Gynaecological Oncology (Platinum) -EMQ

Option List:

A. Lactate detrydrogenase
B. CA125
C. Inhibin
D. HCG
E. placental alkaline phosphatase
F. α-fetoprotein
G. AMH
H. Carcinoma embryonic antigen
I. Testosterone

The above option has tumour markers and hormones which are produced by various tumours, please select appropriate tumour marker which helps diagnose particular tumour.

1. 18-year-old girl without a significant past medical history has been diagnosed and treated for a yolk-sac tumour.

2. 40 year old woman presents with nausea and vomiting,and heavy vaginal bleeding. She has undergone dilatation and evacuation for complete molar pregnancy 8weeks back. She gives history of weight loss, she has been sent for scan suggestive of mass in uterus.

3. Postmenopausal lady presents with bleeding, she gives history of vague pelvic pain, sudden weight loss and anorexia. On examination she has complex solid ovarian mass

4. Postmenopausal lady presented with rapid weight loss and anorexia. She has been treated for GI malignancy. On examination bilateral solid ovarian mass present

5. Postmenopausal lady presents with history of heaviness in abdomen, sudden weight loss and anorexia. She has also recently noticed virilization.On examination there is complex solid ovarian mass

6. A compound that is elevated in women with an ovarian dysgerminoma, and also in third trimester of pregnancy.

Option List:

A. Vulvectomy
B. Excisional biopsy
C. Punch biopsies of vulva
D. Stage 1b with wide local excision
E. Treat with oestrogen cream
F. Treat with steroids cream
G. Radiotherapy
H. Radical vulvectomy unilateral lymphadenectomy
I. Refer to gynaecology cancer centre.
J. Wide local lesion with ipsilateral groin lymph node removal
K. Radical vulvectomy and bilateral groin lymph adenectomy
L. Stage 1a cancer with wide local excision

7. A 70-year-old is referred to the gynaecology clinic with a history of vulval itching and soreness for the last year, with worsening of symptoms over the last month. On examination, irregular exophytic growth on vulva. Some areas show elevated and irregular surface contour and feel firm and tender to palpate. There is no obvious ulceration. What would be the most appropriate next step?

8. A 75-year-old has been referred with vulval soreness and a  vulval lesion involving the left labia minora. Her past medical history includes hypertension, COPD and atrial fibrillation. The following is the picture:

Option List:

A. laparoscopically assisted vaginal hysterectomy
B. radical hysterectomy, radiotherapy and chemotherapy
C. external radiotherapy
D. TAH, BSO, peritoneal cytology, omectectomy, pelvic para-aortic lymphadenectomy.
E. laparoscopic hysterectomy with bilateral salpingectomy
F. laparotomy and bilateral salpingo-oophorectomy (BSO)
G. presurgical radiotherapy followed by completion hysterectomy
H. chemoradiation
I. palliative care
J. total abdominal hysterectomy (TAH) with BSO,
K. tamoxifen
L. progesterone
M. annual follow-up
N. optimal debulking surgery
O. combined surgery and chemotherapy
P. no further therapy
Q. laparoscopic hysterectomy with bilateral salpingo-oophrectomy

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.

9. A 52-year-old P1 woman was referred to the gynaecology clinic with irregular vaginal bleeding and abdominal pain lasting 2 months. Pelvic ultrasound showed an enlarged uterus with 13 mm thick endometrium and a 10 cm complex adnexal mass on the right side. Outpatient Pipelle sampling has shown well-differentiated endometroid adenocarcinoma cells. Subsequent MRI has shown a three-quarters myometrial invasion. What is the most appropriate option?

10. A 40-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?

Option List:

A. Bleomycin
B. Cisplatin
C. Carboplatin
D. PalclitAxel
E. Doxorubicin
F. 5- flurouracil
G. Ifosfamide
H. Methotrexate
I. Mesna

Each of the following cases describes various side effects of chemotherapy agents. Choose from above options the drug causing the side effect. Each option can be used once or more than once.

11. Woman on chemotherapy developed Motor and sensory neuropathy which is restricting her to do daily tasks

12. A 50 year old woman presented with breathlessness, orthopnoea and swelling of legs. Her ECG and echo suggestive of heart failure. When records reviewed, she is on chemotherapy.

13. A 55year old woman presented with oliguria, puffiness of face and her renal tests showed renal failure, on further evaluation she is on chemotherapy.

14. Woman on chemotherapy presented with painful swelling and fissuring of the skin of the hands and feet. Dermatologist reviewed and addressed this as hand–foot syndrome.

15. Woman on chemotherapy presented with blood stained urine. Urine analysis and ultrasound suggestive of Haemorrhagic cystitis

Option List:

A. Ovarian Leyding cell tumor
B. Papillary thyroid cancer
C. Endometrial adenocarcinoma
D. Fallopian tube cancer
E. Endodermal sinus tumor
F. Mature teratoma
G. Small call ovarian cancer
H. Primary GL tumor
I. Granulosa cell tumor
J. Ovarian papiliary serous carcinoma
K. Krukenberg Tumour
M. Dysgerminoma

The following clinical vignettes describe clinical features and histopathological features of different types of ovarian cancer. Choose appropriate type of tumour for clinical vignette explained below. Each option can be used once or more than once or not at all.

16. Young patient presented with a pelvic mass and also complains of virilization. On examination - clitoromegaly, breast atrophy and hirsutism. Elevated testosterone levels and ovarian / pelvic mass seen on imaging studies. Histopathology of this tumor shows Reinke crystals which are rod like cytoplasmic inclusions.

17. Post-menopausal woman presents with vaginal bleeding and ovarian cancer. Histopathology of tumor shows Call-Exner bodies which have follicle line appearance with small eosinophilia fluid filled punched spaces between tumor cells.

18. A 13 year young girl presented with pelvic pain resulting from peritoneal stretching, and pressure on adjacent organsfrom few days.She was admitted with severe abdominal pain suggestive of torsion. Laparotomy was done immediately.Histopathology shows Schiller–Duval bodies, resembling Glomerulus. They have mesodermal core with central capillary, lined by flattened layers of both visceral and parietal cells.

19. A 60 year old post-menopausal woman, presents with anorexia, pelvic pain and pelvic pressure symptoms. On examination huge pelvic mass is seen. Suggestive of ovarian cancer. OnHistopathology -

Psammoma bodies are seen which are multiple, discrete, and laminated calcified bodies formed by accumulation of calcium on single necrotic or degenerated tumor cells.

20. A 44 year old woman presented with vaginal bleeding, a change in menstrual habits and hirsutism. She has been treated for adenocarcinoma of GIT. On examination bilateral ovarian tumours noted. Histopathology shows Nests of pleomorphic, mucin-filled, signet ring cells

Option List:

A. 15%
B. 45%
C. 4-5%
D. 3-14%
E. 30%
F. 1.4%
G. 2.5%
H. 13.23%
I. 7%
J. 50-60%

Each of the following clinical scenarios below relate to various incidence of ovarian cancer with various risk factors.

For each patient select the single most appropriate option from the list above. Each option may be used once, more than once or not at all.

21. Ms. A, 35years nulliparous, is here to talk to you in clinic.Her mother was diagnosed to have epithelial ovarian cancer stage 3and is on treatment.Her maternal aunt that is her mother ‘s sister died of ovarian cancer. She is here to know management options and what is her risk of developing the disease?

22. Mrs.C is anxiously waiting to see you in the clinic. When you explored her concerns, she is worried that her friend has been diagnosed with Ovarian cancer recently.Mrs. C was brought up in church, she doesn’t know much about her family. On exploring further, she has 2 children and used combined pills for almost 4years and she has been sterilised now. She is completely asymptomatic.You reassure that since she has taken combined pills & has undergone tubal sterilisation her risk of developing ovarian cancer is reduced by what percentage ?

23. Mrs. X, 30 years old nulliparous woman presented with severe dysmenorrhea, menorrhagia from last few cycles. On further evaluation she has grade 3 endometriosis with chocolate cyst of 5x4cm.Her colleague’s mom died of ovarian cancer recently.She is anxious to know risk of malignant transformation of ovarian endometriosis.

24. Mrs. D is recently diagnosed to be a BRCA1 carrier. She was evaluated because of her high risk family history. What is the risk of her developing ovarian cancer?

25. Mrs.S, is diagnosed with hereditary nonpolyposis colorectal cancer (HNPCC), what is her risk of developing ovarian cancer?