Cervical Cancer — MCQs
Management of stage IIB cancer of the cervix is?
A patient presents with bilateral ovarian carcinoma, capsule involvement, ascites, and paraaortic lymphadenopathy. What is the appropriate stage of the disease?
A postmenopausal diabetic woman presents with bleeding per vaginum. The most likely diagnosis is :
Which of the following is the MOST significant risk factor for carcinoma of the cervix?
E6 and E7 genes of which virus are implicated in oncogenesis?
Which statement is TRUE regarding the relationship between HPV vaccination and cervical cancer screening?
Which of the following treatment options best represents the standard management approach for stage IB cervical cancer?
Investigation of choice in postcoital bleeding in a 60-year-old woman is:
Most common presentation of cervical cancer is -
Which condition does NOT increase the risk of cervical cancer?
Cervical Cancer Indian Medical PG Practice Questions and MCQs
Question 1: Management of stage IIB cancer of the cervix is?
- A. Radiotherapy
- B. Chemotherapy
- C. Hysterectomy
- D. Radiotherapy combined with chemotherapy (Correct Answer)
Explanation: ***Radiotherapy combined with chemotherapy*** - For **Stage IIB cervical cancer**, disease has spread to the **parametrium** but not to the pelvic sidewall or lower third of the vagina. - Concurrent **chemoradiation** is the standard primary treatment for locally advanced cervical cancer (stages IB2-IVA) as it has been shown to improve overall survival compared to radiation alone. *Radiotherapy* - While **radiotherapy** is a crucial component of treatment for locally advanced cervical cancer, using it alone for Stage IIB disease is not considered optimal. - Adding **concurrent chemotherapy** significantly improves treatment efficacy and patient outcomes compared to radiotherapy alone. *Chemotherapy* - **Chemotherapy alone** is generally not sufficient as primary treatment for Stage IIB cervical cancer. - It is often used as a **sensitizer to radiation** or for metastatic disease, but not as a monotherapy for locally advanced disease. *Hysterectomy* - **Hysterectomy** (surgical removal of the uterus) is primarily used for early-stage cervical cancer (IA-IB1). - For **Stage IIB cervical cancer**, the disease has spread beyond the uterus, making surgery alone an inadequate treatment.
Question 2: A patient presents with bilateral ovarian carcinoma, capsule involvement, ascites, and paraaortic lymphadenopathy. What is the appropriate stage of the disease?
- A. Stage 1C
- B. Stage 3C (Correct Answer)
- C. Stage 2C
- D. Stage 4C
Explanation: ***Stage 3C*** - **Bilateral ovarian carcinoma** with **capsule involvement**, **ascites**, and especially **paraaortic lymph node metastases** are defining features of Stage IIIC ovarian cancer. - Involvement of **retroperitoneal lymph nodes**, including paraaortic nodes, automatically upstages the disease to Stage III, irrespective of other abdominal spread. *Stage 1C* - This stage refers to ovarian cancer confined to **one or both ovaries**, with evidence of rupture, capsule involvement, or malignant cells in ascites/peritoneal washings, but **without lymph node involvement**. - The presence of **paraaortic lymphadenopathy** in this patient immediately excludes Stage 1C. *Stage 2C* - Stage 2 ovarian cancer involves one or both ovaries with **pelvic extension** beyond the ovaries, but still **without lymph node involvement**. - The patient's involvement of **paraaortic lymph nodes** goes beyond pelvic extension and therefore excludes Stage 2C. *Stage 4C* - Stage 4 ovarian carcinoma involves **distant metastasis** beyond the peritoneal cavity or distant lymph nodes (e.g., pleural effusion with positive cytology, parenchymal liver/spleen metastasis). - While paraaortic lymphadenopathy indicates advanced disease, it falls within the criteria for Stage 3 due to its location, not Stage 4.
Question 3: A postmenopausal diabetic woman presents with bleeding per vaginum. The most likely diagnosis is :
- A. Malignancy of the vulva
- B. Malignancy of the cervix
- C. Malignancy of the endometrium (Correct Answer)
- D. Malignancy of the ovary
Explanation: ***Malignancy of the endometrium*** - **Postmenopausal bleeding** is the classic presenting symptom of **endometrial cancer**, which must be ruled out in all such cases. - **Diabetes** is a known risk factor for endometrial cancer, along with obesity, hypertension, and unopposed estrogen exposure. *Malignancy of the vulva* - Vulvar cancer typically presents with a **pruritic lesion**, lump, or ulcer on the vulva, rather than solely with vaginal bleeding. - While bleeding can occur from an advanced vulvar lesion, it is not the primary or most common presentation for new onset postmenopausal bleeding. *Malignancy of the cervix* - Cervical cancer often presents with **postcoital bleeding** or irregular vaginal bleeding in premenopausal women, or less commonly, postmenopausal bleeding. - Screening with **Pap smears** typically detects precancerous changes or early cervical cancer, making it less likely to be the first presentation with postmenopausal bleeding in a well-screened population. *Malignancy of the ovary* - Ovarian cancer is often asymptomatic in its early stages and presents with non-specific symptoms like **abdominal distension**, bloating, or pelvic pain. - **Vaginal bleeding** is not a typical symptom of ovarian cancer, unless the tumor is very large, involves adjacent structures, or is a hormone-producing tumor.
Question 4: Which of the following is the MOST significant risk factor for carcinoma of the cervix?
- A. Multiparity
- B. HIV infection
- C. None of the options (Correct Answer)
- D. Smoking
Explanation: ***None of the options*** - The **MOST significant risk factor** for cervical carcinoma is **persistent infection with high-risk HPV types** (especially HPV 16 and 18), which is found in >99% of cervical cancers and is considered the **necessary cause**. - Since **HPV infection** is not listed among the options, none of the given choices represents the most significant risk factor. - While HIV, smoking, and multiparity are all associated with increased cervical cancer risk, they are **secondary factors** that work primarily by affecting HPV persistence or acting as co-factors. *HIV infection* - **HIV infection** is an important risk factor as it compromises immune surveillance and reduces the ability to clear **HPV infections**, leading to persistent high-risk HPV and progression to CIN and invasive cancer. - However, HIV increases risk **through its effect on HPV persistence**, not as an independent primary cause. - Without HPV, HIV alone does not cause cervical cancer. *Smoking* - **Smoking** is an independent co-factor that increases cervical cancer risk, with tobacco carcinogens found in cervical mucus acting synergistically with **HPV**. - It is a secondary risk factor, not the primary cause. *Multiparity* - **Multiparity** shows a weak association with cervical cancer risk, possibly related to hormonal changes or increased HPV exposure. - It is the least significant among the listed factors and is not a primary driver of cervical carcinogenesis.
Question 5: E6 and E7 genes of which virus are implicated in oncogenesis?
- A. HPV (Correct Answer)
- B. Cytomegalovirus (CMV)
- C. Epstein-Barr Virus (EBV)
- D. Human T-lymphotropic Virus type 1 (HTLV-1)
Explanation: ***HPV*** - The **E6** and **E7** oncoproteins of **High-Risk Human Papillomavirus (HPV)** are critical for oncogenesis, primarily in cervical cancer. - **E6** degrades the tumor suppressor protein **p53**, and **E7** inactivates the **retinoblastoma (Rb)** protein, leading to uncontrolled cell proliferation. *Cytomegalovirus (CMV)* - While CMV can be associated with certain cancers like glioblastoma, its direct role in oncogenesis does not involve specific E6/E7 genes. - CMV primarily causes opportunistic infections and congenital abnormalities, not through the mechanism of E6/E7. *Epstein-Barr Virus (EBV)* - EBV is associated with various cancers such as **nasopharyngeal carcinoma** and **Burkitt lymphoma**. - Its oncogenic mechanisms involve proteins like **LMP1** and **EBNA2**, which dysregulate cell growth, rather than E6/E7. *Human T-lymphotropic Virus type 1 (HTLV-1)* - HTLV-1 is the causative agent of **Adult T-cell Leukemia/Lymphoma (ATLL)**. - Its oncogenic potential is linked to the **Tax protein**, which alters gene expression and promotes T-cell proliferation, not through E6/E7.
Question 6: Which statement is TRUE regarding the relationship between HPV vaccination and cervical cancer screening?
- A. Vaccinated women require less frequent screening than unvaccinated women
- B. Screening recommendations are currently the same regardless of vaccination status (Correct Answer)
- C. HPV vaccination eliminates the need for cervical cancer screening
- D. Screening should begin at a younger age in vaccinated women
Explanation: ***Screening recommendations are currently the same regardless of vaccination status*** * Current guidelines recommend the same cervical cancer screening schedule for all eligible individuals, **regardless of their HPV vaccination status**. * This is because the HPV vaccine does not protect against all oncogenic HPV types, and individuals may have been exposed to HPV prior to vaccination. *Vaccinated women require less frequent screening than unvaccinated women* * This statement is incorrect because there is **no evidence to support less frequent screening** for vaccinated women. * The persistence of **high-risk HPV types not covered by the vaccine** and the possibility of prior exposure necessitate consistent screening. *HPV vaccination eliminates the need for cervical cancer screening* * This is incorrect; HPV vaccination significantly reduces the risk of cervical cancer but **does not eliminate it completely**. * Vaccines protect against the most common high-risk HPV types but **not all of them**, making continued screening essential. *Screening should begin at a younger age in vaccinated women* * This is incorrect; current guidelines recommend the **same starting age for cervical cancer screening** (typically 21 or 25, depending on the guideline) for both vaccinated and unvaccinated women. * There is **no clinical rationale to initiate screening earlier** in vaccinated individuals.
Question 7: Which of the following treatment options best represents the standard management approach for stage IB cervical cancer?
- A. Surgery and Radiotherapy
- B. Surgery (Correct Answer)
- C. Chemotherapy and Radiotherapy
- D. Surgery and Chemotherapy
Explanation: ***Surgery*** - For **stage IB cervical cancer**, **radical hysterectomy with pelvic lymphadenectomy** is the primary standard surgical treatment option. - Surgery alone is appropriate for cases without high-risk features on final pathology. - This represents the cornerstone primary management approach for early-stage cervical cancer. - Alternative primary treatment is definitive **concurrent chemoradiation**, which is considered equivalent to surgery. *Surgery and Radiotherapy* - **Adjuvant radiotherapy** (or chemoradiation) is added only if **high-risk pathologic features** are found post-surgery, such as positive margins, parametrial involvement, or positive lymph nodes. - This is not the standard primary approach but rather selective adjuvant therapy based on surgical pathology findings. - Not all stage IB cases require adjuvant radiotherapy. *Surgery and Chemotherapy* - **Adjuvant chemotherapy alone** is NOT standard management for cervical cancer. - When adjuvant therapy is needed, it is **concurrent chemoradiation** (radiation with chemotherapy as a radiosensitizer), not chemotherapy alone. - Chemotherapy alone does not provide adequate locoregional control for cervical cancer. *Chemotherapy and Radiotherapy* - **Concurrent chemoradiation** is the primary treatment for **locally advanced cervical cancer** (stages IB3 with certain features, IIB-IVA). - It is also an alternative to surgery for primary treatment of stage IB, but the question asks for standard management, which traditionally refers to the surgical approach for early-stage disease. - This is definitive treatment without surgery for larger or locally advanced tumors.
Question 8: Investigation of choice in postcoital bleeding in a 60-year-old woman is:
- A. Pap smear
- B. Colposcopy and biopsy (Correct Answer)
- C. Pelvic ultrasound
- D. Cone excision of cervix
Explanation: ***Colposcopy and biopsy*** - **Postcoital bleeding** in a 60-year-old postmenopausal woman requires investigation for **cervical pathology** (cancer, polyps, or atrophic changes). - **Colposcopy** allows direct visualization of the cervix with magnification, identifying suspicious areas for targeted **biopsy**, which provides definitive histological diagnosis. - While this age group also requires **endometrial evaluation** (transvaginal ultrasound), the question specifically asks for investigation of **postcoital bleeding**, which typically originates from the **cervix or vagina**. - Colposcopy with biopsy is the most appropriate initial investigation when cervical pathology is the suspected source. *Pap smear* - A **Pap smear** is a **screening tool** for cervical cancer in asymptomatic women, not a diagnostic test for symptomatic bleeding. - It has lower sensitivity for detecting invasive cancer compared to direct visualization and biopsy. - In the presence of **postcoital bleeding** (a red flag symptom), tissue diagnosis via biopsy is required rather than cytology alone. *Pelvic ultrasound* - **Pelvic/transvaginal ultrasound** is essential for evaluating **endometrial thickness** in postmenopausal women and assessing uterine and ovarian pathology. - However, it does not provide direct visualization of **cervical lesions** or tissue diagnosis. - While important in comprehensive evaluation of postmenopausal bleeding, it is not the primary investigation for **postcoital bleeding** specifically, which more commonly indicates cervical pathology. - Ultrasound would be complementary to rule out endometrial causes. *Cone excision of cervix* - **Cone biopsy (conization)** is both a diagnostic and therapeutic procedure for **high-grade cervical dysplasia (CIN 2/3)** or **microinvasive cervical cancer**. - It is performed **after** colposcopy and biopsy confirm significant cervical pathology, not as the initial investigation. - This is an invasive surgical procedure requiring anesthesia and carries risks of bleeding, infection, and cervical stenosis.
Question 9: Most common presentation of cervical cancer is -
- A. Abnormal vaginal bleeding (Correct Answer)
- B. Pelvic pain
- C. Pain during intercourse
- D. Unusual vaginal discharge
Explanation: ***Abnormal vaginal bleeding*** - **Abnormal vaginal bleeding** is the most frequent presenting symptom of cervical cancer, often manifesting as **postcoital bleeding**, intermenstrual bleeding, or heavier, longer menstrual periods. - This symptom arises as the tumor on the cervix ulcerates and bleeds due to its friable nature and rich vascularization. *Pelvic pain* - **Pelvic pain** is typically a symptom of more **advanced cervical cancer**, indicating tumor invasion into surrounding tissues or nerves. - It is not usually an early or the most common presenting symptom, unlike abnormal bleeding. *Pain during intercourse* - **Pain during intercourse (dyspareunia)** can be a symptom of cervical cancer, particularly with larger lesions or those causing inflammation. - However, it is less common than abnormal bleeding and often occurs concurrently with or after the onset of bleeding symptoms. *Unusual vaginal discharge* - An **unusual vaginal discharge**, which may be watery, foul-smelling, or blood-tinged, can occur with cervical cancer. - While a common symptom, it is generally considered less frequent than abnormal vaginal bleeding as the primary presenting complaint.
Question 10: Which condition does NOT increase the risk of cervical cancer?
- A. Multiple sexual partners
- B. HPV infection
- C. Nulliparity (Correct Answer)
- D. Smoking
Explanation: ***Nulliparity*** - **Nulliparity** (never having given birth) is generally associated with a *reduced* risk of cervical cancer, or it has no significant impact. - Increased parity (multiple full-term pregnancies) is a risk factor, possibly due to hormonal changes or chronic inflammation. *Multiple sexual partners* - Having multiple sexual partners increases the risk of exposure to **Human Papillomavirus (HPV)**, the primary cause of cervical cancer. - Greater exposure to various HPV strains elevates the likelihood of persistent viral infection and subsequent cellular changes. *HPV infection* - **High-risk HPV strains** (e.g., HPV 16, 18) are the leading cause of cervical cancer, responsible for almost all cases. - Persistent infection with these oncogenic HPV types leads to progressive cervical dysplasia and, eventually, invasive cancer. *Smoking* - Smoking is an independent risk factor for cervical cancer, even after accounting for HPV infection. - Chemicals in tobacco smoke can reach the cervical mucus and damage DNA, impairing the immune system's ability to clear HPV infections.
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