ABOG ABOG Gynecologic Oncology & Cancer Management 2 — Questions and Answers
Question 1: A patient with vulvar cancer requires a sentinel lymph node biopsy. What is the preferred mapping agent used in the United States?
- Technetium-99m with blue dye (Correct answer)
- Indocyanine green only
- Methylene blue alone
- Fluorescein dye
Correct answer: Technetium-99m with blue dye
Technetium-99m radiocolloid combined with blue dye (isosulfan blue or methylene blue) is the standard dual-mapping technique for sentinel lymph node biopsy in vulvar cancer.
Question 2: Which hereditary syndrome is most strongly associated with ovarian and endometrial cancer risk?
- Lynch syndrome (HNPCC) (Correct answer)
- BRCA1 mutation only
- Li-Fraumeni syndrome
- Cowden syndrome
Correct answer: Lynch syndrome (HNPCC)
Lynch syndrome (hereditary nonpolyposis colorectal cancer) confers a 40–60% lifetime risk of endometrial cancer and 10–12% risk of ovarian cancer due to mismatch repair gene mutations.
Question 3: What is the standard chemotherapy regimen for advanced epithelial ovarian cancer after cytoreductive surgery?
- Carboplatin and paclitaxel (Correct answer)
- Cisplatin and 5-fluorouracil
- Doxorubicin and cyclophosphamide
- Gemcitabine and bevacizumab
Correct answer: Carboplatin and paclitaxel
Carboplatin plus paclitaxel (every 3 weeks for 6 cycles) is the standard first-line chemotherapy regimen for advanced epithelial ovarian cancer.
Question 4: In gestational trophoblastic neoplasia (GTN), which single-agent chemotherapy is used for low-risk disease?
- Methotrexate (Correct answer)
- Cisplatin
- Doxorubicin
- Etoposide
Correct answer: Methotrexate
Methotrexate (with or without folinic acid rescue) is the preferred single-agent chemotherapy for low-risk gestational trophoblastic neoplasia due to high cure rates and favorable toxicity profile.
Question 5: A Pap smear shows HSIL. After colposcopy confirms CIN 3, what is the standard treatment?
- Loop electrosurgical excision procedure (LEEP) (Correct answer)
- Observation only for 6 months
- Immediate hysterectomy
- Cryotherapy alone
Correct answer: Loop electrosurgical excision procedure (LEEP)
LEEP (loop electrosurgical excision procedure) is the standard treatment for CIN 3 as it provides both treatment and a tissue specimen for pathologic evaluation.
Question 6: What is the role of PARP inhibitors in ovarian cancer management?
- Maintenance therapy in BRCA-mutated patients after platinum response (Correct answer)
- First-line surgery alternative
- Salvage therapy for platinum-resistant disease only
- Prevention in high-risk women
Correct answer: Maintenance therapy in BRCA-mutated patients after platinum response
PARP inhibitors (olaparib, niraparib, rucaparib) are FDA-approved as maintenance therapy for patients with BRCA-mutated advanced ovarian cancer who respond to platinum-based chemotherapy.
ABOG ABOG Gynecologic Oncology & Cancer Management 2
A patient with vulvar cancer requires a sentinel lymph node biopsy.
What is the preferred mapping agent used in the United States?