1) Which histological type of endometrial carcinoma is associated with the worst prognosis?
A. Clear cell adenocarcinoma
B. Mucinous adenocarcinoma
C. Secretory adenocarcinoma
D. Papillary adenocarcinoma
E. Ciliated adenocarcinoma
2) With respect to the staging of endometrial carcinoma
A. Stage Ia – tumour confined to the body of the uterus and invading the inner 75% of the myometrium
B. Stage IIa – tumour confined to the body of the uterus and invading the inner 75% of the myometrium
C. Stage Ib – tumour confined to the body of the uterus and invading the inner 75% of the myometrium
D. Stage Ic – tumour confined to the endometrium
E. Stage IIa – tumour confined to the body of the uterus with positive peritoneal cytology
3) A 77 year old woman presents with a 6 months history of post-menopausal bleeding. Endometrial biopsy shows a well differentiated endometroid adenocarcinoma. MRI scan shows a 28 x 33 mm tumour confined to the body of the uterus and invading the inner 30% of the myometrium. The ovaries, liver, kidneys and bladder appear normal. The stage of the tumour is
A. Stage Ia
B. Stage Ib
C. Stage Ic
D. Stage IIa
E. Stage IIb
4) A healthy 77 year old woman presents with a 6 months history of post-menopausal bleeding. Endometrial biopsy shows a well differentiated endometroid adenocarcinoma. MRI scan shows a 28 x 33 mm tumour confined to the body of the uterus and invading the inner 30% of the myometrium. The ovaries, liver, kidneys and bladder appear normal. Which one is the most appropriate treatment option?
A. Laparoscopic hysterectomy
B. TAH
C. TAH + BSO + pelvic lymph node sampling
D. TAH + BSO
E. Radical abdominal hysterectomy
5) A healthy 67 year old woman presents with a 6 months history of post-menopausal bleeding. Endometrial biopsy shows a poorly differentiated endometroid adenocarcinoma. MRI scan shows a 38 x 30 mm tumour confined to the body of the uterus and invading the inner 80% of the myometrium. The ovaries, liver, kidneys and bladder appear normal. Which one is the most appropriate treatment option?
A. Laparoscopic hysterectomy + BSO
B. TAH + BSO + omentectomy
C. TAH + BSO + pelvic and para-aortic lymph node sampling
D. TAH + BSO + adjuvant radiotherapy
E. Radical abdominal hysterectomy + pelvic lymph node sampling + adjuvant radiotherapy
6) In otherwise healthy women with stage Ib endometrial cancer, post-operative radiotherapy is associated with
A. No significant difference in the risk of recurrence
B. Increased risk of regional recurrence with decreased overall survival
C. Decreased risk of regional recurrence with no change in overall survival
D. Decreased risk of distant metastases
E. Decreased risk of regional recurrence with improvement in overall survival
7) A healthy 57 year old woman presents with a 6 months history of post-menopausal bleeding. Endometrial biopsy shows a clear cell adenocarcinoma. MRI scan shows a 45 x 30 x 48 mm tumour in the body of the uterus and invading the inner 30% of the myometrium. The tumour extends into the endocervical glands but there is no invasion of the endocervical stroma. The ovaries, liver, kidneys and bladder appear normal. Which one is the most appropriate treatment option?
A. Laparoscopic hysterectomy
B. TAH + adjuvant radiotherapy
C. TAH + BSO + pelvic lymph node sampling
D. TAH + BSO
E. Radical abdominal hysterectomy
8) The ASTEC trial was a study of
A. TAH + BSO versus Radical abdominal hysterectomy in women with early endometrial cancer
B. TAH + BSO versus TAH + BSO + pelvic lymphadenectomy in women with early endometrial cancer
C. TAH + BSO versus TAH + BSO + pelvic lymphadenectomy in women with advanced endometrial cancer
D. TAH + BSO versus TAH + BSO + adjuvant radiotherapy in women with early endometrial cancer
E. TAH + BSO + adjuvant radiotherapy versus TAH + BSO + pelvic lymphadenectomy in women with early endometrial cancer
9) The ASTEC trial reported that
A. Pelvic lymphadenectomy resulted in improved overall survival and improved disease-free survival in women with early endometrial cancer
B. Pelvic lymphadenectomy resulted in no improvement in overall survival and no improvement in disease-free survival in women with early endometrial cancer
C. Pelvic lymphadenectomy resulted in improved disease-free survival but no improvement in overall survival in women with advanced endometrial cancer
D. Radiotherapy resulted in improved overall survival and improved disease-free survival in women with early endometrial cancer
E. Radiotherapy resulted in improved overall survival and improved disease-free survival in women with advanced endometrial cancer
10) A 67 year old woman presents with a 6 months history of brown watery vaginal discharge. Endometrial biopsy shows a papillary adenocarcinoma. MRI scan shows a 30 x 48 mm tumour in the body of the uterus and invading the inner 65% of the myometrium. The tumour extends into the endocervical canal and there is invasion of the endocervical stroma but not the parametrium. The ovaries, liver, kidneys and bladder appear normal.
A. Stage IIa
B. Stage II
C. Stage IIc
D. Stage IIIa
E. Stage IIIb
11) A 67 year old woman presents with a 6 months history of brown watery vaginal discharge. Endometrial biopsy shows a papillary adenocarcinoma. MRI scan shows a 30 x 48 mm tumour in the body of the uterus and invading the inner 65% of the myometrium. The tumour extends into the endocervical canal and there is invasion of the endocervical stroma but not the parametrium. The ovaries, liver, kidneys and bladder appear normal. Which one is the most appropriate treatment option?
A. TAH + BSO + omentectomy
B. TAH + BSO + pelvic and para-aortic node sampling
C. TAH + BSO + pelvic and para-aortic node sampling + adjuvant radiotherapy
D. TAH + BSO + pelvic and para-aortic node sampling + adjuvant chemotherapy
E. Radical abdominal hysterectomy + adjuvant chemo-radiotherapy
12) With respect to staging of endometrial cancer
A. Stage IIIa – invasion of endocervical stroma
B. Stage II – invasion of endocervical glands
C. Stage IIIa – spread to one or both ovaries
D. Stage IIIa – positive peritoneal cytology
E. Stage IIIb – positive para-aortic nodes
13) A 67 year old woman with a history of tamoxifen therapy presents with a 6 months history of post-menopausal bleeding. Endometrial biopsy shows a mucinous adenocarcinoma. MRI scan shows a 59 x 30 x 68 mm tumour involving the body of the uterus and extending to involve the right ovary. The tumour extends into the endocervical canal and there is invasion of the endocervical stroma but not the parametrium. The left ovary, liver, kidneys and bladder appear normal. The stage of the tumour is
A. Stage IIIa
B. Stage IIIb
C. Stage IIIc
D. Stage IVa
E. Stage IIc
14) A 67 year old woman with a history of tamoxifen therapy presents with a 6 months history of post-menopausal bleeding. Endometrial biopsy shows a mucinous adenocarcinoma. MRI scan shows a 59 x 30 x 68 mm tumour involving the body of the uterus and extending to involve the right ovary. The tumour extends into the endocervical canal and there is invasion of the endocervical stroma but not the parametrium. The left ovary, liver, kidneys and bladder appear normal. Which one is the most appropriate treatment option?
A. Chemotherapy
B. Combined chemo-radiotherapy
C. TAH + BSO + adjuvant radiotherapy
D. Radical abdominal hysterectomy + adjuvant radiotherapy
E. TAH + BSO + pelvic and para-aortic lymphadenectomy + adjuvant radiotherapy
15) A 57 year old woman presents with a 6 months history of post-menopausal bleeding. Endometrial biopsy shows an endometroid adenocarcinoma. MRI scan shows a 59 x 68 mm tumour involving the body of the uterus and extending into the endocervical canal and the upper third of the vagina. There is invasion of the endocervical stroma but not the parametrium. The ovaries liver, kidneys and bladder appear normal. The stage of the tumour is
A. Stage IIIa
B. Stage IIIb
C. Stage IIIc
D. Stage IVa
E. Stage IIc
16) A 67 year old woman presents with a 6 months history of brown watery vaginal discharge. Endometrial biopsy shows a papillary adenocarcinoma. MRI scan shows a 30 x 48 mm tumour in the body of the uterus and invading the inner 65% of the myometrium. The tumour extends into the endocervical canal and there is invasion of the endocervical stroma but not the parametrium. The ovaries, liver, kidneys and bladder appear normal. These findings are confirmed at histology. In addition, three pelvic and one para-aortic lymph node are positive. The stage of the tumour is
A. Stage IIa
B. Stage II
C. Stage IIc
D. Stage IIIb
E. Stage IIIc
17) With respect to staging of endometrial cancer
A. Stage IVa – extension to involve both ovaries
B. Stage IVb – extension into bladder mucosa
C. Stage IVa – extension into rectal mucosa
D. Stage IIIb – extension into the uterine serosa
E. Stage IIIa – extension into the upper third of the vagina
18) The overall 5 year survival of endometrial cancer is
A. 40%
B. 56%
C. 62%
D. 78%
E. 92%
19) With respect to endometrial cancer, what proportion of women with apparent stage I disease will have occult metastases in the ovaries?
A. 0.5%
B. 1%
C. 5%
D. 10%
E. 25%
20) With respect to the prognosis of endometrial cancer
A. Adenosquamous carcinoma has a worse prognosis compared to clear cell carcinoma
B. 20% of women with clinical stage I disease have positive lymph nodes on histology
C. 20% of women with stage I disease on histology have positive lymph nodes
D. Women with progesterone receptor positive tumours have a better prognosis compared to women with progesterone receptor negative tumours
E. The grade of the tumour does not affect prognosis if optimal surgical and histological staging is undertaken
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