Gynecologic Oncology Practice Questions

Q: Meig's syndrome consists of the following except?

Alkalosis. **Explanation:** Meigs’ syndrome is a classic clinical triad characterized by the presence of a **benign ovarian tumor** (most commonly an **Ovarian Fibroma**), **ascites**, and **pleural effusion (hydrothorax)**. **Why Alkalosis is the correct answer:** Alkalosis is not a component of Meigs’ syndrome. While patients with massive ascites or pleural effusion may occasionally develop respiratory or metabolic disturbances due to physical discomfort or underlying pathology, there is no specific association between Meigs’ syndrome and systemic alkalosis. **Analysis of other options:** * **Ascites:** Present in nearly all cases. It is thought to be caused by the release of inflammatory mediators (like VEGF) or fluid transudation from the surface of the tumor. * **Hydrothorax:** Typically a right-sided pleural effusion. Fluid moves from the peritoneum to the pleural space through transdiaphragmatic lymphatics or small diaphragmatic defects. * **Benign Ovarian Tumor:** By definition, the tumor must be benign. While **Fibroma** (a sex cord-stromal tumor) is the most common, other tumors like thecoma, cystadenoma, or granulosa cell tumors can also be involved. **High-Yield Clinical Pearls for NEET-PG:** * **The "Pseudo-Meigs" Syndrome:** This refers to the same triad (ascites + hydrothorax) but associated with other pelvic masses such as **uterine leiomyomas**, germ cell tumors, or **malignant** ovarian tumors. * **Resolution:** A hallmark of Meigs’ syndrome is that both the ascites and hydrothorax resolve completely and permanently following the **surgical removal** of the tumor. * **Nature of Fluid:** The fluid in both the abdomen and chest is typically a **transudate**. * **Tumor Marker:** CA-125 levels may be elevated in Meigs’ syndrome, which can falsely mimic ovarian malignancy. Always correlate clinically.

Q: CA-125 is a marker antigen for the screening of which malignancy?

Ovarian cancer. **Explanation:** **Correct Answer: D. Ovarian Cancer** CA-125 (Cancer Antigen 125) is a high-molecular-weight glycoprotein produced by derivatives of the **coelomic epithelium** (including the endometrium, fallopian tubes, and peritoneum). It is the most widely used tumor marker for **Epithelial Ovarian Cancer (EOC)**, particularly the serous subtype. While not specific enough for screening the general asymptomatic population due to low positive predictive value, it is gold-standard for monitoring treatment response and detecting recurrence in known cases. **Analysis of Incorrect Options:** * **A. Prostate Cancer:** The primary marker is **PSA (Prostate-Specific Antigen)**. CA-125 has no clinical utility here. * **B. Breast Cancer:** Common markers include **CA 15-3** and **CA 27-29**. While CA-125 can sometimes be elevated in advanced breast cancer, it is not used for screening or primary diagnosis. * **C. Brain Cancer:** There are no established serum protein markers for brain tumors; diagnosis relies on neuroimaging (MRI) and biopsy. **High-Yield Clinical Pearls for NEET-PG:** 1. **Cut-off Value:** The standard upper limit of normal is **35 U/mL**. 2. **Specificity Issues:** CA-125 is often elevated in **benign conditions** (Endometriosis, Pelvic Inflammatory Disease, Fibroids, and Pregnancy) and other malignancies (Endometrial, Pancreatic, and Lung cancer). 3. **Post-menopausal Significance:** A raised CA-125 in a post-menopausal woman with an adnexal mass is highly suspicious of malignancy (90% predictive value). 4. **Mucinous Tumors:** CA-125 is less sensitive for mucinous ovarian tumors; **CEA** and **CA 19-9** are more relevant in such cases. 5. **RMI (Risk of Malignancy Index):** CA-125 is a key component of the RMI score used to triage pelvic masses.

Q: What is the most common presenting feature of a complete mole?

Bleeding per vaginum. **Explanation:** A **Complete Hydatidiform Mole** is a gestational trophoblastic disease characterized by the proliferation of trophoblastic tissue and hydropic swelling of chorionic villi. **Why Bleeding per vaginum is correct:** **Vaginal bleeding** is the most common presenting symptom, occurring in over 80–90% of cases. It typically occurs in the first trimester (around 6–16 weeks). The bleeding results from the separation of the molar vesicles from the decidua, often described as "prune juice" discharge due to the oxidation of retained blood. **Analysis of Incorrect Options:** * **Amenorrhoea:** While patients with a mole will have a history of amenorrhoea (as it is a pregnancy-related condition), it is the *precursor* to the pathology, not the *presenting feature* that brings the patient to the clinic. * **Vomiting (Hyperemesis):** This occurs due to abnormally high levels of hCG. While common in molar pregnancies, it is a secondary feature and less frequent than vaginal bleeding. * **Headache:** This is usually a sign of pre-eclampsia. While molar pregnancy is a known risk factor for early-onset pre-eclampsia (before 20 weeks), it is a complication rather than the primary presenting feature. **NEET-PG High-Yield Pearls:** * **Karyotype:** Complete mole is usually **46, XX** (diploid, purely paternal origin); Partial mole is **69, XXX/XXY** (triploid). * **USG Finding:** Classic **"Snowstorm appearance"** (due to multiple hydropic villi). * **Ovarian Finding:** Bilateral **Theca Lutein Cysts** may be present due to high hCG levels. * **Management:** Suction and Evacuation is the treatment of choice. * **Risk of Malignancy:** Higher in complete moles (~15–20%) compared to partial moles (<5%).

Q: Which of the following is NOT true regarding endometrial carcinoma in clinical stage III?

Peritoneal involvement. This question tests your knowledge of the **FIGO Staging for Endometrial Carcinoma** (revised in 2009 and 2023). ### **Why "Peritoneal Involvement" is the Correct Answer** In the FIGO staging system for endometrial cancer, **Stage III** represents local and/or regional spread of the tumor. While Stage III includes spread to the serosa, adnexa, vagina, and lymph nodes, **peritoneal involvement (specifically malignant peritoneal implants/carcinomatosis)** is classified as **Stage IVB**. Spread to the peritoneal surface signifies distant abdominal metastasis, moving the disease beyond regional confinement. ### **Analysis of Incorrect Options (Why they are Stage III)** * **A. Vaginal metastasis:** This is classified as **Stage IIIB**. It represents direct extension or lymphatic spread to the lower reproductive tract. * **B. Para-aortic lymph node involvement:** This is classified as **Stage IIIC2**. * **D. Pelvic lymph node involvement:** This is classified as **Stage IIIC1**. *(Note: Involvement of any regional lymph nodes—pelvic or para-aortic—automatically places the patient in Stage IIIC).* ### **High-Yield Clinical Pearls for NEET-PG** * **Staging Method:** Endometrial cancer is primarily **surgically staged** (unlike cervical cancer, which was historically clinically staged). * **Stage IIIA:** Tumor involves the uterine serosa and/or adnexa (direct extension). * **Stage IV Breakdown:** * **IVA:** Invasion of bladder and/or bowel mucosa. * **IVB:** Distant metastasis, including **peritoneal involvement**, inguinal lymph nodes, or lung/liver/bone metastasis. * **Prognostic Factor:** Lymph node status (Stage IIIC) is one of the most significant prognostic factors for survival. * **Cytology:** Positive peritoneal cytology no longer changes the FIGO stage (since 2009) but should be recorded separately.

Q: What is the most common presentation of vulval carcinoma?

Pruritus. **Explanation:** **1. Why Pruritus is Correct:** Pruritus (itching) is the **most common presenting symptom** of vulval carcinoma, reported in approximately 60-70% of cases. This is often due to the long-standing association with chronic inflammatory conditions like **Lichen Sclerosus** or Vulvar Intraepithelial Neoplasia (VIN). Patients frequently have a history of chronic itching for years before a definitive mass or lesion is identified. **2. Analysis of Incorrect Options:** * **Pain (A):** Pain is usually a late feature, occurring only when the tumor is advanced, infected, or involves deep nerves. * **Wart-like growth (B):** While vulval cancer can present as a verrucous (warty) lesion, especially in HPV-related cases in younger women, it is less common than the symptom of pruritus. * **Non-healing ulcer (C):** An ulcerated lesion is a common physical finding upon examination, but it is typically the *sign* discovered after the patient presents with the *symptom* of itching or a palpable lump. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common histological type:** Squamous Cell Carcinoma (SCC) accounts for >90% of cases. * **Most common site:** Labia majora (specifically the anterior two-thirds). * **Primary mode of spread:** Lymphatic spread is the most important prognostic factor. The first nodes involved are the **superficial inguinal nodes**. * **Sentinel Lymph Node Biopsy:** Indicated in Stage IA/IB (lesions <4cm and clinically node-negative). * **Staging:** Vulval cancer is staged clinically and surgically using the **FIGO system**. * **Risk Factors:** Bimodal distribution—younger women (HPV 16, 18) and older postmenopausal women (Lichen sclerosus/dystrophy).

Q: Carcinoma of the cervix with involvement of the upper one-third of the vagina but not the parametrium is classified as which stage?

Stage IIA. This question tests your knowledge of the **FIGO Staging for Cervical Cancer** (revised 2018). ### **Explanation of the Correct Answer** **Stage II** is defined as carcinoma that has extended beyond the uterus but has not reached the pelvic wall or the lower third of the vagina. It is subdivided based on the site of involvement: * **Stage IIA:** Involvement of the **upper two-thirds of the vagina** without parametrial involvement. * **IIA1:** Clinically visible lesion ≤ 4 cm. * **IIA2:** Clinically visible lesion > 4 cm. * **Stage IIB:** Involvement of the **parametrium** (but not reaching the pelvic side wall). Since the question specifies involvement of the upper one-third of the vagina without parametrial involvement, it falls squarely into **Stage IIA**. ### **Why Other Options are Incorrect** * **Stage IIIA (Option B):** Involves the **lower third** of the vagina, but does not extend to the pelvic wall. * **Stage IIB (Option C):** Specifically involves the **parametrium**. The presence or absence of parametrial involvement is the key clinical distinction between IIA and IIB. * **Stage IIIB (Option D):** Extension to the **pelvic wall** and/or causes hydronephrosis or a non-functioning kidney. ### **High-Yield Clinical Pearls for NEET-PG** * **Clinical Staging:** Cervical cancer is primarily staged **clinically** (using physical exam, colposcopy, cystoscopy, and proctoscopy), though the 2018 FIGO update now allows the use of imaging (MRI/CT/PET) and pathology to assign the stage. * **The "Cut-off" for Surgery:** Generally, Stage **IIA1 and below** are treated surgically (Radical Hysterectomy). Stage **IIB and above** (involving parametrium) are treated with **Concurrent Chemoradiotherapy (CCRT)**. * **Stage IVA vs. IVB:** IVA involves adjacent organs (bladder/rectum mucosa); IVB involves distant metastasis.

Q: The process of carcinogenesis in carcinoma of the cervix begins at which anatomical location?

Transformation zone. **Explanation:** The correct answer is **C. Transformation zone**. **Why it is correct:** The transformation zone (TZ) is the area of the cervix where the original **columnar epithelium** of the endocervix is replaced by **stratified squamous epithelium** through a process called **squamous metaplasia**. This region is highly metabolically active and contains undifferentiated reserve cells. When High-Risk Human Papillomavirus (HR-HPV) infection occurs, the virus preferentially integrates into the DNA of these unstable, transforming cells. This disruption of the cell cycle (via E6 and E7 oncoproteins) leads to dysplasia (CIN) and eventually invasive squamous cell carcinoma. **Why other options are incorrect:** * **A. Endocervix:** This is lined by simple columnar epithelium. While adenocarcinoma can arise here, the vast majority of cervical cancers (squamous cell type) originate at the junctional TZ. * **B. Ectocervix:** This is lined by mature, stable stratified squamous epithelium. While it can be involved as the cancer spreads, it is not the primary site where the neoplastic process initiates. **High-Yield Clinical Pearls for NEET-PG:** * **Squamocolumnar Junction (SCJ):** The TZ is located between the original SCJ and the new SCJ. Its location varies with age and hormonal status (moves inward/cephalad after menopause). * **Screening:** Pap smears and HPV DNA testing specifically aim to sample cells from the transformation zone. A Pap smear is considered "satisfactory" only if TZ cells (endocervical cells) are present. * **Colposcopy:** The primary goal of colposcopy is to visualize the entire transformation zone to identify the most dysplastic area for biopsy. * **Most Common Histology:** Squamous cell carcinoma (80-85%) is the most common type, followed by Adenocarcinoma.

Question 1

Meig's syndrome consists of the following except?

Accepted Answer

Alkalosis

Answer

Ascites

Answer

Hydrothorax

Answer

Benign ovarian tumor

Question 2

CA-125 is a marker antigen for the screening of which malignancy?

Accepted Answer

Ovarian cancer

Answer

Prostate cancer

Answer

Breast cancer

Answer

Brain cancer

Question 3

What is the most common presenting feature of a complete mole?

Accepted Answer

Bleeding per vaginum

Answer

Vomiting

Answer

Amenorrhoea

Answer

Headache

Question 4

Which of the following is NOT true regarding endometrial carcinoma in clinical stage III?

Accepted Answer

Peritoneal involvement

Answer

Vaginal metastasis

Answer

Para-aortic lymph node involvement

Answer

Pelvic lymph node involvement

Question 5

What is the most common presentation of vulval carcinoma?

Accepted Answer

Pruritus

Answer

Pain

Answer

Wart-like growth

Answer

Non-healing ulcer

Question 6

Carcinoma of the cervix with involvement of the upper one-third of the vagina but not the parametrium is classified as which stage?

Accepted Answer

Stage IIA

Answer

Stage IIIA

Answer

Stage IIB

Answer

Stage IIIB

Question 7

Women receiving estrogen therapy have an increased risk of developing which of the following cancers?

Accepted Answer

Carcinoma of the gall bladder

Answer

Breast cancer

Answer

Endometrial carcinoma

Answer

Hepatocellular carcinoma

Question 8

The process of carcinogenesis in carcinoma of the cervix begins at which anatomical location?

Accepted Answer

Transformation zone

Answer

Endocervix

Answer

Ectocervix

Answer

None of the above

Question 9

What is the most common complication after radical hysterectomy?

Accepted Answer

Ureteral injury

Answer

Bladder atony

Answer

Prolapse of vaginal vault

Answer

Bowel dysfunction

Question 10

A 35-year-old female P3+0 is observed to have CIN grade III on colposcopic biopsy. What is the best initial management?

Accepted Answer

LEEP (Loop Electrosurgical Excision Procedure)

Answer

Cryosurgery

Answer

Conization

Answer

Hysterectomy

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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