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

CHAPTER 32
Vaginal Cancer

32–1. Primary vaginal cancer comprises what percentage of gynecologic malignancies?

a. 1to2

b. 5to7

c. 9to11

d. 13 to 15

32–2. Most vaginal cancers are which of the following?

a. Primary vaginal leiomyosarcoma

b. Primary vaginal adenocarcinoma

c. Squamous cell cancer metastatic from the cervix

d. Endometrioid adenocarcinoma metastatic from the endometrium

32–3. The caudal ends of the fused müllerian tubes (shown here) are originally lined by which of the following epithelia?

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Reproduced, with permission, from Bradshaw KD: Anatomic disorders. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed., New York, McGraw-Hill, 2008, Figure 18-1E.

a. Columnar

b. Transitional cell

c. Stratified squamous

d. None of the above

32–4. Which of the following is a common form of primary vaginal cancer spread?

a. Lymphatic

b. Exfoliative

c. Hematogenous

d. None of the above

32–5. Shown here, which is the most common histologic type of primary vaginal cancer?

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Photograph contributed by Dr. Kelley Carrick. Reproduced, with permission, from Nishida KJ: Vaginal cancer. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 32-1B.

a. Melanoma

b. Adenocarcinoma

c. Squamous cell carcinoma

d. Clear cell adenocarcinoma

32–6. Of the following, which has been most closely linked with primary squamous cell cancer of the vagina?

aBRCA1 mutation

b. Human papillomavirus

c. Diethylstilbestrol exposure

d. Hereditary nonpolyposis colon cancer (HNPCC)

32–7. Which of the following is the most common presenting complaint in women with primary vaginal cancer?

a. Bleeding

b. Constipation

c. Vaginal mass

d. Urinary retention

32–8. Most vaginal cancers develop in which part of the vagina?

a. Upper third

b. Middle third

c. Lower third

d. None of the above

32–9. In a woman with vaginal cancer, which procedures are used to determine the International Federation of Gynecology and Obstetrics (FIGO) stage?

a. Vaginectomy alone

b. Physical examination

c. Computed tomography alone

d. Vaginectomy with pelvic lymphadenectomy

32–10. The tumor shown here corresponds to which International Federation of Gynecology and Obstetrics (FIGO) stage?

Image

Reproduced, with permission, from Richardson DL: Vaginal cancer. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 32-3.

a. Stage I

b. Stage II

c. Stage III

d. Stage IV

32–11. In addition to an advanced International Federation of Gynecology and Obstetrics (FIGO) stage, which of the following is associated with a poorer prognosis for survival with primary vaginal cancer?

a. Nulliparity

b. Younger age

c. Adenocarcinoma cell type

d. All of the above

32–12. Which of the following is NOT considered appropriate sole therapy for this stage of squamous cell vaginal cancer?

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Reproduced, with permission, from Richardson DL: Vaginal cancer. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 32-3.

a. Cisplatin chemotherapy

b. External beam radiation

c. Radial vaginectomy plus pelvic lymphadenectomy

d. All of the above

32–13. Which chemotherapeutic agent is commonly paired with radiotherapy for the treatment of primary vaginal cancer?

a. Cisplatin

b. Doxorubicin

c. Vincristine

d. Methotrexate

32–14. Which of the following is commonly used to treat stage IVA squamous cell vaginal cancer?

a. Cisplatin chemotherapy alone

b. External beam radiation plus cisplatin chemotherapy

c. Radical vaginectomy plus lymphadenectomy, then cisplatin chemotherapy alone

d. Radical vaginectomy plus lymphadenectomy, then external beam radiation alone

32–15. Which of the following is among the most common sites of distant spread of primary squamous cell cancer?

a. Bone

b. Brain

c. Spleen

d. Omentum

32–16. During surveillance for recurrent disease, which of the following findings suggests pelvic sidewall disease?

a. Sciatica

b. Lymphedema

c. Hydronephrosis

d. All of the above

32–17. For women with a central tumor recurrence following radiotherapy, which of the following are treatment options?

a. Brachytherapy

b. Wide local excision

c. Pelvic exenteration

d. External beam radiation plus cisplatin

32–18. In addition to cervical abnormalities, such as the cervical hood shown here, which of the following are linked to diethylstilbestrol exposure?

Image

Reproduced, with permission, from Nishida KJ: Vaginal cancer. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 32-7.

a. Vaginal adenosis

b. Müllerian uterine anomalies

c. Vaginal clear cell carcinoma

d. All of the above

32–19. Which of the following is true of vaginal adenocarcinoma?

a. Primary adenocarcinoma is believed to arise from vaginal adenosis.

b. Primary adenocarcinoma is less common than cancer metastatic to the vagina.

c. Endometrial cancer is the most common source of adenocarcinoma metastatic to the vagina.

d. All of the above

32–20. Which of the following is the most common malignancy of the vagina in infants and children?

a. Melanoma

b. Chondrosarcoma

c. Leiomyosarcoma

d. Embryonal rhabdomyosarcoma

32–21. Sarcoma botryoides most commonly presents with which of the following symptoms?

a. Uremia

b. Hemoptysis

c. Vaginal bleeding

d. Urinary retention

32–22. Which of the following is currently considered appropriate treatment for sarcoma botryoides?

a. Chemotherapy alone

b. Radiotherapy alone

c. Pelvic exenteration

d. Radiotherapy followed by radical excision

32–23. A Schiller-Duval body, found during histologic evaluation, and an elevated alpha-fetoprotein (AFP) level may be found with which type of vaginal cancer?

a. Yolk sac tumor

b. Leiomyosarcoma

c. Clear cell adenocarcinoma

d. Embryonal rhabdomyosarcoma

32–24. Although a benign nevus was identified by histologic evaluation, this upper right vaginal wall lesion was biopsied to exclude melanoma. Which of the following is true of vaginal melanoma?

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a. It is most commonly diagnosed in young women.

b. It is most frequently found in the distal vagina.

c. It is the most common site for reproductive tract melanoma.

d. All of the above

32–25. Which melanoma staging system is NOT applicable for vaginal melanoma?

a. Clark

b. Chung

c. Breslow

d. All of the above

Chapter 32 ANSWER KEY

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