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

2. Question 1 A 64 year old women presented to her GP with an episode of post- menopausal bleeding. She was referred to a surgical gynaecological oncologist who performed a hysteroscopy and biopsy. What is the most likely diagnosis? Click Here For Answer Large cell, non-keratinizing squamous cell carcinoma of the cervix Adenocarcinoma of the cervix Endometrioid carcinoma of the endometrium Serous carcinoma of the endometrium Clear cell carcinoma of the endometrium

3. Question 1 A 64 year old women presented to her GP with an episode of post- menopausal bleeding. She was referred to a surgical gynaecological oncologist who performed a hysteroscopy and biopsy. What is the most likely diagnosis? Click Here For Next Question Large cell, non-keratinizing squamous cell carcinoma of the cervix Adenocarcinoma of the cervix Endometrioid carcinoma of the endometrium Serous carcinoma of the endometrium Clear cell carcinoma of the endometrium

4. Question 2 A 50 year old women underwent a TAH, BSO and bilateral pelvic lymphadenectomy for endometrial cancer. On histological review she was found to have a grade 2 endometrial adenocarcinoma invading into the outer half of the myometrium. A few cervical glands were involved and there were also small deposits in the omentum. What stage is her disease? Click Here For Answer Stage IV Stage IIB Stage IIIA Stage IIIB Stage IIIC

5. Question 2 A 50 year old women underwent a TAH, BSO and bilateral pelvic lymphadenectomy for endometrial cancer. On histological review she was found to have a grade 2 endometrial adenocarcinoma invading into the outer half of the myometrium. A few cervical glands were involved and there were also small deposits in the omentum. What stage is her disease? Click Here For Next Question Stage IV Stage IIB Stage IIIA Stage IIIB Stage IIIC

6. Question 3 A 35 year old women was diagnosed with a stage IIB endometrial carcinoma and underwent a TAH, BSO and bilateral pelvic lymphadenectomy. What is the most appropriate adjuvant treatment? Click Here For Answer No adjuvant treatment Vaginal brachytherapy only Pelvic EBRT only Pelvic EBRT and vaginal brachytherapy Chemotherapy followed by pelvic EBRT and vaginal brachytherapy

7. Question 3 A 35 year old women was diagnosed with a stage IIB endometrial carcinoma and underwent a TAH, BSO and bilateral pelvic lymphadenectomy. What is the most appropriate adjuvant treatment? Click Here For Next Question No adjuvant treatment Vaginal brachytherapy only Pelvic EBRT only Pelvic EBRT and vaginal brachytherapy Chemotherapy followed by pelvic EBRT and vaginal brachytherapy

8. Question 4 A 42 year old woman underwent a TAH, BSO and bilateral pelvic lymphadenectomy and was found to have stage IIIC endometrial adenocarcinoma. She is offered adjuvant chemotherapy. Which drug or drug-combination is most likely to cause peripheral neuropathy? Click Here For Answer Cisplatin / paclitaxel Single-agent carboplatin Carboplatin / paclitaxel Carboplatin / docetaxel Cisplatin / docetaxel

9. Question 4 A 42 year old woman underwent a TAH, BSO and bilateral pelvic lymphadenectomy and was found to have stage IIIC endometrial adenocarcinoma. She is offered adjuvant chemotherapy. Which drug or drug-combination is most likely to cause peripheral neuropathy? Click Here For Next question Cisplatin / paclitaxel Single-agent carboplatin Carboplatin / paclitaxel Carboplatin / docetaxel Cisplatin / docetaxel

10. Question 5 A 48 year old woman is offered chemotherapy for stage IV endometrial cancer. Which drug combination is most active in endometrial carcinoma? Click Here For Answer Doxorubicin / carboplatin Doxorubicin / cisplatin Doxorubicin / paclitaxel / cisplatin Paclitaxel / cisplatin Doxorubicin / carboplatin / paclitaxel

11. Question 5 A 48 year old woman is offered chemotherapy for stage IV endometrial cancer. Which drug combination is most active in endometrial carcinoma? Click Here For Next Question Doxorubicin / carboplatin Doxorubicin / cisplatin Doxorubicin / paclitaxel / cisplatin Paclitaxel / cisplatin Doxorubicin / carboplatin / paclitaxel

12. Question 6 A 63 year old woman is offered radiotherapy as part of the ASTEC study. Which of the following FIGO stages, if any, is suitable for entry into the trial? Click Here For Answer Stage IB G2 Stage IC G2 Stage IIA G2 Stage IIB G2 None of the above

13. Question 6 A 63 year old woman is offered radiotherapy as part of the ASTEC study. Which of the following FIGO stages, if any, is suitable for entry into the trial? Click Here For Next Question Stage IB G2 Stage IC G2 Stage IIA G2 Stage IIB G2 None of the above

14. Question 7 A 67 year old woman is offered adjuvant EBRT and brachytherapy treatment for stage II endometrial carcinoma. Which is the most suitable dose? Click Here For Answer 45Gy in 25# EBRT + 15Gy LDR brachytherapy to 0.5cm 45Gy in 25# EBRT + 20Gy LDR brachytherapy to 0.5cm 45Gy in 25# EBRT + 25Gy LDR brachytherapy to 0.5cm 50.4Gy in 28# EBRT + 15Gy LDR brachytherapy to 0.5cm 50.4Gy in 28# EBRT + 20Gy LDR brachytherapy to 0.5cm

15. Question 7 A 67 year old woman is offered adjuvant EBRT and brachytherapy treatment for stage II endometrial carcinoma. Which is the most suitable dose? Click Here For Next Question 45Gy in 25# EBRT + 15Gy LDR brachytherapy to 0.5cm 45Gy in 25# EBRT + 20Gy LDR brachytherapy to 0.5cm 45Gy in 25# EBRT + 25Gy LDR brachytherapy to 0.5cm 50.4Gy in 28# EBRT + 15Gy LDR brachytherapy to 0.5cm 50.4Gy in 28# EBRT + 20Gy LDR brachytherapy to 0.5cm

16. Question 8 A 45 year old woman has a diagnosis of serous carcinoma of the endometrium on biopsy. A surgical gynaecological oncologist operates. What is the most suitable operation? Click Here For Answer TAH & BSO only TAH & BSO & bilateral pelvic lymphadenectomy (BPL) TAH & BSO & omentectomy TAH & BSO & BPL & omentectomy Staging laparotomy

17. Question 8 A 45 year old woman has a diagnosis of serous carcinoma of the endometrium on biopsy. A surgical gynaecological oncologist operates. What is the most suitable operation? Click Here For Next Question TAH & BSO only TAH & BSO & bilateral pelvic lymphadenectomy (BPL) TAH & BSO & omentectomy TAH & BSO & BPL & omentectomy Staging laparotomy

18. Question 9 A 43 year old woman has a diagnosis of stage IIIA serous carcinoma of the endometrium. What is the most suitable adjuvant treatment? Click Here For Answer No adjuvant treatment Radiotherapy only Chemotherapy only Chemotherapy then radiotherapy Radiotherapy then chemotherapy

19. Question 9 A 43 year old woman has a diagnosis of stage IIIA serous carcinoma of the endometrium. What is the most suitable adjuvant treatment? Click Here For Next Slide No adjuvant treatment Radiotherapy only Chemotherapy only Chemotherapy then radiotherapy Radiotherapy then chemotherapy

20. The End