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MRCOG PART 2 SBAs and EMQs

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notes331
EMQ1476
SBA2073
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Oncology emqs

Oncology emqs Posted by Dhivya C.

Dear Dr.Paul

Could you please clarify the answer for the following question.

Options for Questions 21

 

A

TAH

B

TAH + BSO

C

TAH + BSO + omentectomy

D

TAH + BSO + omentectomy + peritoneal biopsies

E

TAH + BSO + omentectomy + peritoneal biopsies + lymphadenectomy

F

TAH + BSO + omentectomy + peritoneal washings + peritoneal biopsies + lymphadenectomy

G

Unilateral salpingo-oophrectomy

H

BSO + omentectomy + peritoneal biopsies + lymphadenectomy

I

Unilateral salpingo-oophrectomy + omentectomy + peritoneal washings + peritoneal biopsies + lymphadenectomy

J

Unilateral salpingo-oophrectomy + omentectomy

K

Systemic chemotherapy

L

Intra-peritoneal chemotherapy

M

Unilateral salpingo-oophrectomy + omentectomy + peritoneal washings + peritoneal biopsies + lymphadenectomy + endometrial biopsy

N

Biopsy of tumour + frozen section

Instrunctions:For each scenario described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

Explanation

Stage I and Stage II Ovarian cancer
Stage I

  • Tumour confined to the ovaries.
  • Stage Ia: tumour confined to one ovary with ovarian capsule intact and no tumour on the surface of the ovary. Peritoneal cytology is negative.
  • Stage Ib: tumour confined to both ovaries with ovarian capsule intact and no tumour on the surface of the ovary. Peritoneal cytology is negative.
  • Stage Ic: tumour on the surface of an ovary OR positive peritoneal cytology OR the tumour ruptures before / during surgery

Treatment options:

  • Well / moderately well differentiated Stage Ia / Ib
  • Total abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy is adequate for patients with well differentiated or moderately well differentiated stage IA and stage IB disease.
  • The under-surface of the diaphragm should be visualized and biopsied
  • Pelvic and abdominal peritoneal biopsies and pelvic and para-aortic lymph node biopsies are required and peritoneal washings should be obtained.
  • In women who have not completed their family and have grade I tumours, unilateral salpingo-oophorectomy may be performed. Such women require full surgical staging including peritoneal washings and biopsies, biopsy of para-aortic nodes and omentectomy. Endometrial biopsy should also be taken as 10-29% have a co-existing endometrial malignancy. Laparoscopic staging may be performed.

 

Question 21

A 67 year old woman with a 3 months history of urinary frequency is found to have a 7cm complex left ovarian mass with ascites. Chest X-ray and liver function tests are normal. CT scan shows that the tumour is confined to the left ovary with an intact ovarian capsule.

According to the NICE guidelines april 2011
 
" Do not include systematic retroperitoneal lymphadenectomy (block dissection of lymph nodes from the pelvic side walls to the level of the renal veins) as part of standard surgical treatment in women with suspected ovarian cancer whose disease appears to be confined to the ovaries (that is, who appear to have stage I disease). "
 
Also in the notes provided by you there is no mention about lymphadenectomy for stage Ic ovarian carcinoma.
 
Could you please clarify this.
 
Many Thanks
Dhivya
Posted by Dhivya C.

Is option D a better option than option F.

Many thanks

Dhivya