Gynaecological oncology

Question 1

What is the name of the pre-malignant condition of the cervix?

Answer 1

CIN

Question 2

What proportion of women will develop cervical cancer over the next 10 years if they leave CIN II/III untreated?

Answer 2

1/3rd

Question 3

What are the RFs for CIN and cervical cancer?

Answer 3

1. HPV exposure
2. Oral contraceptives
3. Smoking
4. Immunocompromise

Question 4

Which strains are most commonly associated with HPV?

Answer 4

16, 18, 31, 33

Question 5

Which replication protein does HPV encode?

Answer 5

E1

Question 6

Which HPV strains does Gardasil protect against?

Answer 6

6, 11, 16, 18

Question 7

Which strains of HPV are responsible for what proportion of cases of genital warts?

Answer 7

6 and 11 - responsible for 90%

Question 8

What proportion of cases of cervical cancer do HPV strains 16 and 18 account for?

Answer 8

75% (and 75-80% of anal cancer)

Question 9

How is CIN Dx?

Answer 9

Cervical smear = a histological Dx since women with CIN is asymptomatic

Question 10

What is CIN I?

Answer 10

Atypical cells in the lower third of the epithelium only

Question 11

What is CIN II?

Answer 11

Atypical cells in the lower two thirds of the epithelium only

Question 12

What is CIN III?

Answer 12

Atypical cells found full thickness. Similar in appearance to malignant lesions, but do not invade the basement membrane

Question 13

Between what ages are women invited for 3-yearly cervical smears?

Answer 13

25-49

Question 14

Between what ages are women invited for 5-yearly cervical smear?

Answer 14

50-64

Question 15

Since the introduction of screening, by what % has cervical cancer cases dropped per year?

Answer 15

7%

Question 16

What proportion of cervical smear samples are inadequate?

Answer 16

2.3%

Question 17

Why might a cervical smear sample be inadequate?

Answer 17

Sample vaginal rather than cervical; composed of endocervical cells; contains insufficient cells

Question 18

What proportion of adequate samples are abnormal?

Answer 18

6.5%

Question 19

How might a cervical sample be abnormal?

Answer 19

Borderline changes - 3.5%
CIN I - 1.8%
CIN II - 0.5%
CIN III - 0.6%
Suspected invasive cancer or glandular neoplasia - 0.1%

Question 20

How is a woman with a borderline of CIN I result, who is HPV -ve, followed up?

Answer 20

Back to routine recall

Question 21

How is a woman with a borderline of CIN I result, who is HPV +ve, followed up?

Answer 21

Colposcopy (within 8wks), followed by screening at 6, 12 and 24 months

Question 22

How is a woman with CIN II or III followed up?

Answer 22

Colposcopy (within 4wks) + LLETZ, followed by screening at 6 and 12 months, and then annually for 9 years (i.e. 10 year F/U)

Question 23

How is neoplasia followed up?

Answer 23

Urgent colposcopy (within 2wks)

Question 24

How may cervical cancer present?

Answer 24

1. Asymptomatic
2. PCB
3. IMB
4. PMB
5. Offensive PV discharge

Question 25

What are the two type of cervical cancer?

Answer 25

1. Squamous carcinoma | 2. Adenocarcinoma

Question 26

When does endometrial cancer tend to occur?

Answer 26

Highest prevalence at 60y/o, <15% occurring pre-menopausally

Question 27

What are the two most common types of endometrial cancer?

Answer 27

1. Adenocarcinoma (>90%) | 2. Adenosquamous carcinoma

Question 28

What are the RFs for endometrial cancer?

Answer 28

1. Unopposed oestrogen excess - exogenous oestrogens, e.g. tamoxifen, and endogenous oestrogens, e.g. in obesity, PCOS, nullparity and late menopause 2. DM 3. HTN 4. Lynch syndrome

Question 29

What is the most common presentation of endometrial cancer?

Answer 29

PMB

Question 30

What tends to be cause of death in ovarian cancer?

Answer 30

Bowel obstruction and/or perforation

Question 31

What are the protective factors for ovarian cancer?

Answer 31

1. COCP 2. Tubal ligation 3. Pregnancy 4. Breast feeding

Question 32

What are the risk factors for ovarian cancer?

Answer 32

1. Nullparity 2. Non-breast feeding 3. Infertility 4. Total menstrual years 5. FHx 6. Unopposed exogenous oestrogen

Question 33

What are the 3 types of ovarian tumours?

Answer 33

1. Epithelial tumours - accounts for 90% of ovarian malignancies 2. Germ cell tumours 3. Sex cord tumours

Question 34

How may ovarian cancers present?

Answer 34

1. Asymptomatic 2. Bloating 3. Early satiety 4. Anorexia 5. Pain (uncommon) 6. Urinary uregency/frequency

Question 35

What blood marker should be measured in suspected ovarian cancer?

Answer 35

CA-125

Question 36

What factors does the risk of malignancy index (RMI) take into account?

Answer 36

1. U = USS 2. M = menopausal status 3. CA125

Question 37

A patient complaining of a lump in their 'privates' may be suffering from what?

Answer 37

1. Syphilitic chancre 2. Vulval warts 3. Bartholin's gland cyst 4. Bartholin's abscess 5. Congenital vaginal cyst 6. Carcinoma of the vulva 7. Carcinoma of the vagina