Page 36 of 37
OG33.1-5,OG34.1-5 | Gynaecological Oncology and Operative Gynaecology — Assignment
CLINICAL SCENARIO
Gynaecological cancers — cervical, endometrial, ovarian, and gestational trophoblastic disease — each have distinct biological behaviour, staging systems, and treatment pathways. This assignment asks you to apply your knowledge of FIGO staging and evidence-based management principles to a structured clinical case, demonstrating competence in diagnosis, staging accuracy, and treatment planning.
Instructions
Choose ONE of the following two case scenarios (A or B) and write a structured case-based analysis addressing all sections of the scaffolding below. Your analysis must correctly apply the relevant FIGO staging system (state the version: FIGO 2018 for cervical cancer; FIGO 2023 for endometrial cancer; FIGO 2014 for ovarian cancer — do NOT apply one system to another cancer), cite management guidelines accurately, and demonstrate clear clinical reasoning.
Case A: A 48-year-old woman presents with 6 months of post-coital and intermenstrual bleeding. Speculum examination reveals a 3.5 cm exophytic mass on the cervix. Biopsy confirms squamous cell carcinoma. MRI pelvis shows the tumour confined to the cervix with no parametrial or vaginal extension. CT-PET demonstrates bilateral pelvic lymph node metastases but no para-aortic or distant involvement.
Case B: A 65-year-old woman (BMI 34, type 2 diabetic on insulin) presents with 5 months of postmenopausal bleeding. Endometrial biopsy confirms moderately differentiated endometrioid adenocarcinoma. MRI shows myometrial invasion involving 60% of myometrial thickness, no cervical stromal invasion, and no lymph node enlargement on imaging.
Length: 900–1200 words total (excluding section headings)
What to Submit
Section 1: Clinical Presentation and Differential Diagnosis
Guidance: Describe the key clinical features of your chosen case. List three differential diagnoses that you would consider before the biopsy result. Briefly explain why the biopsy finding is the diagnosis in this case. (Approximately 150–200 words)
Section 2: FIGO Staging — Precise Application
Guidance: State the exact FIGO stage for your case. For Case A: apply FIGO 2018 cervical cancer staging precisely — state the IB sub-stage criteria (IB1/IB2/IB3), explain the role of nodal involvement in determining Stage IIIC1 vs IIIC2, and justify why the imaging findings in this case produce the stage you have assigned. For Case B: apply FIGO 2023 endometrial cancer staging — state whether myometrial invasion depth reaches the IB threshold, and explicitly address whether endocervical gland involvement (if found) would change the stage to II. Do NOT conflate staging systems from different gynaecological cancers. (Approximately 250–300 words)
Section 3: Investigations Required for Staging and Treatment Planning
Guidance: List the investigations required to complete staging and plan treatment for your chosen case. For each investigation, state the information it provides and how it influences the management decision. Distinguish between investigations used for diagnosis, staging, and treatment planning. (Approximately 150–200 words)
Section 4: Multidisciplinary Management Plan
Guidance: Outline the evidence-based management plan for your case stage by stage. Include: (a) the primary treatment modality and rationale; (b) adjuvant treatment if applicable; (c) the roles of surgery, chemotherapy, and radiotherapy in your case — explaining which is first-line and why; (d) fertility considerations if relevant; (e) one significant treatment complication and its management. For Case A, clearly state the radiation field (standard pelvic vs extended field) and chemotherapy agent. (Approximately 250–300 words)
Section 5: Prognosis and Follow-up
Guidance: State the approximate 5-year survival rate for the FIGO stage you assigned. Outline a structured follow-up protocol (frequency of visits, investigations at follow-up, and duration). Discuss TWO patient-specific factors in your case that modify prognosis. (Approximately 150 words)
Grading Rubric — Gynaecological Oncology Assignment Marking Rubric
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| FIGO Staging Accuracy — Correct identification and precise application of the relevant FIGO staging system with accurate stage assignment and justification | 30 pts | Correct FIGO system cited (with version year), precise stage assigned with all sub-stage criteria correctly applied (IB1/IB2/IB3 for cervical; myometrial invasion threshold for endometrial); no transplantation of one staging system onto another; staging trap addressed explicitly (nodal status for IIIC1/C2; glandular vs stromal cervical involvement for endometrial Stage II) |
| Clinical Reasoning and Differential Diagnosis — Quality of clinical reasoning from presentation to diagnosis, with appropriate differentials | 20 pts | Three clinically relevant differentials listed with brief reasoning; the correct diagnosis clearly favoured by specific features (e.g., biopsy, symptoms, epidemiology); reasoning flows logically from presentation to diagnosis |
| Management Plan — Evidence-based, stage-appropriate multidisciplinary management including surgery, chemotherapy, and radiotherapy roles | 30 pts | Primary and adjuvant treatment correctly identified and justified for the stated stage; roles of each modality explained; radiation field and chemotherapy agent named correctly (Case A); complication managed appropriately; no contraindicated treatments recommended |
| Investigations — Appropriate, targeted investigation list with rationale linked to staging and treatment decisions | 10 pts | Investigations clearly listed with specific roles (diagnosis vs staging vs treatment planning); investigations match the clinical context; key staging investigations included (MRI pelvis, CT-PET or CT chest/abdomen/pelvis as appropriate) |
| Prognosis and Communication — Accurate survival data, structured follow-up, and clear written communication | 10 pts | Approximate 5-year survival stated and realistic for the assigned stage; follow-up protocol structured (frequency, investigations, duration); two prognostic factors identified and discussed; writing is clear, logical, and within word limit |
PEER REVIEW
Review your assigned peer's submission using the rubric provided. For each criterion, award a score and provide 2–3 sentences of specific, constructive feedback. In your Section 2 review (FIGO Staging), pay particular attention to: (1) Is the correct FIGO system cited with version year? (2) Are sub-stage criteria (IB1/IB2/IB3 for cervical; invasion depth for endometrial) applied precisely? (3) Is the staging trap addressed (IIIC1 vs IIIC2; glandular vs stromal cervical involvement)? Your feedback should be specific and referenced to the rubric — avoid vague comments such as 'good work'. Total peer review response: 300–400 words.