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MRCOG PART 2 SBAs and EMQs

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notes328
EMQ1470
SBA2076
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Cx CA staging/Rx

Cx CA staging/Rx Posted by Ganesh T.

I thought this is Cx CA Stage 2A, thus radical hyst+pelvic lymphadenectomy.  Is my staging wrong or is it to do with her age/mordbidity etc.  Many thanks for your explanation.

 

Options for Questions 35-35
A Total abdominal hysterectomy B Total abdominal hysterectomy + BSO
C Radical hysterectomy + pelvic lymphadenectomy D Radical hysterectomy + pelvic lymphadenectomy + radiotherapy
E External beam radiotherapy F Intracavitary radiotherapy
G Combined chemo-radiotherapy H Chemotherapy
I Radical hysterectomy + para-aortic lymphadenectomy J Palliative care

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
Question 35 A healthy 72 year old woman presents with a 6 months history of post-menopausal bleeding. Clinical examination identifies a 2.5cm ulcerated lesion on the cervix. Biopsy confirms squamous cell carcinoma. MRI scan confirms that the tumour extends into the upper third of the vagina but there is no parametrial invasion.


 
Posted by Farrukh G.

If you click on the explanation link, you will see the explanation which states:

 

 

Stage IIA

  • Cervical carcinoma invading beyond the uterus but not to the pelvic side-wall or the lower third of the vagina and with no parametrial invasion
  • Treatment options:
  • Intracavitary radiotherapy combined with external-beam pelvic radiotherapy plus chemotherapy with cisplatin or cisplatin/5-FU for patients with bulky tumors. Radiotherapy to para-aortic nodes may be indicated in primary tumors 4 cm or larger.
  • Radical hysterectomy and pelvic lymphadenectomy. The high incidence of compromised margins, parametrial spread, and positive nodes leading to postoperative radiotherapy / chemotherapy makes surgery a less suitable approach