MRCOG Part 2 – Gynaecological Oncology SBAs

A 38 year old woman is referred urgently with an ultrasound scan showing an adnexal mass. Which of the following is defined as a malignant feature by IOTA Simple Rules?

A woman has pelvic exenteration surgery for recurrent FIGO Stage III vulval cancer with complete resection of the vulva, perineum, lavator ani and viscera below levator ani. What classification of pelvic exenteration is this?

A woman has pelvic exenteration surgery for recurrent FIGO Stage III vulval cancer. Which of the following are poor prognostic factors associated with survival?

A woman has pelvic exenteration surgery for recurrent FIGO Stage III vulval cancer. What is the operative mortality rate for pelvic exenteration?

What is the inheritance pattern for BRCA1 and BRCA2 germline mutations?

A woman is referred for genetic counselling after a diagnosis of breast cancer with BRCA1 germline mutation. Which of the following characteristics are less suggestive of an underlying BRCA1 mutation?

What is the prevalence of Lynch Syndrome in women with endometrial cancer?

A 65 year old woman has primary cytoreduction surgery for Stage 3A1 ovarian cancer. What is the first line post-operative chemotherapy following primary surgery for ovarian cancer?

A 65 year old woman has primary cytoreduction surgery for Stage 3A1 ovarian cancer and receives adjuvant paclitaxel and carboplatin chemotherapy. What percentage of patients with ovarian cancer initially respond to first-line chemotherapy?

A 65 year old woman is diagnosed with advanced ovarian cancer. Which of the following is an indication for neoadjuvant chemotherapy followed by interval debulking surgery?

A 65 year old woman has primary cytoreduction surgery for Stage 3A1 ovarian cancer and receives adjuvant paclitaxel and carboplatin chemotherapy. During follow up, she is found to have disease recurrence nine months after completing chemotherapy.  What is the definition of this platinum-free interval for prognostic purposes?

A 38 year old woman is referred urgently with an ultrasound scan showing an adnexal mass. Which of the following is defined as a benign feature by IOTA Simple Rules?

A 65 year old woman has primary cytoreduction surgery for Stage 3A1 ovarian cancer and receives adjuvant paclitaxel and carboplatin chemotherapy. During follow up, she is found to have disease recurrence nine months after completing chemotherapy.  What is the likely response rate to second line chemotherapy?

A 40 year old woman has a total abdominal hysterectomy and bilateral salpingo-oophorectomy for Type 1 endometrioid Stage I endometrial cancer and subsequently develops debilitating menopausal symptoms. What is the most appropriate management option?

A 40 year old woman has a total abdominal hysterectomy and bilateral salpingo-oophorectomy for Stage IB cervical adenocarcinoma and subsequently develops debilitating menopausal symptoms. What is the most appropriate management option?

A 40 year old woman has a total abdominal hysterectomy and bilateral salpingo-oophorectomy for Type 2 endometrial cancer with histology confirming Grade 3 endometrioid type and subsequently develops debilitating menopausal symptoms. What is the most appropriate management option?

A 40 year old woman has platinum-based chemoradiotherapy and brachytherapy for Stage IIA2 cervical squamous cell carcinoma and subsequently develops significant dyspareunia. What is the most appropriate management option?

A 50 year old woman is referred to gynaecology clinic by her GP with an elevated CA125 result with normal pelvic ultrasound scan. Which of the following is not associated with elevated CA125 levels?

A 25 year old is referred to Gynaecology clinic by her geneticist following a recent diagnosis of Lynch syndrome with a mutation in the MSH2 gene identified. What should be recommended to reduce her risk of cancer?

A 25 year old is referred to Gynaecology clinic by her geneticist following a recent diagnosis of Lynch syndrome with a mutation in the MSH2 gene identified. What should be recommended to reduce her risk of gynaecological cancer after she has completed her family?

A 40 year old woman with known Lynch syndrome has a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy for risk reduction and subsequently develops debilitating menopausal symptoms. What is the most appropriate management option?

What is the 5-year survival rate for Stage I endometrial cancer?

A 38 year old woman is referred urgently with an ultrasound scan showing an adnexal mass. Which of the following is classified as a malignant adnexal mass by IOTA Simple Rules?

What is the 5-year survival rate for Stage IV endometrial cancer?

Which of the following is the highest risk factor for endometrioid endometrial cancer?

A 60 year old woman presents to her GP with new onset of watery vaginal discharge and occasional episodes of blood-stained urine. What is the most appropriate investigation?

A 60 year old woman presents to her GP with a single episode of postmenopausal bleeding and is referred as a suspected cancer pathway referral for transvaginal pelvic ultrasound and Gynaecology review. What endometrial thickness cut-off should be used for further investigation?

A 60 year old woman presents to her GP with a single episode of postmenopausal bleeding and is referred as a suspected cancer pathway referral for transvaginal pelvic ultrasound and Gynaecology review. Pelvic ultrasound confirms a thickened cystic endometrium measuring 9mm and outpatient endometrial sampling is performed.  Which of the following is the most significant risk of outpatient endometrial sampling?

A 60 year old woman presents to her GP with a single episode of postmenopausal bleeding and is referred as a suspected cancer pathway referral for transvaginal pelvic ultrasound and Gynaecology review. Pelvic ultrasound confirms a thickened cystic endometrium measuring 9mm and outpatient endometrial sampling is performed however the histology reports confirms that the sample was inadequate.   What is the most appropriate management?

A 34 year old woman has a large loop excision of the transformation zone (LLETZ) for CIN3 and the histology shows involved margins. She attends for her follow up cervical smear at 6 months post treatment but reports that she is now 13 weeks pregnant.  What is the most appropriate management plan?

A 24 year old woman attends with unprovoked vaginal bleeding at 18 weeks gestation in her first pregnancy. On speculum examination, there is an abnormal appearance of the cervix with a craggy 3cm mass at the anterior aspect.  She has never had a smear test previously due to her age and is referred for urgent colposcopy.  Colposcopy is suspicious for invasive disease. What is the most appropriate management?

A 24 year old woman attends with unprovoked vaginal bleeding at 18 weeks gestation in her first pregnancy. On speculum examination, there is an abnormal appearance of the cervix with a craggy 3cm mass at the anterior aspect.  She has never had a smear test previously due to her age and is referred for urgent colposcopy.  Colposcopy is suspicious for invasive disease and a large loop excision of the transformation zone (LLETZ) is performed in theatre without complications.  The histology confirms invasive squamous cell carcinoma of the cervix with 12mm of stromal invasion at greatest measured dimension.  What is the next most appropriate investigation?

A 24 year old woman attends with unprovoked vaginal bleeding at 18 weeks gestation in her first pregnancy. On speculum examination, there is an abnormal appearance of the cervix with a craggy 3cm mass at the anterior aspect.  She has never had a smear test previously due to her age and is referred for urgent colposcopy.  Colposcopy is suspicious for invasive disease and a large loop excision of the transformation zone (LLETZ) is performed in theatre without complications.  The histology confirms invasive squamous cell carcinoma of the cervix with 12mm of stromal invasion at greatest measured dimension.  Staging MRI Pelvis confirms that there is no evidence of invasive disease beyond the cervix.  What is the most appropriate next management?

A 30 year old woman has a laparoscopic ovarian cystectomy and the histology confirms a diagnosis of borderline ovarian tumour. What is the most common histological type of borderline ovarian tumour?

A 24 year old woman attends with unprovoked vaginal bleeding at 18 weeks gestation in her first pregnancy. On speculum examination, there is an abnormal appearance of the cervix with a craggy 3cm mass at the anterior aspect.  She has never had a smear test previously due to her age and is referred for urgent colposcopy.  Colposcopy is suspicious for invasive disease and a large loop excision of the transformation zone (LLETZ) is performed in theatre without complications.  The histology confirms invasive squamous cell carcinoma of the cervix with 12mm of stromal invasion at greatest measured dimension.  Staging MRI Pelvis confirms that there is no evidence of invasive disease beyond the cervix but laparoscopic lympadenectomy confirms positive pelvic lymph node involvement.  The woman is fully committed to the pregnancy and declines Clause A termination of pregnancy.  What is the next most appropriate management?

A 71 year old woman is referred as a two-week wait referral following a single episode of post-menopausal bleeding. Which of the following is not associated with an increased risk of endometrial cancer?

A 67 year old presents to her GP as she has recently read a newspaper article about women’s health and is concerned that she may have symptoms suggestive of ovarian cancer.  Which of the following are not potential symptoms or signs of ovarian cancer?

A 65 year old woman presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating.  She is worried that she has developed irritable bowel syndrome.  Abdominal and pelvic examination is unremarkable.  The GP requests some blood tests including a CA-125.  The results are shown below:

What is the most appropriate next management?

A 65 year old woman presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating.  She is worried that she has developed irritable bowel syndrome.  Abdominal and pelvic examination is unremarkable.  The GP requests some blood tests including a CA-125.  The results are shown below:

What is the most appropriate next management?

A 71 year old woman presents to her GP as she is very worried that she may have endometrial cancer.  She is asymptomatic but her sister has recently died of endometrial cancer.  She is otherwise fit and well with a normal BMI and no significant past medical history.  Which of the following statements regarding screening for endometrial cancer is correct?

A 67 year old presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating. She is concerned that she may be at increased risk of developing ovarian cancer.  Which of the following is not a risk factor for ovarian cancer?

A 67 year old presents to her GP with symptoms of lower abdominal pain, fatigue and persistent bloating.  She is concerned that she may be at increased risk of developing ovarian cancer.  Which of the following is associated with an increased risk of developing for ovarian cancer?

A 30 year old woman attends her GP as her mother has recently been diagnosed with ovarian cancer and found to carry to the BRCA1 mutation.  She requests referral for genetic counselling.  Which of the following is not an indication for referral for testing for pathogenic variants associated with ovarian cancer?

A 30 year old woman has a laparoscopic ovarian cystectomy and at the time of surgery, is noted to have gelatinous ascites consistent with pseudomyxoma peritonei. The histology confirms a diagnosis of borderline ovarian tumour.  What is the most likely histological type of borderline ovarian tumour?

Which of the following vulval conditions is not associated with an increased risk of malignancy?

A 30 year old woman has a laparoscopic ovarian cystectomy and the histology confirms a diagnosis of borderline ovarian tumour. Which of the following is not associated with a reduced risk of borderline ovarian tumours?

A 45 year old woman has a laparoscopic ovarian cystectomy and the histology confirms a diagnosis of mucinous borderline ovarian tumour. She has two children and does not wish to retain fertility. She is referred to the regional cancer centre and undergoes completion surgery.  Which of the following is the most appropriate completion surgery?

A 30 year old woman has a laparoscopic ovarian cystectomy and the histology confirms a diagnosis of borderline ovarian tumour. What gene mutations are associated with borderline ovarian tumours?

What is the most common indication for pelvic exenteration for gynaecological cancer?

A 38 year old woman is referred urgently with an ultrasound scan showing an adnexal mass. Which of the following is defined as a malignant feature by IOTA Simple Rules?

A 31 year old woman has an open unilateral salpingo-oophorectomy, peritoneal washing and omental biopsy and histology confirms complete resection of a Stage IA dysgerminoma.  How often should tumour markers be performed in the first six months post-operatively?

A 31 year old woman has an open unilateral salpingo-oophorectomy, peritoneal washing and omental biopsy and histology confirms complete resection of a Stage IA yolk sac tumour.  How often should tumour markers be performed in the first six months post-operatively?

Which tumour marker is most likely to be elevated in a patient with an immature teratoma?

Which histological subtype of malignant ovarian germ cell tumour is most likely to present bilaterally?

What is the most appropriate chemotherapy regimen for a patient with advanced malignant ovarian germ cell tumor?

A 31 year old nulliparous woman presents with abdominal pain, irregular periods and bloating.  Pelvic ultrasound shows a 5cm solid complex ovarian mass and laboratory testing confirms high alpha-fetoprotein (aFP) levels.  Staging CT scan is suggestive of regional lymph node involvement.  She wishes to conserve her fertility. What is the most appropriate management?

A 31 year old woman has an open unilateral salpingo-oophorectomy, peritoneal washing, omental biopsy and selective removal of enlarged lymph nodes and histology confirms complete resection of a Stage 1A dysgerminoma.  She wishes to conceive in the future and asks when she can try to get pregnant in the future.  What is the recommended period of surveillance before trying to conceive?

A 31 year old woman has an open unilateral salpingo-oophorectomy, peritoneal washing, omental biopsy and selective removal of enlarged lymph nodes and histology confirms Stage 1A dysgerminoma. What is the relapse rate following surgical resection of Stage 1A dysgerminoma?

A 31 year old woman has an open unilateral salpingo-oophorectomy, peritoneal washing, omental biopsy and selective removal of enlarged lymph nodes and histology confirms Stage 1A dysgerminoma. What is the recommended management post surgery?

What is the most appropriate first-line treatment for a stage I dysgerminoma in a young woman who wishes to preserve fertility?

A 70 year old woman is referred to a rapid access gynaecology clinic with a suspicious vulval lesion.  She has a background of lichen sclerosus but has not used topical corticosteroids for several years.  On examination, there is a irregular 2.5cm ulcerated vulval lesion on the right labia majora which bleeds on contact and is friable.  What is the most appropriate next step?

A 70 year old woman is referred to a rapid access gynaecology clinic with a suspicious vulval lesion.  She has a background of lichen sclerosus but has not used topical corticosteroids for several years.  On examination, there is a irregular 2.5cm ulcerated vulval lesion on the right labia majora which bleeds on contact and is friable and there are palpable right inguinal lymph nodes.  Wedge biopsy confirms vulval squamous cell carcinoma.  What is the most appropriate investigation?

A 70 year old woman is referred to a rapid access gynaecology clinic with a suspicious vulval lesion.  She has a background of lichen sclerosus but has not used topical corticosteroids for several years.  On examination, there is a irregular 2.5cm ulcerated vulval lesion on the right labia majora which bleeds on contact and is friable with large palpable ipsilateral lymph nodes.  Wedge biopsy confirms vulval squamous cell carcinoma. What is the most appropriate investigation?

What is the second most common vulval malignancy?

Which of the following is a contra-indication to sentinel lymph node biopsy in vulval cancer?

Which of the following is the most common complication following inguino-femoral lymph node dissection?

A 35-year-old woman has a LLETZ procedure following a cervical smear test result showing high grade (severe) dyskaryosis.  The histology confirms a 9mm cervical squamous cell carcinoma with 5mm depth of stromal invasion.  She is nulliparous and wishes to conceive in the future. She has radical trachelectomy with concurrent cerclage and sentinel lymph node biopsy confirms that there is no nodal involvement.  What is the chance of a live birth after radical trachelectomy?

A 35-year-old woman has a LLETZ procedure following a cervical smear test result showing high grade (severe) dyskaryosis.  The histology confirms a 9mm cervical squamous cell carcinoma with 5mm depth of stromal invasion.  She is nulliparous and wishes to conceive in the future. She has radical trachelectomy with concurrent cerclage and sentinel lymph node biopsy confirms that there is no nodal involvement.  What is the chance of a premature birth after radical trachelectomy?