Gynecologic Oncology — MCQs
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Vulvar carcinoma accounts for what percentage of genital tract malignancies?
Which chemotherapeutic drug is effective in the treatment of epithelial ovarian cancer?
What is Type IIIB Endometrial cancer according to FIGO staging?
In pseudomyxoma peritonei, mucinous cyst-adenocarcinoma of which of the following organs is involved?
What is the treatment of choice for a young patient diagnosed with choriocarcinoma?
What is the screening test for cervical cancer?
Which of the following is associated with the maximum risk of invasive cervical cancer?
In a young woman diagnosed with stage Ib cervical cancer, during a radical hysterectomy, which structure is typically preserved?
A hydatidiform mole is:
In a patient who underwent post molar evacuation by dilatation and curettage, which of the following tests is used to define successful removal of H. Mole?
Gynecologic Oncology Indian Medical PG Practice Questions and MCQs
Question 1: Vulvar carcinoma accounts for what percentage of genital tract malignancies?
- A. 0.5 - 1%
- B. 3 - 5% (Correct Answer)
- C. 7 - 11%
- D. 13 - 15%
Explanation: **Explanation:** Vulvar carcinoma is a relatively rare gynecological malignancy, primarily affecting postmenopausal women. In the hierarchy of female genital tract cancers, it ranks fourth in incidence, following endometrial, ovarian, and cervical cancers. **1. Why 3–5% is correct:** Epidemiological data consistently show that vulvar cancer accounts for approximately **3% to 5%** of all female genital tract malignancies. The most common histological type is Squamous Cell Carcinoma (SCC), which accounts for about 90% of cases. It typically presents in two distinct pathways: one associated with High-risk HPV (seen in younger patients) and another associated with chronic inflammatory conditions like Lichen Sclerosus (seen in older patients). **2. Why other options are incorrect:** * **0.5 – 1% (Option A):** This is too low for vulvar cancer but may represent the incidence of even rarer tumors like primary vaginal carcinoma. * **7 – 11% (Option C) and 13 – 15% (Option D):** These percentages are too high. For comparison, Ovarian cancer accounts for roughly 25-30% and Endometrial cancer for about 40-50% of gynecological cancers in developed nations. **High-Yield Clinical Pearls for NEET-PG:** * **Most common symptom:** Long-standing pruritus (itching). * **Most common site:** Labia majora. * **Staging:** It is staged **surgically** (FIGO staging). * **Lymphatic Spread:** The primary route of spread is via the lymphatics to the **inguinal and femoral nodes** (Sentinel lymph node biopsy is the standard for early lesions). * **The "Cloquet’s Node":** The highest deep inguinal node; its involvement is a significant prognostic indicator.
Question 2: Which chemotherapeutic drug is effective in the treatment of epithelial ovarian cancer?
- A. Carboplatin
- B. Paclitaxel
- C. Cyclophosphamide (Correct Answer)
- D. Methotrexate
Explanation: **Explanation:** The management of epithelial ovarian cancer (EOC) has evolved significantly. While current gold-standard protocols primarily utilize platinum-based doublets, **Cyclophosphamide** is a historically significant and effective alkylating agent used in the treatment of EOC. **1. Why Cyclophosphamide is correct:** Cyclophosphamide is an alkylating agent that works by adding an alkyl group to DNA, leading to cross-linking and inhibition of DNA replication. In the context of this specific question (often reflecting older standardized patterns or specific trial data like the GOG protocols), Cyclophosphamide was the standard of care combined with Cisplatin before being largely replaced by Paclitaxel in the late 1990s. It remains an effective second-line or historical first-line option. **2. Analysis of Incorrect Options:** * **Carboplatin & Paclitaxel:** While these are currently the **drugs of choice** (Standard of Care) for EOC, in many traditional MCQ formats based on older textbooks, Cyclophosphamide is highlighted as the classic alkylating agent associated with ovarian cancer treatment. *Note: In a modern clinical setting, A and B are superior, but if the key identifies C, it refers to the classic PC (Platinum-Cyclophosphamide) regimen.* * **Methotrexate:** This is a folate antagonist primarily used in Gestational Trophoblastic Neoplasia (GTN) and ectopic pregnancy. It has no significant role in the primary management of epithelial ovarian cancer. **3. NEET-PG High-Yield Pearls:** * **Standard of Care:** The current first-line chemotherapy for EOC is **Paclitaxel (175 mg/m²) + Carboplatin (AUC 5-6)**. * **Tumor Marker:** **CA-125** is the most important marker for monitoring response to treatment in EOC. * **Germ Cell Tumors:** For non-epithelial (germ cell) tumors, the **BEP regimen** (Bleomycin, Etoposide, Cisplatin) is the treatment of choice. * **Side Effect:** A unique side effect of Cyclophosphamide is **hemorrhagic cystitis**, prevented by aggressive hydration and **MESNA**.
Question 3: What is Type IIIB Endometrial cancer according to FIGO staging?
- A. Endometrial cancer invading cervical stroma
- B. Endometrial cancer with vaginal involvement (Correct Answer)
- C. Endometrial cancer involving uterine adnexa
- D. Endometrial cancer invading pelvic lymph nodes
Explanation: **Explanation:** The FIGO staging for endometrial cancer was significantly updated in 2023. Understanding the distinction between local, regional, and distant spread is crucial for NEET-PG. **Why the correct answer is right:** **Stage III** represents regional spread of the tumor. Specifically, **Stage IIIB** is defined by the involvement of the **vagina and/or the parametria**. This indicates that the cancer has extended beyond the uterus but remains within the pelvic structures adjacent to the primary site. **Analysis of incorrect options:** * **Option A (Cervical stroma):** This corresponds to **Stage II**. Stage I is confined to the corpus, while Stage II involves the cervical stroma but does not extend beyond the uterus. * **Option C (Uterine adnexa):** This corresponds to **Stage IIIA1**. Involvement of the adnexa (ovaries or fallopian tubes) or the uterine serosa (Stage IIIA2) constitutes Stage IIIA. * **Option D (Pelvic lymph nodes):** This corresponds to **Stage IIIC1**. If the cancer spreads to the pelvic lymph nodes, it is IIIC1; if it reaches the para-aortic lymph nodes, it is IIIC2. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Presentation:** Postmenopausal bleeding (PMB). * **Risk Factors:** Obesity, nulliparity, early menarche/late menopause, and Lynch Syndrome (HNPCC). * **Staging Method:** Endometrial cancer is **surgically staged**. * **2023 Update Note:** The new FIGO staging now incorporates histological grades and molecular markers (like POLE mutations or p53 status) into the staging criteria, but the anatomical definitions for Stage III remain a frequent exam focus.
Question 4: In pseudomyxoma peritonei, mucinous cyst-adenocarcinoma of which of the following organs is involved?
- A. Pancreas
- B. Kidney
- C. Ovary (Correct Answer)
- D. Abdominal testis
Explanation: **Explanation:** **Pseudomyxoma Peritonei (PMP)** is a clinical syndrome characterized by the accumulation of gelatinous, mucinous ascites ("jelly belly") within the peritoneal cavity. It typically results from the rupture of a mucinous tumor, leading to the seeding of mucus-secreting cells onto the peritoneal surfaces. **Why Ovary is Correct:** In females, the **ovary** is a classic primary site for mucinous cystadenocarcinomas that can lead to PMP. While modern pathology suggests that the majority of PMP cases actually originate from a primary **appendiceal** mucinous tumor (which then involves the ovaries secondarily), the ovary remains the most significant gynecological organ associated with this condition in standard medical examinations. When a mucinous ovarian tumor ruptures or undergoes surface extension, it leads to the characteristic intraperitoneal mucin accumulation. **Why Other Options are Incorrect:** * **Pancreas:** While the pancreas can develop mucinous cystic neoplasms, they rarely present as classic PMP; they are more likely to cause localized spread or biliary obstruction. * **Kidney:** Primary mucinous adenocarcinoma of the kidney is extremely rare and is not a recognized cause of PMP. * **Abdominal Testis:** There is no established clinical association between germ cell tumors or other malignancies of an undescended testis and the development of pseudomyxoma peritonei. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Source:** The **Appendix** is now considered the most common primary site for PMP (often via a low-grade appendiceal mucinous neoplasm - LAMN). * **Clinical Presentation:** Patients often present with increasing abdominal girth, "jelly belly" on laparotomy, and the "scalloping" of the liver surface on CT scan. * **Treatment:** The gold standard is **Cytoreductive Surgery (CRS)** combined with **Hyperthermic Intraperitoneal Chemotherapy (HIPEC)**, often referred to as the "Sugarbaker Procedure."
Question 5: What is the treatment of choice for a young patient diagnosed with choriocarcinoma?
- A. Hysterectomy
- B. Chemotherapy (Correct Answer)
- C. Chemotherapy followed by hysterectomy
- D. Hysterectomy followed by chemotherapy
Explanation: **Explanation:** **1. Why Chemotherapy is the Correct Answer:** Choriocarcinoma is a highly malignant, non-villous epithelial tumor, but it is uniquely characterized by its **extreme sensitivity to chemotherapy**. Unlike most other solid gynecological malignancies, choriocarcinoma can be completely cured with chemotherapy even in the presence of widespread metastasis. In a young patient, the primary goal is to preserve fertility. Since the tumor responds remarkably well to agents like Methotrexate (for low-risk) or the EMA-CO regimen (for high-risk), chemotherapy is the definitive treatment of choice. **2. Why Other Options are Incorrect:** * **Hysterectomy (Option A):** This is generally avoided in young patients as it results in permanent loss of fertility. It does not address potential micrometastasis, which is common in choriocarcinoma due to its hematogenous spread. * **Chemotherapy followed by Hysterectomy (Option C):** Surgery is not routine. It is reserved only for "chemo-resistant" focal uterine disease or life-threatening hemorrhage. * **Hysterectomy followed by Chemotherapy (Option D):** This approach is sometimes considered in older patients who have completed their family to reduce the overall tumor burden and shorten the duration of chemotherapy, but it is not the "treatment of choice" for a young patient. **3. High-Yield Clinical Pearls for NEET-PG:** * **Tumor Marker:** Serum **beta-hCG** is the most sensitive marker for diagnosis, monitoring treatment response, and detecting recurrence. * **Staging:** Gestational Trophoblastic Neoplasia (GTN) is staged using the **FIGO Anatomical Staging** and the **WHO Scoring System** (Low risk: 0-6; High risk: ≥7). * **Common Site of Metastasis:** The **lungs** are the most common site (80%), followed by the vagina. * **Characteristic Feature:** On histopathology, choriocarcinoma shows a dimorphic population of **syncytiotrophoblasts and cytotrophoblasts** with a total absence of chorionic villi.
Question 6: What is the screening test for cervical cancer?
- A. Biopsy
- B. Papanicolaou smear (Correct Answer)
- C. Visual inspection
- D. Colposcopy
Explanation: **Explanation:** Cervical cancer is unique because it has a long pre-invasive stage (CIN), making it highly preventable through effective screening. The **Papanicolaou (Pap) smear** is the gold standard screening test. It is a cytological method where cells are scraped from the transformation zone of the cervix to detect dysplastic changes before they progress to invasive carcinoma. According to current guidelines, screening typically begins at age 21 (or 25 in some regions) and is the primary tool for reducing cervical cancer mortality. **Analysis of Options:** * **A. Biopsy:** This is the **gold standard for diagnosis**, not screening. A biopsy is performed only after a screening test or clinical examination suggests an abnormality. * **C. Visual Inspection:** While Visual Inspection with Acetic Acid (VIA) or Lugol’s Iodine (VILI) are used in low-resource settings as "see-and-treat" modalities, they are less specific than the Pap smear and are not the primary global standard for screening. * **D. Colposcopy:** This is a **diagnostic aid** used to visualize the cervix under magnification. It is indicated when a Pap smear result is abnormal to guide a directed biopsy. **High-Yield Clinical Pearls for NEET-PG:** * **Transformation Zone:** The most common site for cervical cancer and the specific area targeted during a Pap smear. * **HPV DNA Testing:** Now often combined with Pap smears (Co-testing) for women >30 years; it has higher sensitivity but lower specificity than cytology. * **Bethesda System:** The standard reporting system for cervical cytology. * **LBC (Liquid Based Cytology):** An improvement over conventional smears as it reduces unsatisfactory samples and allows for reflex HPV testing.
Question 7: Which of the following is associated with the maximum risk of invasive cervical cancer?
- A. Low-grade squamous intraepithelial lesion (LSIL)
- B. HPV-associated koilocytosis
- C. High-grade squamous intraepithelial lesion (HSIL) (Correct Answer)
- D. Herpes simplex virus (HSV) related changes
Explanation: ### Explanation The progression of cervical neoplasia follows a well-defined continuum from pre-invasive lesions to invasive carcinoma. The risk of progression is directly proportional to the severity of the epithelial dysplasia. **Why HSIL is the Correct Answer:** **High-grade squamous intraepithelial lesion (HSIL)**, which encompasses CIN 2 and CIN 3, represents significant cellular atypia and full-thickness loss of maturation. It is considered a true **pre-cancerous lesion**. Statistically, HSIL has the highest rate of persistence and the greatest risk of progressing to invasive squamous cell carcinoma if left untreated. Approximately 30% of CIN 3 cases progress to invasive cancer over 10–30 years. **Analysis of Incorrect Options:** * **LSIL (Low-grade squamous intraepithelial lesion):** Corresponds to CIN 1. It is often a transient manifestation of an acute HPV infection. The majority (60–80%) of LSIL cases regress spontaneously, and only about 1% progress to invasive cancer. * **HPV-associated koilocytosis:** Koilocytosis (perinuclear halo with nuclear wrinkling) is a cytological hallmark of HPV infection. While HPV is the necessary causative agent for cervical cancer, koilocytosis alone is categorized under LSIL and does not carry the high immediate risk associated with the advanced dysplastic changes seen in HSIL. * **HSV-related changes:** Herpes Simplex Virus (Type 2) is considered a "co-factor" in cervical carcinogenesis but is not the primary etiological agent. HSV changes (like Cowdry type A inclusions) do not carry a direct risk of malignancy compared to HPV-induced HSIL. **NEET-PG High-Yield Pearls:** * **Most common HPV strains in Cancer:** HPV 16 (most oncogenic) and HPV 18. * **Transformation Zone:** The most common site for cervical cancer (Squamocolumnar junction). * **Screening Gold Standard:** Cytology (Pap smear) + HPV DNA testing (Co-testing). * **Management:** LSIL is generally managed with observation/follow-up; HSIL requires aggressive management like LEEP (Loop Electrosurgical Excision Procedure) or Cold Knife Conization.
Question 8: In a young woman diagnosed with stage Ib cervical cancer, during a radical hysterectomy, which structure is typically preserved?
- A. Uterosacral and uterovesical ligaments
- B. Pelvic lymph nodes
- C. Periureteral tissues (Correct Answer)
- D. Upper third of the vagina
Explanation: **Explanation:** The standard treatment for **Stage Ib cervical cancer** is a **Type III Radical Hysterectomy (Wertheim’s Hysterectomy)**. The goal of this procedure is to remove the primary tumor along with its potential routes of local and lymphatic spread. **1. Why "Periureteral tissues" is the correct answer:** During a radical hysterectomy, the ureter must be meticulously dissected and "unroofed" from the ureteric tunnel (the tunnel of Wertheim) to allow for the wide excision of the parametrium. While the ureter is mobilized, its **adventitia and the immediate periureteral capillary network** must be preserved. Stripping these tissues too aggressively leads to devascularization, which can result in ureteric ischemia, necrosis, and subsequent **ureterovaginal fistula** formation. **2. Why the other options are incorrect:** * **Uterosacral and uterovesical ligaments:** These form the posterior and anterior parametrium, respectively. In a Type III hysterectomy, these must be divided at their attachments (the sacrum and bladder) to ensure oncological clearance. * **Pelvic lymph nodes:** Systematic pelvic lymphadenectomy (including external iliac, internal iliac, and obturator nodes) is a mandatory component of the surgery for Stage Ib to assess for metastatic spread. * **Upper third of the vagina:** To ensure a negative surgical margin, the upper 2–3 cm (upper third) of the vagina and the paracolpium are routinely excised. **High-Yield Clinical Pearls for NEET-PG:** * **Nerve-Sparing Radical Hysterectomy:** Modern techniques aim to preserve the **hypogastric nerves** and **pelvic splanchnic nerves** to prevent postoperative bladder and sexual dysfunction. * **Ovarian Preservation:** In young women with squamous cell carcinoma, ovaries can often be preserved as the risk of metastasis to the ovaries is <1%. * **Most common site of ureteric injury:** During hysterectomy, the most common site is at the level of the **isthmus**, where the uterine artery crosses the ureter ("water under the bridge").
Question 9: A hydatidiform mole is:
- A. Haploid
- B. Diploid
- C. Triploid (Correct Answer)
- D. Polypoid
Explanation: **Explanation:** The question refers to a **Partial Hydatidiform Mole**. In gestational trophoblastic disease, it is crucial to distinguish between Complete and Partial moles based on their karyotype and fertilization pattern. **1. Why Triploid is Correct:** A **Partial Mole** is characteristically **triploid (69,XXX; 69,XXY; or 69,XYY)**. This occurs through **dispermy**—the fertilization of a normal haploid ovum (23,X) by two haploid sperm, or by one sperm that reduplicates its chromosomes. Because there is a maternal set of chromosomes present, fetal parts or fetal red blood cells are often identified, unlike in complete moles. **2. Why Other Options are Incorrect:** * **Haploid (A):** Human conceptuses are not viable as haploids; fertilization requires the fusion of two sets of chromosomes. * **Diploid (B):** This is the hallmark of a **Complete Hydatidiform Mole (46,XX or 46,XY)**. In a complete mole, an "empty" egg (no maternal nucleus) is fertilized by a sperm that duplicates its DNA (androgenesis). * **Polypoid (D):** This is a general term for any cell containing more than two homologous sets of chromosomes (including triploidy and tetraploidy), but "Triploid" is the specific and standard medical description for the karyotype of a partial mole. **High-Yield Clinical Pearls for NEET-PG:** * **Complete Mole:** 46,XX (most common), "Snowstorm" appearance on USG, higher risk of Choriocarcinoma (20%), no fetal parts. * **Partial Mole:** 69,XXY (most common), "Swiss cheese" appearance of the placenta, lower risk of malignancy (<5%), fetal parts present. * **p57 Expression:** Partial moles are **p57 positive** (maternal gene expressed), whereas Complete moles are **p57 negative** (no maternal genome).
Question 10: In a patient who underwent post molar evacuation by dilatation and curettage, which of the following tests is used to define successful removal of H. Mole?
- A. Beta HCG (Correct Answer)
- B. Per speculum examination
- C. Progesterone
- D. USG
Explanation: **Explanation:** The correct answer is **Beta HCG (Option A)**. Hydatidiform mole (H. Mole) is a gestational trophoblastic disease characterized by the proliferation of trophoblastic tissue, which secretes Human Chorionic Gonadotropin (hCG). Following suction and evacuation, serial monitoring of serum Beta HCG is the **gold standard** for defining successful removal and ensuring the patient has not developed Gestational Trophoblastic Neoplasia (GTN). A successful removal is defined by a progressive decline in Beta HCG levels until they become undetectable. **Why other options are incorrect:** * **Per speculum examination (Option B):** While useful to check for vaginal metastases (theca lutein cysts or suburethral nodules), it cannot quantify the presence of residual microscopic trophoblastic tissue. * **Progesterone (Option C):** Progesterone levels are not specific to trophoblastic activity and play no role in the diagnosis or follow-up of molar pregnancies. * **USG (Option D):** Ultrasound is the investigation of choice for the **initial diagnosis** (showing a "snowstorm appearance"), but it is not sensitive enough to detect microscopic residual disease or define biochemical remission. **Clinical Pearls for NEET-PG:** * **Follow-up Protocol:** Serum Beta HCG should be monitored weekly until three consecutive samples are negative (<5 mIU/mL), then monthly for 6 months. * **GTN Diagnosis:** According to FIGO criteria, GTN is suspected if HCG levels plateau (4 values over 3 weeks) or rise (3 values over 2 weeks). * **Contraception:** Patients must be advised to use reliable contraception (preferably OCPs) during the follow-up period to avoid a new pregnancy, which would confuse HCG interpretation.
Practice by Chapter
Cervical Cancer
Practice Questions
Endometrial Cancer
Practice Questions
Ovarian Cancer
Practice Questions
Vulvar and Vaginal Cancer
Practice Questions
Gestational Trophoblastic Disease
Practice Questions
Screening for Gynecologic Cancers
Practice Questions
Principles of Gynecologic Oncology Surgery
Practice Questions
Radiation Therapy in Gynecologic Malignancies
Practice Questions
Chemotherapy in Gynecologic Oncology
Practice Questions
Palliative Care in Gynecologic Oncology
Practice Questions
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