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Cervical Cancer

Oncology Registrars’ Forum. “Best of Five”. Cervical Cancer. May 2007 Dr Anna Winship Guy’s & St. Thomas’ NHS Trust. Click Here For First Question. Question 1.

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Cervical Cancer

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  1. Oncology Registrars’ Forum “Best of Five” Cervical Cancer May 2007 Dr Anna Winship Guy’s & St. Thomas’ NHS Trust Click Here For First Question

  2. Question 1 • A 53 year old woman attends her gynaecologist with vaginal bleeding. At EUA an ulcer is found at the cervix, extending into the left fornix. Disease is palpable in the left parametrium but does not quite reach the pelvic sidewall. What investigation should be performed next? Cystoscopy CT scan of chest / abdomen / pelvis Biopsy Sigmoidoscopy MRI of pelvis Click Here For Answer

  3. Question 1 • A 53 year old woman attends her gynaecologist with vaginal bleeding. At EUA an ulcer is found at the cervix, extending into the left fornix. Disease is palpable in the left parametrium but does not quite reach the pelvic sidewall. What investigation should be performed next? Cystoscopy CT scan of chest / abdomen / pelvis Biopsy Sigmoidoscopy MRI of pelvis Click Here For Next Slide

  4. Question 2 • A 53 year old woman attends her gynaecologist with vaginal bleeding. At EUA an ulcer is found at the cervix, extending into the left fornix. Disease is palpable in the left parametrium but does not quite reach the pelvic sidewall. Histology is of a moderately differentiated squamous cell carcinoma. Imaging does not show further disease. What is the FIGO stage of the disease? Stage IB2 Stage IIA Stage IIB Stage IIIA Stage IIIB Click Here For Answer

  5. Question 2 • A 53 year old woman attends her gynaecologist with vaginal bleeding. At EUA an ulcer is found at the cervix, extending into the left fornix. Disease is palpable in the left parametrium but does not quite reach the pelvic sidewall. Histology is of a moderately differentiated squamous cell carcinoma. Imaging does not show further disease. What is the FIGO stage of the disease? Stage IB2 Stage IIA Stage IIB Stage IIIA Stage IIIB Click Here For Next Question

  6. Question 3 • A 35 year old women was found to have cervical intraepithelial neoplasia at routine screening. Which of the human papilloma virus subtypes is not associated with malignant transformation? 11 16 18 31 33 Click Here For Answer

  7. Question 3 • A 35 year old women was found to have cervical intraepithelial neoplasia at routine screening. Which of the human papilloma virus subtypes is not associated with malignant transformation? 11 16 18 31 33 Click Here For Next Question

  8. Question 4 • A 35 year old women was found to have cervical intraepithelial neoplasia at routine screening. Which of the following is not a recognised risk factor for cervical cancer? Smoking Oral contraceptive pill Early age at first sexual intercourse Early first pregnancy Multiple sexual partners Click Here For Answer

  9. Question 4 • A 35 year old women was found to have cervical intraepithelial neoplasia at routine screening. Which of the following is not a recognised risk factor for cervical cancer? Smoking Oral contraceptive pill Early age at first sexual intercourse Early first pregnancy Multiple sexual partners Click Here For Next Question

  10. Question 5 • A 50 year old city worker was diagnosed with stage IIIB squamous cell carcinoma of the cervix. She received 50.4Gy in 28# EBRT and has been admitted prior to brachytherapy. What is the half-life of iridium? 30.00 years 5.27 years 37.01 days 74.02 days 90.62 days Click Here For Answer

  11. Question 5 • A 50 year old city worker was diagnosed with stage IIIB squamous cell carcinoma of the cervix. She received 50.4Gy in 28# EBRT and has been admitted prior to brachytherapy. What is the half-life of iridium? 30.00 years 5.27 years 37.01 days 74.02 days 90.62 days Click Here For Next Question

  12. Question 6 • A 50 year old city worker was diagnosed with stage IIIB squamous cell carcinoma of the cervix. She received 50.4Gy in 28# EBRT and has been admitted prior to brachytherapy. Her treatment will be prescribed to point A. Where is point B defined according to ICRU? 5cm superior to the lateral vaginal fornix & 2cm lateral to midline 2cm superior to the lateral vaginal fornix & 5cm lateral to midline 2cm superior to the lateral vaginal fornix & 2cm lateral to midline 3cm superior to the lateral vaginal fornix & 3cm lateral to midline 5cm superior to the lateral vaginal fornix & 2cm lateral to midline Click Here For Answer

  13. Question 6 • A 50 year old city worker was diagnosed with stage IIIB squamous cell carcinoma of the cervix. She received 50.4Gy in 28# EBRT and has been admitted prior to brachytherapy. Her treatment will be prescribed to point A. Where is point B defined according to ICRU? 5cm superior to the lateral vaginal fornix & 2cm lateral to midline 2cm superior to the lateral vaginal fornix & 5cm lateral to midline 2cm superior to the lateral vaginal fornix & 2cm lateral to midline 3cm superior to the lateral vaginal fornix & 3cm lateral to midline 5cm superior to the lateral vaginal fornix & 2cm lateral to midline Click Here For Next Question

  14. Question 7 • A 50 year old city worker was diagnosed with stage IIIB squamous cell carcinoma of the cervix. She received 50.4Gy in 28# EBRT and has been admitted prior to brachytherapy. Her treatment will be prescribed to point A. What is the definition of medium dose rate according to the ICRU 1984? 0.4-2 Gy / hour 1-5 Gy / hour 2-12 Gy / hour 1-5 Gy / minute 2-12 Gy / minute Click Here For Answer

  15. Question 7 • A 50 year old city worker was diagnosed with stage IIIB squamous cell carcinoma of the cervix. She received 50.4Gy in 28# EBRT and has been admitted prior to brachytherapy. Her treatment will be prescribed to point A. What is the definition of medium dose rate according to the ICRU 1984? 0.4-2 Gy / hour 1-5 Gy / hour 2-12 Gy / hour 1-5 Gy / minute 2-12 Gy / minute Click Here For Next Question

  16. Question 8 • A 46 year old woman underwent a Schauta hysterectomy. What is another name for this procedure? Extended hysterectomy Radical abdominal hysterectomy Radical vaginal hysterectomy Subtotal hysterectomy Total abdominal hysterectomy Click Here For Answer

  17. Question 8 • A 46 year old woman underwent a Schauta hysterectomy. What is another name for this procedure? Extended hysterectomy Radical abdominal hysterectomy Radical vaginal hysterectomy Subtotal hysterectomy Total abdominal hysterectomy Click Here For Next Question

  18. Question 9 • A 24 year old woman underwent colposcopic examination and was found to have an invasive cancer confined to the cervix. There was 4mm stromal invasion and the lesion was 6mm in diameter. What is the FIGO stage? Stage Ia1 Stage Ia2 Stage Ia3 Stage Ib1 Stage Ib2 Click Here For Answer

  19. Question 9 • A 24 year old woman underwent colposcopic examination and was found to have an invasive cancer confined to the cervix. There was 4mm stromal invasion and the lesion was 6mm in diameter. What is the FIGO stage? Stage Ia1 Stage Ia2 Stage Ia3 Stage Ib1 Stage Ib2 Click Here For Next Question

  20. Question 10 • A 50 year old city worker was diagnosed with stage IIIB squamous cell carcinoma of the cervix. She received 50.4Gy in 28# EBRT and has been admitted prior to brachytherapy. Her treatment will be prescribed to point A. Where is the bladder reference point? Posterior surface of a Foley catheter containing 5cm3 of fluid Posterior surface of a Foley catheter containing 6cm3 of fluid Posterior surface of a Foley catheter containing 7cm3 of fluid Posterior surface of a Foley catheter containing 8cm3 of fluid Posterior surface of a Foley catheter containing 10cm3 of fluid Click Here For Answer

  21. Question 10 • A 50 year old city worker was diagnosed with stage IIIB squamous cell carcinoma of the cervix. She received 50.4Gy in 28# EBRT and has been admitted prior to brachytherapy. Her treatment will be prescribed to point A. Where is the bladder reference point? Posterior surface of a Foley catheter containing 5cm3 of fluid Posterior surface of a Foley catheter containing 6cm3 of fluid Posterior surface of a Foley catheter containing 7cm3 of fluid Posterior surface of a Foley catheter containing 8cm3 of fluid Posterior surface of a Foley catheter containing 10cm3 of fluid Click Here For Next Question

  22. Question 11 • A 55 year old accountant was diagnosed with stage IB adenosquamous carcinoma of the cervix. She underwent radical hysterectomy and bilateral pelvic lymphadenectomy. Histology showed a 4cm tumour with evidence of lymphovascular invasion. 4 out of 15 nodes were positive. What adjuvant therapy, if any, is most appropriate? No adjuvant therapy Chemotherapy only Brachytherapy only EBRT only Chemotherapy, EBRT and brachytherapy Click Here For Answer

  23. Question 11 • A 55 year old accountant was diagnosed with stage IB adenosquamous carcinoma of the cervix. She underwent radical hysterectomy and bilateral pelvic lymphadenectomy. Histology showed a 4cm tumour with evidence of lymphovascular invasion. 4 out of 15 nodes were positive. What adjuvant therapy, if any, is most appropriate? No adjuvant therapy Chemotherapy only Brachytherapy only EBRT only Chemotherapy, EBRT and brachytherapy Click Here For Next Question

  24. Question 12 • A 44 year old nurse was diagnosed with relapsed cervical cancer. She received chemoradiation 2 years ago and was well until recently. Her main symptom is breathlessness from lung metastases. Which drug or drug-combination should be used at this time? Single-agent cisplatin Single-agent carboplatin Cisplatin / topotecan Carboplatin / topotecan Cisplatin / paclitaxel Click Here For Answer

  25. Question 12 • A 44 year old nurse was diagnosed with relapsed cervical cancer. She received chemoradiation 2 years ago and was well until recently. Her main symptom is breathlessness from lung metastases. Which drug or drug-combination should be used at this time? Single-agent cisplatin Single-agent carboplatin Cisplatin / topotecan Carboplatin / topotecan Cisplatin / paclitaxel Click Here For Next Slide

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