Gynecologic Oncology Practice Questions

Q: Vulvar carcinoma accounts for what percentage of genital tract malignancies?

3 - 5%. **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.

Q: What is Type IIIB Endometrial cancer according to FIGO staging?

Endometrial cancer with vaginal involvement. **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.

Q: In pseudomyxoma peritonei, mucinous cyst-adenocarcinoma of which of the following organs is involved?

Ovary. **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."

Q: What is the screening test for cervical cancer?

Papanicolaou smear. **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.

Q: A hydatidiform mole is:

Triploid. **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).

Q: 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?

Beta HCG. **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.

Question 1

Vulvar carcinoma accounts for what percentage of genital tract malignancies?

Accepted Answer

3 - 5%

Answer

0.5 - 1%

Answer

7 - 11%

Answer

13 - 15%

Question 2

Which chemotherapeutic drug is effective in the treatment of epithelial ovarian cancer?

Accepted Answer

Cyclophosphamide

Answer

Carboplatin

Answer

Paclitaxel

Answer

Methotrexate

Question 3

What is Type IIIB Endometrial cancer according to FIGO staging?

Accepted Answer

Endometrial cancer with vaginal involvement

Answer

Endometrial cancer invading cervical stroma

Answer

Endometrial cancer involving uterine adnexa

Answer

Endometrial cancer invading pelvic lymph nodes

Question 4

In pseudomyxoma peritonei, mucinous cyst-adenocarcinoma of which of the following organs is involved?

Accepted Answer

Ovary

Answer

Pancreas

Answer

Kidney

Answer

Abdominal testis

Question 5

What is the treatment of choice for a young patient diagnosed with choriocarcinoma?

Accepted Answer

Chemotherapy

Answer

Hysterectomy

Answer

Chemotherapy followed by hysterectomy

Answer

Hysterectomy followed by chemotherapy

Question 6

What is the screening test for cervical cancer?

Accepted Answer

Papanicolaou smear

Answer

Biopsy

Answer

Visual inspection

Answer

Colposcopy

Question 7

Which of the following is associated with the maximum risk of invasive cervical cancer?

Accepted Answer

High-grade squamous intraepithelial lesion (HSIL)

Answer

Low-grade squamous intraepithelial lesion (LSIL)

Answer

HPV-associated koilocytosis

Answer

Herpes simplex virus (HSV) related changes

Question 8

In a young woman diagnosed with stage Ib cervical cancer, during a radical hysterectomy, which structure is typically preserved?

Accepted Answer

Periureteral tissues

Answer

Uterosacral and uterovesical ligaments

Answer

Pelvic lymph nodes

Answer

Upper third of the vagina

Question 9

A hydatidiform mole is:

Accepted Answer

Triploid

Answer

Haploid

Answer

Diploid

Answer

Polypoid

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?

Accepted Answer

Beta HCG

Answer

Per speculum examination

Answer

Progesterone

Answer

USG

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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