Ovarian Cancer — MCQs
Which of the following screening methods is NOT effective for early detection of cancer in asymptomatic women?
Which of the following is not true about breast cancer?
Which of the following is the ovarian counterpart of testicular seminoma?
Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
Staging of ovarian cancer when the rectum is involved.
Point A and point B Manchester locations are important for treatment of which cancer –
Which tumor type is associated with an increased risk of endometrial carcinoma?
A 58 year old woman with suspected ovarian cancer was operated for surgical staging. On laparotomy and subsequent histopathological examination of the specimen it was found that both ovaries were involved, capsule was ruptured, ascites was present containing malignant cells. Uterus and tubes were normal and there were no peritoneal implants. The FIGO stage for this patient would be:
Normal upper limit of CA-125 is?
A 65 year old postmenopausal lady presents in Gynaecology OPD with abdominal distension and weight loss. On investigation she was diagnosed to have an ovarian tumour. The most common type of ovarian tumour in this woman would be
Ovarian Cancer Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following screening methods is NOT effective for early detection of cancer in asymptomatic women?
- A. Office endometrial washing for endometrial cancer
- B. USG in endometrial cancer
- C. CA-125 for ovarian cancer (Correct Answer)
- D. Pap smear for cervical cancer
Explanation: ***CA-125 for ovarian cancer*** - While elevated in some ovarian cancers, **CA-125 lacks sufficient sensitivity and specificity** as a stand-alone screening tool for early detection in asymptomatic women. - Its use for general population screening has **not been shown to reduce mortality** from ovarian cancer and can lead to **false positives** and unnecessary invasive procedures. - Major trials (UKCTOCS, PLCO) have not demonstrated mortality benefit from CA-125 screening. *Office endometrial washing for endometrial cancer* - While this involves collecting cells from the uterine lining for cytological analysis, **endometrial washing/cytology has poor sensitivity** and is not established as an effective screening method. - However, it has shown **some promise in research settings** for high-risk individuals, though it is not a standard or widely recommended screening approach. - **Endometrial biopsy** remains the gold standard for diagnosis in symptomatic women, but routine screening of asymptomatic women is not recommended. *USG in endometrial cancer* - **Transvaginal ultrasonography (TVUS)** can effectively measure **endometrial thickness** and is valuable for evaluating postmenopausal bleeding. - While not used for population-based screening of asymptomatic women, it aids in **risk stratification** and guiding further investigation like biopsy in symptomatic patients. - When used appropriately in symptomatic women, TVUS is a useful diagnostic adjunct. *Pap smear for cervical cancer* - The **Pap smear** is a highly effective and widely adopted screening method for **cervical cancer**, detecting precancerous and cancerous changes in cervical cells. - Its widespread use has **significantly reduced the incidence and mortality rates** of cervical cancer due to its ability to identify abnormalities early, allowing for timely intervention. - This is the gold standard for cancer screening with proven mortality benefit.
Question 2: Which of the following is not true about breast cancer?
- A. Family history is a risk factor
- B. Paget’s disease affects the nipple
- C. Lobular carcinoma is most common (Correct Answer)
- D. Estrogen exposure increases risk
Explanation: ***Lobular carcinoma is most common*** - This statement is **incorrect** because **invasive ductal carcinoma (IDC)** accounts for the majority (**70-80%**) of all breast cancers. - While **invasive lobular carcinoma (ILC)** is the second most common type, it only represents about **5-15%** of cases. *Family history is a risk factor* - A **positive family history**, especially in a first-degree relative, significantly increases the risk of breast cancer due to inherited genetic mutations like **BRCA1** and **BRCA2**. - These mutations impair DNA repair, leading to uncontrolled cell growth. *Paget’s disease affects the nipple* - **Paget's disease of the nipple** is a rare form of breast cancer that presents as an eczematous lesion of the nipple and areola. - It is often associated with an **underlying invasive or in-situ ductal carcinoma**. *Estrogen exposure increases risk* - Prolonged or higher levels of **estrogen exposure** are known risk factors for breast cancer, as estrogen stimulates the growth of hormone-receptor-positive breast cancer cells. - Factors increasing estrogen exposure include **early menarche, late menopause, obesity**, and **hormone replacement therapy**.
Question 3: Which of the following is the ovarian counterpart of testicular seminoma?
- A. Dermoid
- B. Dysgerminoma (Correct Answer)
- C. Endodermal sinus tumor
- D. Brenner tumor
Explanation: ***Dysgerminoma*** - **Dysgerminoma** is the most common malignant germ cell tumor of the ovary and is histologically identical to testicular **seminoma** [1]. - Both tumors arise from **primordial germ cells** and share similar morphology, including large, uniform cells with clear cytoplasm and prominent nucleoli, often arranged in nests and separated by fibrous septa with lymphocytic infiltration [1], [3]. *Dermoid* - **Dermoid cysts**, also known as mature cystic teratomas, are germ cell tumors composed of well-differentiated tissues from all three germ layers (ectoderm, mesoderm, endoderm) [2]. - They are typically benign and do not have a direct testicular counterpart that is histologically identical to seminoma. *Brenner tumor* - **Brenner tumors** are uncommon epithelial ovarian tumors characterized by nests of transitional epithelial cells resembling urothelium, separated by a fibrous stroma. - They are not germ cell tumors and do not have a testicular counterpart to seminoma. *Endodermal sinus tumor* - The **endodermal sinus tumor** (yolk sac tumor) is another type of malignant germ cell tumor of the ovary, but it is characterized by structures resembling the primitive yolk sac and the presence of **Schiller-Duval bodies**. - While it has a testicular counterpart, it is not histologically identical to seminoma; its testicular counterpart is also called a yolk sac tumor and is distinct from seminoma [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1034-1035. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 979-980.
Question 4: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
- A. Cyclophosphamide
- B. Methotrexate
- C. Cisplatin (Correct Answer)
- D. Dacarbazine
Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**. - It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel. *Methotrexate* - **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis. - While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death. - It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines. *Dacarbazine* - **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma. - It is **not indicated for the treatment of ovarian carcinoma**.
Question 5: Staging of ovarian cancer when the rectum is involved.
- A. Stage I
- B. Stage 2 (Correct Answer)
- C. Stage 4
- D. Stage 3
Explanation: ***Stage 2*** - **Rectal involvement** in ovarian cancer represents direct extension to other **pelvic structures**, which defines **Stage II disease** according to FIGO staging. - **Stage IIB** specifically includes extension to other pelvic intraperitoneal tissues, including the rectum, sigmoid colon, bladder, and uterus. - The rectum is a **pelvic organ**, and its involvement represents local spread within the pelvis, not distant metastasis. *Stage I* - **Stage I** ovarian cancer is confined to the **ovaries or fallopian tubes** only. - There is no extension beyond the ovaries or fallopian tubes, making rectal involvement inconsistent with this stage. *Stage 3* - **Stage III** involves tumor **outside the pelvis** with peritoneal implants beyond the pelvis or positive retroperitoneal lymph nodes. - This represents intra-abdominal spread but still within the peritoneal cavity, not limited to pelvic organ involvement like the rectum. *Stage 4* - **Stage IV** is defined by **distant metastasis outside the peritoneal cavity**, including parenchymal liver or spleen metastasis, pleural effusion with positive cytology, or metastasis to extra-abdominal organs. - Direct rectal involvement does not constitute distant metastasis and therefore is not Stage IV.
Question 6: Point A and point B Manchester locations are important for treatment of which cancer –
- A. Vagina
- B. Cervix (Correct Answer)
- C. Ovary
- D. Uterus
Explanation: ***Cervix*** - **Point A** and **Point B Manchester** locations are historical references used in **brachytherapy** for **cervical cancer**, defining critical dose points within the pelvis. - These points help guide the placement of radiation sources to ensure adequate tumor coverage while sparing surrounding healthy tissues. *Vagina* - While radiation therapy is used for vaginal cancer, the **Manchester system's Point A and B** are specifically defined for cervical anatomy, not primarily for vaginal tumors. - Different dosimetry systems or specific vaginal applicators are often used for vaginal brachytherapy. *Ovary* - Ovarian cancer is primarily treated with **surgery and chemotherapy**; external beam radiation is sometimes used, but brachytherapy with **Point A and B** is not a standard approach. - The anatomical location of the ovaries makes brachytherapy less suitable for delivering targeted, high-dose radiation compared to cervical cancer. *Uterus* - Endometrial (uterine) cancer treatment may involve brachytherapy, but it typically uses different applicators (e.g., **tandem and ovoids** or cylinders) and dose specifications that are distinct from the Manchester system's **Point A and B** for the cervix. - The geometry and treatment volumes for uterine brachytherapy are different due to the distinct anatomy and tumor spread patterns.
Question 7: Which tumor type is associated with an increased risk of endometrial carcinoma?
- A. Sertoli Leydig cell
- B. Immature teratoma
- C. Gonadoblastoma tumor
- D. Granulosa theca cell (Correct Answer)
Explanation: ***Granulosa theca cell*** - Granulosa-theca cell tumors are associated with an increased risk of **endometrial carcinoma** due to their potential to cause **excess estrogen production**. - The **estrogen stimulation** of the endometrium can lead to hyperplasia and subsequently to carcinoma. *Immature teratoma* - Immature teratomas are primarily germ cell tumors and are not typically associated with **endometrial cancer risk**. - Their malignant potential is primarily linked to **germ cell neoplasia** rather than estrogen exposure. *Sertoli Leydig cell* - Sertoli-Leydig cell tumors cause **androgen production** [1], which may have effects on the endometrium but do not significantly raise endometrial carcinoma risk. - These tumors are more associated with **virilization** [1] rather than estrogen-related pathways. *Gonadoblastoma tumor* - Gonadoblastomas are rare and typically found in individuals with **disorders of sexual development**; they are not commonly linked to endometrial cancer. - Their risk is more associated with **germ cell tumor presentation**, without significant impact on endometrial tissue. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1037-1038.
Question 8: A 58 year old woman with suspected ovarian cancer was operated for surgical staging. On laparotomy and subsequent histopathological examination of the specimen it was found that both ovaries were involved, capsule was ruptured, ascites was present containing malignant cells. Uterus and tubes were normal and there were no peritoneal implants. The FIGO stage for this patient would be:
- A. Stage III
- B. Stage II
- C. Stage IV
- D. Stage I (Correct Answer)
Explanation: ***Stage I*** - This case represents **Stage IC** (specifically IC3) according to FIGO ovarian cancer staging criteria. - **Stage IC3** is defined as ovarian tumor with **capsule rupture and/or positive peritoneal washings/ascites with malignant cells**. - Key features present: both ovaries involved, **capsule ruptured**, **ascites with malignant cells**, but **no peritoneal implants**. - The absence of peritoneal implants outside the pelvis means this cannot be Stage III, making Stage IC the correct classification. *Stage II* - Stage II requires **pelvic extension** with involvement of uterus, fallopian tubes, or other pelvic structures. - In this case, the uterus and tubes are explicitly **normal**, ruling out Stage II. - Stage II does not involve malignant ascites as the primary criterion. *Stage III* - Stage III requires **peritoneal implants outside the pelvis** and/or **retroperitoneal/inguinal lymph node involvement**. - This case explicitly states there are **no peritoneal implants**, which excludes Stage III classification. - Common misconception: malignant ascites alone does NOT constitute Stage III; visible implants or lymph node involvement are required. *Stage IV* - Stage IV involves **distant metastasis** to organs such as liver parenchyma, lungs, or extra-abdominal sites, or **pleural effusion with malignant cells**. - No evidence of distant organ involvement is present in this case. - This is clearly not Stage IV disease.
Question 9: Normal upper limit of CA-125 is?
- A. 65 U/mL
- B. 85 U/mL
- C. 25 U/mL (Correct Answer)
- D. 45 U/mL
Explanation: ***25 U/mL*** - The generally accepted **normal upper limit for CA-125** in healthy individuals is 25 U/mL (though some references use 35 U/mL). - Values above this level may indicate various conditions, including malignancy, but can also be elevated in benign states. *65 U/mL* - A level of 65 U/mL is significantly **above the normal range** and would be considered elevated. - Such a high value would warrant further investigation to determine the underlying cause. *85 U/mL* - A reading of 85 U/mL is highly elevated and would almost certainly raise concern for a significant underlying condition, potentially a **malignancy**. - This value is well beyond the typical cutoff for mild elevation. *45 U/mL* - A level of 45 U/mL is elevated above the normal upper limit, but it is not as high as 65 U/mL or 85 U/mL. - While concerning, it may be seen in both **benign and malignant conditions**, requiring careful clinical correlation.
Question 10: A 65 year old postmenopausal lady presents in Gynaecology OPD with abdominal distension and weight loss. On investigation she was diagnosed to have an ovarian tumour. The most common type of ovarian tumour in this woman would be
- A. Sex cord tumor
- B. Epithelial tumor (Correct Answer)
- C. Germ cell tumor
- D. Trophoblastic tumor
Explanation: ***Epithelial tumor*** - **Epithelial ovarian tumors** are the most common type of ovarian cancer, accounting for about **90%** of all cases. - Their incidence significantly increases with age, particularly in **postmenopausal women**, making them the most likely diagnosis in a 65-year-old presenting with abdominal distension and weight loss. *Sex cord tumor* - **Sex cord-stromal tumors** are rare, comprising about **5-8%** of ovarian neoplasms. - While they can occur at any age, they are less common than epithelial tumors and often present with **hormonal symptoms** due to their steroidogenic capacity. *Germ cell tumor* - **Germ cell tumors** are also rare, primarily affecting **younger women and adolescents**, typically under 30 years old. - They tend to grow rapidly and can present with acute symptoms like sudden onset abdominal pain, which is less characteristic for a 65-year-old postmenopausal woman. *Trophoblastic tumor* - **Trophoblastic tumors** (specifically **gestational trophoblastic disease**) are primarily related to pregnancy and occur when there is abnormal proliferation of trophoblastic tissue, such as in a **hydatidiform mole** or **choriocarcinoma**. - These are extremely rare in a postmenopausal woman without a recent pregnancy history and are not considered ovarian tumors in the traditional sense.
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