Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 30
Cervical Cancer

30–1. Which human papillomavirus (HPV) subtype is most commonly associated with adenocarcinoma of the cervix?

a. HPV 6

b. HPV 16

c. HPV 18

d. HPV 31

30–2. Which of the following is associated with a higher risk of squamous cell carcinoma of the cervix but not adenocarcinoma of the cervix?

a. Smoking

b. Age at first intercourse

c. Number of lifetime sexual partners

d. Combination oral contraceptive pills

30–3. The protein product of the human papillomavirus (HPV) E6 oncogene binds to which of the following tumor-suppressor proteins? After binding, the tumor-suppressor protein is degraded and leads to immortalization of the cell.

a. Rb

b. p16

c. p53

d. Cyclin D1

30–4. Which histologic subtype is represented in the micrograph?

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Photograph contributed by Dr. Kelley Carrick.

a. Melanoma

b. Adenocarcinoma

c. Squamous cell carcinoma

d. Neuroendocrine carcinoma

30–5. Which of the following should not be used for hemostasis in cases of life-threatening hemorrhage from cervical cancer?

a. Lugol solution

b. Emergent radiation

c. Uterine artery embolization

d. Monsel (ferric subsulfate) solution

30–6. In patients with stage I cervical cancer, what percentage of their Pap smears are read as cancer?

a. 10

b. 20

c. 50

d. 80

30–7. A woman comes in for an annual gynecologic examination. During speculum examination, you see the following. What is the most appropriate next step?

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a. Perform a pap smear

b. Perform a cervical biopsy

c. Refer to a gynecologic oncologist

d. Obtain a computed tomography (CT) scan

30–8. A woman undergoes a radical hysterectomy with bilateral pelvic and para-aortic lymph node dissection for a 4-cm squamous cell carcinoma. On final pathologic evaluation of the surgical specimen, the parametria are positive for cancer involvement. Based on these findings, which International Federation of Gynecology and Obstetrics (FIGO) clinical stage is she assigned?

a. IB1

b. IB2

c. IIA1

d. IIB2

30–9. Which of the following tests cannot be used for staging cervical cancer per International Federation of Gynecology and Obstetrics (FIGO) criteria?

a. Cystoscopy

b. Chest radiograph

c. Computed tomography

d. Intravenous pyelogram

30–10. A woman has a 6-cm adenocarcinoma of the cervix, positive para-aortic nodes found on positron emission tomography (PET) scan, and hydronephrosis. Based on these findings, which FIGO stage is she assigned?

a. IB2

b. IIB

c. IIIB

d. IVB

30–11. What is the most significant prognostic factor for early stage cervical cancer?

a. Grade

b. Histology

c. Depth of invasion

d. Lymph node metastasis

30–12. What is the most appropriate surgical procedure for a woman who has completed childbearing with a stage IA1 squamous cell carcinoma of the cervix?

a. Cold knife conization

b. Extrafascial hysterectomy

c. Type III radical hysterectomy

d. Modified (type II) radical hysterectomy

30–13. What is the most appropriate treatment for a 30-year-old G1P1 with stage IA1 adenocarcinoma of the cervix who desires future fertility?

a. Trachelectomy

b. Cold knife conization

c. Extrafascial hysterectomy and later, gestational surrogacy

d. Modified (type II) radical hysterectomy and later, gestational surrogacy

30–14. For a 37-year-old woman who has completed child-bearing, you perform cold knife conization for CIN 3 found in ectocervical biopsies and in endocervical curettage (ECC) samples. The specimen is shown in the photograph, with a stitch at 12:00. The final pathologic analysis reveals a grade 2 invasive squamous cell carcinoma, with a depth of invasion of 2 mm and a width of 8 mm, and CIN 3 at the margins. What is the most appropriate next step?

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Photograph contributed by Dr. Sasha Andrews.

a. Extrafascial hysterectomy

b. Type III radical hysterectomy

c. Repeat cold knife conization and ECC

d. Radiation with concomitant chemotherapy

30–15. Where is the uterine artery ligated during a type III radical hysterectomy?

a. At the uterine isthmus

b. At the level of the ureter

c. At the origin of the uterine artery

d. At the level of the uterosacral ligament

30–16. Which of the following arrows depicts where the uterosacral ligament is ligated during a type II radical hysterectomy?

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Reproduced, with permission, from Schorge JO: Surgeries for gynecologic malignancies. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 43-2.3.

a. A

b. B

c. C

d. None of the above

30–17. Patients with which of the following would not require adjuvant chemoradiation after radical hysterectomy and lymph node dissection?

a. Positive parametria

b. Positive lymph nodes

c. 3-cm tumor with deep-third stromal invasion and lymphovascular space invasion

d. 4-cm tumor with inner-third stromal invasion and no lymphovascular space invasion

30–18. Which of the following patients should be treated with chemoradiation rather than radical hysterectomy for a stage IB1 squamous cell carcinoma of the cervix (shown here)?

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Reproduced, with permission, from Richardson DL: Cervical cancer. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 30-10.

a. 35-year-old woman with a body mass index (BMI) of 37

b. 55-year-old woman with diabetes mellitus, chronic hypertension, and a BMI of 30

c. 40-year-old woman with moderate to severe pulmonary hypertension and a BMI of 22

d. 65-year-old woman with systemic lupus erythematosus, chronic renal insufficiency, and a BMI of 24

30–19. What percentage of women who have adenocarcinoma of the cervix also have ovarian metastasis?

a. 2

b. 12

c. 22

d. 32

30–20. In brachytherapy, how is point A defined?

a. 2 cm lateral and 2 cm superior to the external os

b. 5 cm lateral and 2 cm superior to the external os

c. 2 cm lateral and 5 cm superior to the external os

d. 5 cm lateral and 2 cm superior to the internal os

30–21. Which of the following is the most commonly used radiation sensitizer for the treatment of cervical cancer?

a. Cisplatin

b. Paclitaxel

c. Carboplatin

d. Fluorouracil (5-FU)

30–22. If a patient with stage IB1 squamous cell carcinoma recurs at the vagina after a radical hysterectomy with pelvic lymph node dissection, what is the most appropriate treatment?

a. Radiation alone

b. Systemic chemotherapy

c. Total pelvic exenteration

d. Radiation with concomitant chemotherapy

30–23. Which of the following is the most appropriate chemotherapy regimen for newly diagnosed stage IVB adenocarcinoma of the cervix?

a. Cisplatin and topotecan

b. Cisplatin and Navelbine

c. Cisplatin and paclitaxel

d. Cisplatin and gemcitabine

30–24. Which of the following is the most appropriate treatment of menopausal symptoms in a 47-year-old treated with chemoradiation for a stage IIB squamous cell carcinoma of the cervix?

a. Clonadine

b. Conjugated estrogen

c. Vaginal estrogen cream

d. Conjugated estrogen with progesterone

30–25. In a woman with recurrent cervical cancer after radiation, which of the following signs or symptoms is not part of a triad that suggests she has sidewall disease and is not a candidate for pelvic exenteration?

a. Lymphedema

b. Hydronephrosis

c. Pelvic lymphadenopathy

d. Back pain which radiates down the leg

Chapter 30 ANSWER KEY

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