?

Answer 36

Surface epithelial - serous adenocarcinoma

Question 37

Name three types of benign ovarian cysts

Answer 37

Follicular cyst, theca-lutein cysts, granulosa cyst

Question 38

Where does a granulosa cell cyst originate from?

Answer 38

Corpus luteum

Question 39

Why can a granulosa cell cyst produce amenorrhoea or delayed onset of menatruation?

Answer 39

Cyst of corpus luteum - persistent progesterone production

Question 40

Which benign ovarian neoplasm is a solid pale yellow tumour?

Answer 40

Brenner tumour

Question 41

What is the most common ovarian tumour in 10-30 year olds?

Answer 41

Dermoid cyst

Question 42

What is Meigs syndrome?

Answer 42

Triad of ovarian fibroma, ascites and hydrothorax

Question 43

What is the most common stromal cell ovarian tumour?

Answer 43

Granulosa cell tumour

Question 44

How can a granulosa cell malignant Timor present?

Answer 44

PMB, sexual precocity in pre adolescents and breast tenderness

Question 45

What five factors increase the risk of ovarian cancer?

Answer 45

Nulliparity, infertility, early menarche, late menopause, HRT

Question 46

What three interventions can decrease the risk of ovarian cancer?

Answer 46

Hysterectomy, salpingo-oophrectomy, sterilisation

Question 47

What three factors can decrease the risk of ovarian cancer?

Answer 47

COCP, breastfeeding, pregnancy

Question 48

Name three genetic factors that can play a role in ovarian cancer.

Answer 48

HNPCC, BRCA1/2, hereditary ovarian cancer syndrome

Question 49

Which tumour marker is associated with breast cancer?

Answer 49

Ca125

Question 50

Cancers of which four organs can also produce a high Ca125?

Answer 50

Pancreas, lungs, breast, colon

Question 51

In what stage of ovarian cancer is there spread to pelvic organs?

Answer 51

Stage two

Question 52

Where does cancer spread to in stage three of ovarian cancer?

Answer 52

Peritoneal cavity, omentum, lymph nodes

Question 53

What are the two mainstays of treatment for ovarian cancer?

Answer 53

Chemotherapy and surgery