Gynaecology Oncology – SBA

1. 34 year-old Rachel, multiparous woman, completed her family, diagnosed with a suspected borderline left ovarian tumour and is awaiting laparotomy.Her case was discussed in oncology MDT and frozen section and conservative or complete staging surgery was decided. On counselling of treatment, she wants to know the accuracy of frozen section.How many cases diagnosed as borderline ovarian tumours on frozen section would be later reclassified as invasive tumours?

2. Ms. Susan, 45-year-old, has been diagnosed with stage 3c ovarian cancer.She is keen to know about her prognosis.
What is the 5-year survival rate in UK for advanced ovarian cancer?

3.Ms.Leslie, 59year old has been referred by GP.She is suspected with fallopian tube cancer, family history of ovarian cancer in her mother and sister.She has been diagnosed as BRCA2 carrier.

All of the following symptoms she can present with except,

4.Mrs. Adams, 62year old haspresented with Anorexia,colicky pain in lower abdomen that gets better with profuse vaginal discharge.On further evaluation she has been diagnosed with Fallopian tube cancer.

All are true regarding her management except

5. Mrs.Hamilton, 62 year old, presented with uncontrollable itching, which is worst at night. On examinations, cigarette paper like appearance, fused labia is seen.Biopsy was taken which showed, hyperkeratotic epidermis, underlying hyalinised dermis and chronic inflammatory cell infiltration. The recommended first line of treatment in Lichen sclerosus is:

6. Ms.Briganza, 50 year old is here for her pap smear as a part of screening programme, she is keen to know about frequency of screening of breast cancer which is offered free in NHS.

Which one of the following correctly describes the NHS breast cancer screening programme?

7.Ms.Sweetie, 44 year old, presented with vulval itching and discomfort,she has been treated for CIN2last year. She is a chronic smoker and smokes around 15 cigarettes a day. On vulval examination,there is warty lesion along with red plaque lesions. When you counsel her, she is asking for most common reason for her condition.

8.You are seeing Mrs. Jennet Maxwell,32year old primigravida, who works as a teacher. She conceived after IVF, is at26 weeks of gestation, and has presented with breathing difficulty for which GP has referred her to scan.

Her pregnancy was a low risk pregnancy.

ALL scans and blood tests have been normal so far.

Her pre-pregnancy weight is 60 kg. Her BMI IS 26.

She is on multivitamins. On examination no signs and symptoms of Deep vein thrombosis is seen.

Her compression duplex ultrasound on leg is normal, so chest X-ray was performed with abdominal shield. It is abnormal. So she is advised to undergo CTPAas there is high suspicion of pulmonary embolism. During counselling she asks her lifetime increase in risk of breast cancer with CTPA

9. What is the most common benign hepatic tumour in pregnancy?

10. Ms. Katie,34 year old multiparous lady has been diagnosed with Lynch syndrome. She was evaluated as her mother was diagnosed with endometrial cancer,aunt was diagnosed with ovarian cancer & two of her maternal uncle died of colon cancer. She has 3children and she has completed her family.What is the suggested management for reduction of risk for her .

11. All are true regarding benefits of oral contraceptive pills except

12. All are true regarding borderline ovarian tumourexcept

13. Which tumour marker is raised in Mucinous borderline ovarian tumour

14. All are true regarding Endometrial polyps except

15. 50 year old BRCA1carrier was diagnosed with invasive breast cancer. She has undergone mastectomy and she is in adjuvant Tamoxifen. She has been counselled regarding risk of developing Endometrial cancer, as it has weak agonist effect on endometrium. Women on tamoxifen have increased incidence of endometrial cancer by

16. A 30 year-old woman who is para 3 presented with heaviness in abdomen and vague symptoms, she was diagnosed as Dysgerminoma. She was treated with surgery and chemotherapy for stage IC dysgerminoma. She wants to know her estimated five-year survival?

17. All are true regarding principles of chemotherapy except

18. A 60 year-old woman who is multiparous presents with lower abdominal pain, bloating and weight loss. No family history of ovarian cancer.
Pelvic examination reveals a 8 cm pelvic mass and a normal size, mobile uterus.
What is the most appropriate primary investigation for suspected ovarian cancer in this case?

19. Which chemotherapeutic drug should be avoided in patient with chronic obstructive pulmonary disease

20. All are true regarding radiotherapy except

21. A 30-year-old multiparous woman with a suspected borderline left ovarian tumour is awaiting laparotomy, frozen section and conservative or complete staging surgery. She wants to know the accuracy of frozen section. How many cases diagnosed as borderline ovarian tumours on frozen section would be later reclassified as invasive tumours?

22. What is the incidence of concomitant endometrial cancer in %, in the uterus specimen if the hysterectomy had been done for atypical hyperplasia?

23. A 46-year-old nulliparous woman is seen with bloating and weight loss. Ultrasound confirms the presence of an irregular vascular 7 cm solid lesion adjacent to the left ovary. Ascites is present. What is the most appropriate course of management?

24. All are true regarding verrucous carcinoma of vulva, except

25. A 55-year-old woman is diagnosed with stage IB endometrial cancer. She declines any surgical intervention and requests radiotherapy as an alternative. What will be the risk of recurrence if she is treated using radiotherapy?

26. Nicholas is 60 years old and is on Tamoxifen for the treatment of breast cancer. Tamoxifen has a weak estrogenic effect on the endometrium. Nicholas presents with post-menopausal bleeding (PMB). What is her risk of developing endometrial cancer when compared to the general population as she is on Tamoxifen ?

27. By what percentage risk of ovarian cancer reduces for each year of use of the combined oral contraceptive pill (COCP)?

28. You are meeting Mrs. James in your gynaecology clinic women. She is 56 years old postmenopausal women, with no medical comorbities. She is otherwise fit and well. There is no family history of any disease. She is here to ask you about screening programme for ovarian cancer. What is the current recommendation regarding screening for ovarian cancer in such patients?

29- Emily,  55 year old had undergone a laparotomy earlier in the day and had unexpectedly been found to have ‘inoperable advanced ovarian cancer’. You are on on-call registrar when the gynaecology ward sister asks you to see her and her husband. The couple wants to know about the operative findings and you decide to break the bad news. What is the next most important step before breaking the bad news?

30. A 30-year-old woman attends the gynaecological oncology clinic with some questions regarding her personal risk of ovarian cancer as she believes that she has a high risk of developing ovarian cancer due to her family history. She has a friend who suffered ovarian cancer and now her daughter having the same more added to her fears. She has done a lot research and obtained a lot of information from the internet, now she would like some information and advice. Apart from her mother side having defective gene there is also her father also has a number of family members that have died at a young age from colon cancer. Does this have any effect on her risk if the cases were due to a gene defect? As Lynch syndrome, also called hereditary nonpolyposis colorectal cancer (HNPCC) is associated with the development of multiple types of cancer. What is the suggested management for reduction of risk of developing gynaecological cancers in a 35-year-old woman with HNPCC who has completed her family?

31.  A 35-year-old woman is contemplating IVF for the third time. The couple is worried about the risk of developing ovarian cancer in the future due to the repeated administration of fertility drugs. Which of the following statements is correct?

32. A 32-year-old woman is referred to colposcopy by her GP. Her cervical smear shows ‘moderate dyskaryosis’. Her BMI is 27. She has had three children, all normal vaginal deliveries, and has been using the combined oral contraceptive pill for the past 2 years. At colposcopy you note coarse vascular patterns with punctation and mosaicism and large dense acetowhite lesions with irregular margins. LLETZ is done , but the margins are unclear. She is keen to discuss management further management with you?

33.  A 28-year-old nulliparous woman is seen in colposcopy following a smear report of severe dyskaryosis. Colposcopy reveals a transformation zone with areas of dense acetowhite epithelium consistent with CIN2. Patient was counselled about LLETZ considering her histology finding. Patient refuses for the treatment. With regard to keep this patient on conservative management what is best advise for her?

34. A 28 year-old woman have positive for high-risk HPV infection. She is referred to colposcopy clinic where reflex cytological cervical smear shows low-grade dyskaryosis but colposcopic findings where normal. She has no relevant past medical history. She has a family history of her maternal aunt and grandmother both dying from cervical cancer. She smokes ten cigarettes per day and has recently broken up with her partner. Her children are aged 12, 5 and 1 years old. Her BMI is 35. She has regular periods and no postcoital bleeding and no vaginal discharge. She is on POP for contraception. What is the most appropriate advice regarding her management?

35. A 26-year-old woman has multiple biopsies of her cervix at the colposcopy clinic due to high-grade dyskaryosis. The histology shows CIN3 with areas of microinvasion.

What is the most appropriate advice regarding her management?

36. A 28-year-old woman has an excisional biopsy of her cervix for high-grade changes on colposcopy for a background of high-grade dyskaryosis. She has no comorbidities and does not want to have children in the future. The histology shows invasive adenocarcinoma extending to 5 mm in depth. The excision margins are clear. Her all blood investigations are normal. Imaging doenot show any LVSI and lyph node enlargement and no distant metastasis. What is the most appropriate advice regarding her management?

37. What is the prevalence of BRCA1 and BRCA2 mutation in woman with fallopian tube cancer and ovarian cancer respectively?

38. CIN 3 refers to

39. Colposcopic examination and biopsy confirm CIN II, and she opts for hysterectomy as her family is complete. Histopathology confirms completely excised CIN. What is the most appropriate follow-up?

40. A 27-year-old patient is found to have high-grade squamous dyskaryosis at routine cervical smear at 6 weeks’ gestation. Colposcopic biopsies show CIN-3. Repeat colposcopy done at the end second trimester shows early invasive disease. Cone biopsy done and the specimen has disease free margins. What would be the most appropriate plan of action?

41. A 75- year-old woman is seen by the GP for routine recall of her lichen sclerosus. She mentions the itching has become gradually worse over the year with no relief after using different creams as suggested by the pharmacist. She also mentions she has some swelling down below that feels like the size of a peanut. She is referred to the hospital and on examination, you note a raised ulcer of 1X1cm with rolled edges. Her general examination is normal with no groin nodes palpable. A biopsy is taken under local anaesthetic in clinic, and biopsy proves it Sqaumous cell cancer. What is the correct combination of a pre-op tests is arranged.

42. A 67-year-old woman is diagnosed with vulval cancer after biopsy. The lesion is 2 cm and lateral. Wide local excision done for biopsy. Lesion on histopathology with sqauamous cell carcinoma with clear margins. The pathologist has phoned and informed you that the frozen section for the sentinel lymph node biopsies is positive.

How will you proceed with the surgery?

 43.  A 65-year-old woman is diagnosed with vulval basal cell carcinoma. The lesion is 3 cm in diameter and less than 20 mm above and lateral to the anus. What is the most appropriate management?

44. A 70-year-old menopausal woman presents with vulval itching and bleeding. On examination, a suspicious lesion is identified and an excision biopsy is performed. The lesion is confirmed as a squamous cell carcinoma with depth of invasion of <1 mm. What is the likelihood of lymph node involvement?

45. A 30-year-old woman attends the colposcopy clinic after a high-grade smear result. After discussion, the woman accepts the LETZ procedure. What is the minimum depth of excision that is accepted in the LETZ procedure?

46. A 55-year-old postmenopausal patient with a BMI of 24 and two episode of postmenopausal bleeding presents to the clinic. She is otherwise asymptomatic. Abdominal and pelvic examination is unremarkable and the endometrial thickness is 6 mm. An outpatient hysteroscopy and biopsy is arranged; the cavity is noted to be 7.5 cm in length and an adequate sample is taken. The endometrium was noted to be atrophic at hysteroscopy and the cavity normal. At 2 weeks later, the histology report reads “some inactive endometrium but sample insufficient for diagnostic purposes”.

47. 60 year old with BMI 38, is postmenopausal since 10 years. Has history of 2 episodes of postmenopausal bleeding. TVS followed by endometrial where copious amount of endometrium was obtained on histopathological examination shows endometrial cancer. MRI was done and it showed Endometrial cancer localised to endometrium and not invading myometrium, No lymph node involvement notes on MRI. What is the stage of cancer ?

48. 60 year old with BMI 38, is postmenopausal since 10 years. Has history of 2 episodes of postmenopausal bleeding. TVS followed by endometrial where copious amount of endometrium was obtained on histopathological examination shows endometrial cancer. MRI was done and it showed Endometrial cancer localised to endometrium and not invading myometrium, No lymph node involvement notes on MRI.  Stage 1 is suspected after MRI. What is best treatment for this patient ?

49. You have to explain principal role of radiotherapy in the treatment of endometrial cancer to your juniors?

50.The following increases the risk of endometrial cancer ?