Tutorial 5th. December 2011

Website.

Tutorial.

Tonight we excelled ourselves, managing three essays and an EMQ.

The essays were:

Question 1.

With regard to cervical cancer:

1.   Critically evaluate the FIGO staging classification.           8 marks

2.   Describe the FIGO staging.                                                    12 marks

Question 2.

 A 25-year-old primigravida attends the antenatal clinic at 36 weeks. She has read a magazine article about delayed cord clamping. DCC.
1. Outline the factors that make DCC unwise. 6 marks.
2. Justify the advice you will give about the risks & benefits of DCC. 8 marks.
3. Outline the arrangements necessary for DCC. 6 marks.

Question3.

A 35-year-old woman plans to go to a malarial area of Africa to join her husband who works there. She is 6 weeks pregnant. Critically evaluate the advice you will give her.

The EMQ was:

EMQ Paper 1 , Question 6 . Ca Cx staging.

Lead-in.

The following scenarios relate to cervical cancer staging.

For each, select the most appropriate staging.

Pick one option from the option list.

Each option can be used once, more than once or not at all.

Scenario 1.

A woman of 25 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 2 mm and 6 mm in width. The resection margins are tumour-free. There is no evidence of spread outside the uterus. She is nulliparous and wishes to retain her fertility.

Scenario 2.

A woman of 25 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 5 mm and 6 mm in width. The resection margins are tumour-free. There is no evidence of spread outside the uterus. She is nulliparous and wishes to retain her fertility.

Scenario 3.

A woman of 25 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 5 mm and 6 mm in width. The resection margins are not tumour-free. There is no evidence of spread outside the uterus. She is nulliparous and wishes to retain her fertility.

Scenario 4.

A woman of 25 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 6 mm and 3 cm in width. The resection margins are tumour-free. There is no evidence of extension outside the uterus. She is nulliparous and wishes to retain her fertility.

Scenario 5.

A woman of 25 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 6 mm and 5 cm in width. The resection margins are tumour-free. She is nulliparous and wishes to retain her fertility.

Scenario 6.

A woman of 38 has a cone biopsy. The histology report shows squamous cell carcinoma penetrating to a depth of 4 mm and 6mm in width. The resection margins are tumour-free. An MR scan shows involvement of the lymphatic nodes in the left of the pelvis.

Scenario 7.

A woman of 45 has carcinoma of the cervix. It extends into the parametrium, but not to the pelvic side-wall. It involves the upper 1/3 of the vagina. There is MR evidence of para-aortic node involvement.

Scenario 8.

A woman of 55 has carcinoma of the cervix. It extends to the pelvic side-wall. It involves the upper 1/3 of the vagina. She has a secondary on the end of her nose.

Scenario 9.

A woman of 55 has carcinoma of the cervix. It involves the bladder mucosa.

Scenario 10.

A woman of 25 has a cone biopsy. It shows malignant melanoma. The lesion invades to a depth of 3 mm and is 5 cm in width. The margins of the biopsy are clear. There is evidence of lymphatic vessel involvement. There is no evidence of spread outside the uterus.

Option list.

Micro-invasive cervical cancer.

Stage Ia1

Stage Ia2

Stage Ia3

Stage Ib1

Stage Ib2

Stage Ib3

Stage IIa

Stage IIb

Stage IIc

Stage IIIa

Stage IIIb

Stage IIIc

Stage IVa

Stage IVb

Stage IVc

Stage Va

Stage Vb

Stage Vc

None of the above.

This question illustrates the problems surrounding staging. If you are not a cancer specialist, it is not something that you think about very often, if ever. So you have to put it into your list of things to revise in the days before the exam. If you haven’t started this list, do so now.

Send my your answers and I'll send mine. But make sure you write them within the time allocated in the exam.