EBCOG P1-3 months May 202-Oncology- Day 3

EMQ

A.laparotomy and bilateral salpingo-oophorectomy (BSO)

B.laparoscopically assisted vaginal hysterectomy

C.radical hysterectomy, radiotherapy and chemotherapy

D.external radiotherapy

E.presurgical radiotherapy followed by completion hysterectomy

F.chemoradiation

G.palliative care

H.total abdominal hysterectomy (TAH) with BSO, peritoneal cytology and selective lymphadenectomy

I.tamoxifen

J.progesterone

K.TAH, BSO, peritoneal cytology, omectectomy , pelvic para-aortic lymphadenectomy.

L.laparoscopic hysterectomy and bilateral salpingectomy

M.annual follow-up

N.optimal debulking surgery

O.combined surgery and chemotherapy

P.no further treatment

Q.laparoscopic hysterectomy and bilateral salpingo-oopherectomy

 

For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

 

1.A 38-year-old parous woman underwent simple hysterectomy with ovarian conservation for severe menorrhagia. Later histopathological examination has shown a well-differentiated endometrial adenocarcinoma limited to the endometrium. What is the appropriate next step?

2. A 51-year-old lady undergoes outpatient hysteroscopy and endometrial sampling for postmenopausal bleeding. Histopathological examination has shown well- differentiated adenocarcinoma cells. A subsequent magnetic resonance imaging (MRI) scan has shown a right lateral uterine wall growth limited to the inner one third of the myometrium. The uterus is found to be of normal size. What is the next step?

3.A 50-year-old nulliparous woman was referred to the gynaecology clinic with irregular vaginal bleeding and abdominal pain lasting 2 months. She has also noted some abdominal distension. Pelvic ultrasound showed an enlarged uterus with 14 mm thick endometrium and a 10 cm complex adnexal mass on the right side. Outpatient Pipelle sampling has shown well-differentiated endometroid adeno- carcinoma cells. Subsequent MRI has shown a three-quarters myometrial invasion. What is the most appropriate option?

4.A 37-year-old lady has been seen in the gynaecology clinic with irregular vaginal bleeding for the past 2 months. She has previously been diagnosed with breast cancer and has been on tamoxifen for 14 years. Pelvic ultrasound and outpatient hysteroscopy are normal. Histology of the endometrial sample has shown atypical endometrial hyperplasia.

Options for

A.Total abdominal hysterectomy

B.Total abdominal hysterectomy + BSO

C.Total abdominal hysterectomy + BSO + pelvic lymphadenectomy

D.Total abdominal hysterectomy + BSO + omentectomy

E.Total abdominal hysterectomy + BSO + para-aortic lymphadenectomy

F.Total laparoscopic hysterectomy + BSO

G.Intracavitary radiotherapy

H.Intracavitary + external beam radiotherapy

I.Total abdominal hysterectomy + BSO + radiotherapy

J.Total abdominal hysterectomy + BSO + chemotherapy

K.Total abdominal hysterectomy + BSO + combined chemo-radiotherapy
L.Radical abdominal hysterectomy + BSO

M.Radical abdominal hysterectomy + BSO + pelvic lymphadenectomy

N.no further treatment

For each scenario described below, choose the appropriate treatment option that is associated with  the lowest risk of morbidity from the above list of options.

5.A 39 yr old nullipara with PCOS is referred to clinic because of persistent vaginal bleeding. Endometrial biopsy shows well differentiated endometroid adenocarcinoma. MRI shows that tumour is confined to body of uterus,doesnt extend beyond inner 20% of myometrium.

6.A healthy 67 yr old is referred to clinic with 3 months h/o PMB. Endometrial biopsy shows well differentiated endometrial carcinoma. MRI shows that tumour is confined to   inner 50% of myometrium but extends to endocervical glands, notcervical stroma.