Oncology

Question 1

What is meigs syndrome

Answer 1

Ovarian mass + right sides right sides pleural effusion

Ovarian tumours that cause meigs: fibroma, thecoma, cytadenom or rarely granulosa cell

Question 2

Rupture of what type of ovarian cyst may cause pseudomyxoma peritonei and small bowel obstruction

Answer 2

Mucinous tumours

Question 3

Mucinous tumours are associated with which rumour markers

Answer 3

CEA and Ca125

Question 4

Regarding clear cell ovarian carcinoma

What is the cellular origin

Answer 4

Mullerian in orginin

Question 5

Regarding clear cell ovarian carcinoma

What % are bilateral

Answer 5

10%

Question 6

Regarding clear cell ovarian carcinoma

What % are associated with a uterine primary

Answer 6

15%

Question 7

Regarding clear cell ovarian carcinoma

What is the prognosis

Answer 7

Poor

Question 8

Regarding brenner ovarian tumours

What % are benign

If malignant what may they be associated with

Answer 8

99%

Bladder tumour

Question 9

Regarding borderline ovarian tumours

What % are serous in origin

Answer 9

50%

Question 10

Regarding borderline ovarian tumours

What is the 5yr survival at stage I

Answer 10

99%

Question 11

Regarding borderline ovarian tumours

What is the 5yr survival at stage III

Answer 11

85%

Question 12

Describe the features of an ovarian thecoma

Answer 12

Usually postmenopausal

Solid, yellow

Almost always benign

Fibroma - meigs syndrome

Question 13

What ovarian tumour shoes signet rings on histology

Answer 13

Krukenburg tumours

Question 14

Regarding krukenburg tumours

Where can they have metastasised from

Answer 14

Stomach, breast, colon

Question 15

Regarding mature teratomas

What % are bilateral
What % undergo malignant change

Answer 15

10-15%

1% malignant change

Question 16

Regarding krukenburg tumours

What % are bilateral

Answer 16

80%

Question 17

How should ovarian cysts considered low risk be followed up in post menopausal women

Answer 17

Ca125 and USS every 3-4 months for 1yr, then discharge back to GP

Question 18

What are the cut off values for RMI that indicate

Low risk
Moderate risk
High risk

What is the risk of malignancy for each

Answer 18

Low risk <25 cancer risk 3%
Moderate risk 25-250 cancer risk 20%
High risk >250 cancer risk 75%

Question 19

What is the incidence of endometrial cancer in the U.K. Per 100,000 women

Answer 19

28:100,000 women

Question 20

What is the peak age for endometrial Ca

Answer 20

70-79yr

Question 21

Regarding endometrial Ca

What is the % known to be due to lifestyle and other known risk factors

Answer 21

37%

Question 22

Regarding endometrial Ca

What % of those affected are <40yr

Answer 22

2-5%

Question 23

What is lynch syndrome

Answer 23

Hereditary non-polyposis colorectal cancer

70% lifetime risk of colon Ca
40-60% lifetime risk of endometrial Ca

Autosomal dominant

Question 24

What is the lifetime risk of endometrial Ca with lynch syndrome

Answer 24

40-60% lifetime risk of endometrial Ca

Question 25

What is the most common gynaecological cancer in the U.K.

Answer 25

Endometrial Ca

Question 26

Regarding endometrial Ca If the endometrial thickened is <5mm, by how much is the risk of cancer reduced by

Answer 26

84%

Question 27

What % of PMB is due to strophic changes

Answer 27

45%

Question 28

What % of PMB is due to | Hyperplasia

Answer 28

10%

Question 29

What % of PMB is due to polyps

Answer 29

15%

Question 30

What imaging should be completed for non-endometroid type endometrial cancer

Answer 30

CXR | CT

Question 31

What is the imaging of choice for endometroid endometrial Ca

Answer 31

MRI

Question 32

Regarding endometrial Ca What is the 5 year survival at stage I

Answer 32

75%

Question 33

Regarding endometrial Ca What is the 5 year survival at stage II

Answer 33

56%

Question 34

Regarding endometrial Ca What is the 5 year survival at stage III

Answer 34

31.5%

Question 35

Regarding endometrial Ca What is the 5 year survival at stage IV

Answer 35

10%

Question 36

Regarding endometrial Ca Describe stage I

Answer 36

Confined to uterus A <50% B>50%

Question 37

Regarding endometrial Ca Describe stage II

Answer 37

Cervical stromal invasion

Question 38

Regarding endometrial Ca Describe stage III

Answer 38

Local &/or regional spread A serosa/adnexa B vagina/parametrium C 1 pelvic LN C2 paraaortic LN

Question 39

Regarding endometrial Ca Describe stage IV

Answer 39

Invades bladder or rectum &/or distant mets A bladder/bowel B distant meta inc inguinal LN

Question 40

Regarding endometrial Ca What is the treatment for stage I disease

Answer 40

If low risk TAH & BSO consider laparoscopically if centre with expertise

Question 41

Regarding endometrial Ca Patients who recur following adjuvant external beam radiotherapy and brachytherapy can be treated again with radiotherapy True or false

Answer 41

False Once max radical dose of radiotherapy administered the patient cannot be rechallenged with a further radical course of radiotherapy

Question 42

Regarding endometrial Ca Do stage I is there any benefit from adjuvant radiotherapy

Answer 42

No Overall good prognosis, TAH AND BSO only

Question 43

Regarding endometrial Ca Where do the majority of recurrences recur

Answer 43

Vault or pelvis

Question 44

What is the first line investigation in primary care of a woman with nonspecific symptoms of ovarian Ca

Answer 44

Ca125

Question 45

By how much does tamoxifen increase the risk of endometrial Ca

Answer 45

3-6x

Question 46

What is the risk that a woman presenting with PMB will have endometrial Ca

Answer 46

10-15%

Question 47

Regarding endometrial Ca Describe stage II

Answer 47

Cervical stromal invasion

Question 48

Regarding endometrial Ca Describe stage IIIa

Answer 48

Tumour invades serosa or adnexa

Question 49

Regarding endometrial Ca Describe stage IIIb

Answer 49

Tumour invades vagina and or parametrium

Question 50

Regarding endometrial Ca Describe stage IIIc1

Answer 50

Pelvic node involvement

Question 51

Regarding endometrial Ca Describe stage IIIc2

Answer 51

Para-aortic node involvement

Question 52

Regarding RMI calculation What is the USS scoring system

Answer 52

``` 1 point for Multilocular Solid areas Evidence of metastasis Ascites Bilateral lesions ``` 0 = 0, 1 = 1, 2-4 = 3

Question 53

Regarding RMI calculation What is the scoring system for menopause

Answer 53

``` Premenopausal = 1 Postmenopausal = 3 ```

Question 54

What is the equation for RMI

Answer 54

RMI = U x M x ca125

Question 55

Who should treat women deemed at moderate risk of malignancy based on their RMI

Answer 55

Lead clinician at a cancer centre Low risk - general gynaecologist High risk - gynae oncologist

Question 56

What is the management of older women with no fertility concerns, who had limited surgery, found subsequently to be a borderline ovarian tumour

Answer 56

Complete surgical staging TAH BSO, peritoneal washings, infracolic omentectomy and exploration of the entire abdominal cavity

Question 57

What is systematic retroperitoneal lymphadanectomy

Answer 57

Block dissection if LN from pelvic side walls to the level of the renal veins

Question 58

What is optimal surgical staging for ovarian Ca

Answer 58

Midline laparotomy, TAH BSO and infracolic omentectomy, biopsies of any perintoneal deposits, random biopsies of the pelvic and abdominal peritoneum and retroperintoneal LN assessment

Question 59

What is the management of women with stage 1 grade 3 ovarian malignancy

Answer 59

Adjuvant chemotherapy with 6 cycles of carboplantin

Question 60

What type of HPV is associated with VIN

Answer 60

HPV 16

Question 61

What is the 5yr survival of ovarian Ca if stage1

Answer 61

90%

Question 62

What is the 5yr survival of ovarian Ca if stage 1c

Answer 62

80%