Gynecologic Oncology Practice Questions

Q: A female patient with a solid ovarian neoplasm developed Meigs syndrome. Which of the following are the components of this triad, EXCEPT?

Pulmonary edema. **Explanation:** **Meigs Syndrome** is a classic clinical triad characterized by the presence of a **benign solid ovarian tumor**, **ascites**, and **pleural effusion**. The syndrome is unique because these features typically suggest advanced malignancy, yet in Meigs syndrome, the condition resolves completely following the surgical removal of the tumor. 1. **Why "Pulmonary Edema" is the correct answer:** Pulmonary edema refers to fluid accumulation within the lung parenchyma (alveoli), usually due to heart failure or systemic fluid overload. In Meigs syndrome, the fluid is **extrapulmonary** (pleural effusion), located in the pleural space. Therefore, pulmonary edema is not a component of the triad. 2. **Analysis of incorrect options:** * **Solid ovarian mass:** The most common tumor associated is an **Ovarian Fibroma** (a benign sex cord-stromal tumor). Other solid tumors like thecomas or Brenner tumors can also cause it. * **Ascites:** Fluid accumulation in the peritoneal cavity is a hallmark. It is thought to result from the tumor surface oozing fluid or pressure on pelvic lymphatics. * **Pleural effusion:** This is typically a **transudate** and is more commonly found on the **right side** (70% of cases). It occurs due to the transfer of ascitic fluid through transdiaphragmatic lymphatics or small diaphragmatic defects. **High-Yield Pearls for NEET-PG:** * **Pseudo-Meigs Syndrome:** A similar triad but associated with other pelvic masses (e.g., ovarian cysts, leiomyomas) or malignant tumors. * **Demons-Meigs Syndrome:** Another name for the same condition. * **Management:** The definitive treatment is **Surgical Excision** of the tumor, which leads to spontaneous resolution of both ascites and effusion. * **Key Histology:** Ovarian fibromas show spindle-shaped cells producing collagen.

Q: Genes most closely associated with familial cases of ovarian cancer are:

BRCA1. **Explanation:** **1. Why BRCA1 is the Correct Answer:** Ovarian cancer has the highest heritability among all adult cancers, with approximately 15–20% of cases being familial. The most common cause is **Hereditary Breast and Ovarian Cancer (HBOC) syndrome**, caused by germline mutations in the **BRCA1** and **BRCA2** genes. * **BRCA1 (on Chromosome 17q):** Carries a lifetime risk of ovarian cancer of approximately **40–50%**. It is more closely associated with ovarian cancer than BRCA2. * **BRCA2 (on Chromosome 13q):** Carries a lifetime risk of approximately **15–25%**. These are tumor suppressor genes involved in DNA repair via homologous recombination. **2. Why Other Options are Incorrect:** * **WT1 (Wilms Tumor 1):** Located on Chromosome 11p13, this gene is primarily associated with Wilms tumor (nephroblastoma) in children and certain syndromes like WAGR and Denys-Drash. * **NF2 (Neurofibromatosis Type 2):** Located on Chromosome 22q, it encodes the protein Merlin. Mutations lead to bilateral acoustic neuromas (vestibular schwannomas) and meningiomas. * **VHL (von Hippel-Lindau):** Located on Chromosome 3p, it is associated with VHL syndrome, characterized by hemangioblastomas, renal cell carcinoma (clear cell), and pheochromocytomas. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common histology:** BRCA-associated ovarian cancers are typically **High-Grade Serous Carcinomas (HGSC)**. * **Lynch Syndrome (HNPCC):** The second most common cause of familial ovarian cancer (associated with MSH2, MLH1, MSH6 genes). * **Prophylaxis:** Risk-reducing salpingo-oophorectomy (RRSO) is recommended by age 35–40 for BRCA1 carriers. * **Treatment:** Patients with BRCA mutations show a better response to Platinum-based chemotherapy and **PARP inhibitors** (e.g., Olaparib).

Q: Which of the following is a predisposing risk factor for carcinoma of the cervix?

All of the above. **Explanation:** Carcinoma of the cervix is primarily caused by persistent infection with high-risk **Human Papillomavirus (HPV)**, but its progression is significantly influenced by various co-factors that impair local immunity or cause cellular damage. * **Option A (HPV Infection):** This is the most critical risk factor. High-risk strains (HPV 16 and 18) produce E6 and E7 oncoproteins, which inhibit tumor suppressor proteins p53 and pRb, respectively, leading to uncontrolled cell proliferation. * **Option B (Smoking):** Tobacco metabolites (cotinine) concentrate in the cervical mucus. Smoking acts as a co-carcinogen by causing DNA damage and depleting Langerhans cells (local immune cells) in the cervix, making it harder for the body to clear an HPV infection. * **Option C (Alcohol consumption):** While less frequently emphasized than smoking, chronic alcohol consumption is an established risk factor. It can lead to immunosuppression and is often associated with nutritional deficiencies (like folate) that increase the susceptibility of the cervical epithelium to neoplastic changes. **Why "All of the above" is correct:** Cervical cancer is multifactorial. While HPV is the "initiator," factors like smoking and alcohol act as "promoters" or "facilitators" of carcinogenesis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common strain:** HPV 16 (Squamous cell carcinoma); HPV 18 (Adenocarcinoma). * **Other Risk Factors:** Early age at first intercourse, multiple sexual partners, high parity, and long-term use of Oral Contraceptive Pills (OCPs). * **Protective Factor:** Barrier contraception (condoms) and Vitamin A/C/E intake. * **Screening:** The transformation zone is the most common site for cervical cancer development.

Q: Alpha-fetoprotein (AFP) is increased in which of the following conditions?

Endodermal sinus tumor. **Explanation:** **Endodermal Sinus Tumor (Yolk Sac Tumor)** is the correct answer because it is derived from the primitive yolk sac. In fetal life, the yolk sac is the primary site of **Alpha-fetoprotein (AFP)** synthesis. Therefore, this tumor serves as a highly specific marker for AFP. It is the most common malignant germ cell tumor in children and young adults, characterized histologically by **Schiller-Duval bodies**. **Analysis of Incorrect Options:** * **Teratoma:** Mature teratomas are benign and do not typically produce markers. Immature teratomas may show a mild elevation of AFP if they contain yolk sac elements, but they are primarily associated with LDH or CA-125. * **Dysgerminoma:** This is the most common malignant germ cell tumor overall. Its characteristic markers are **LDH (Lactate Dehydrogenase)** and sometimes **hCG** (if syncytiotrophoblastic giant cells are present), but never AFP. * **Choriocarcinoma:** This tumor is characterized by the proliferation of trophoblastic tissue, making **beta-hCG** its pathognomonic marker. **High-Yield Clinical Pearls for NEET-PG:** * **AFP** is also elevated in Hepatocellular Carcinoma (HCC) and Neural Tube Defects (NTD). * **Marker Combinations:** If a tumor shows both elevated AFP and hCG, consider an **Embryonal Carcinoma** or a **Mixed Germ Cell Tumor**. * **Schiller-Duval Bodies:** Pathognomonic histological finding for Yolk Sac Tumors (resemble primitive glomeruli). * **Management:** Most malignant germ cell tumors are highly sensitive to the **BEP regimen** (Bleomycin, Etoposide, and Platinum/Cisplatin).

Q: A 22-year-old female underwent suction evacuation for molar pregnancy. Beta HCG levels are persistently high following evacuation. What is the next line of management?

Methotrexate. ### Explanation **Correct Answer: D. Methotrexate** **Medical Concept:** The clinical scenario describes **Gestational Trophoblastic Neoplasia (GTN)**. Following suction evacuation of a molar pregnancy, the primary goal of follow-up is to monitor serum $\beta$-hCG levels. If these levels plateau (remain within $\pm$ 10% over three weekly measurements) or rise (increase $>10\%$ over two weekly measurements), it indicates a malignant transformation into GTN (Invasive mole or Choriocarcinoma). In a young patient (22 years old) with persistent $\beta$-hCG, the standard of care is **single-agent chemotherapy**, typically with **Methotrexate** or Actinomycin-D, to preserve fertility and achieve remission. **Analysis of Incorrect Options:** * **A & B (Follow-up/Monitoring):** While monitoring is the standard post-evacuation protocol, it is only appropriate if $\beta$-hCG levels are *falling*. Once levels become "persistently high" or rise, it signifies GTN, and active intervention is mandatory to prevent metastasis. * **C (Hysterectomy):** Although hysterectomy reduces the tumor burden, it is generally reserved for older patients who have completed their family or those with life-threatening hemorrhage. In a 22-year-old, fertility preservation is a priority, making chemotherapy the preferred first-line treatment. **High-Yield Clinical Pearls for NEET-PG:** * **FIGO Criteria for GTN Diagnosis:** 1. $\beta$-hCG plateau for 4 readings over 3 weeks. 2. $\beta$-hCG rise of $>10\%$ for 3 readings over 2 weeks. 3. Persistence of $\beta$-hCG 6 months after evacuation. 4. Histological diagnosis of choriocarcinoma. * **WHO Scoring:** GTN is classified into Low-risk (Score $\leq$ 6) and High-risk (Score $\geq$ 7). Low-risk cases (like this patient) are treated with single-agent Methotrexate. * **Most common site of metastasis:** Lungs (80%), followed by the vagina.

Question 1

A female patient with a solid ovarian neoplasm developed Meigs syndrome. Which of the following are the components of this triad, EXCEPT?

Accepted Answer

Pulmonary edema

Answer

Pleural effusion

Answer

Ascites

Answer

Solid ovarian mass

Question 2

A 40-year-old woman presents with abnormal cervical cytology on PAP smear suggestive of CIN (III). What is the next best step in management?

Accepted Answer

Colposcopy and LEEP

Answer

Hysterectomy

Answer

Colposcopy and cryotherapy

Answer

Conization

Question 3

Which of the following statements is FALSE regarding vulvar carcinoma?

Accepted Answer

Vulvar carcinoma in situ occurs more commonly in younger females.

Answer

The most common type is squamous cell carcinoma.

Answer

Basaloid or warty types are associated with HPV.

Answer

The keratinizing type is associated with lichen sclerosus and occurs in older females.

Question 4

A woman is found to have a unilateral invasive carcinoma of the vulva that is 1 cm in diameter with no stromal invasion and is not associated with evidence of lymph node spread. What should be the initial management?

Accepted Answer

Wide excision and Sentinel lymph node biopsy

Answer

Chemotherapy

Answer

Radiation therapy

Answer

Radical vulvectomy and bilateral inguinal lymphadenectomy

Question 5

Genes most closely associated with familial cases of ovarian cancer are:

Accepted Answer

BRCA1

Answer

WT1

Answer

NF2

Answer

VHL

Question 6

Which statement regarding the procedure shown below is false?

Accepted Answer

Used to treat high grade cervical intraepithelial neoplasia (CIN)

Answer

Uses freeze-thaw-freeze technique

Answer

Destroys dysplastic epithelium up to a depth of 5mm

Answer

It is an outpatient procedure

Question 7

Which of the following is a predisposing risk factor for carcinoma of the cervix?

Accepted Answer

All of the above

Answer

Human Papillomavirus (HPV) infection

Answer

Smoking

Answer

Alcohol consumption

Question 8

What is considered the best screening test for cervical cancer?

Accepted Answer

Visual inspection with acetic acid (VIA)

Answer

Pap smear

Answer

Both Pap smear and VIA test

Answer

None of the above

Question 9

Alpha-fetoprotein (AFP) is increased in which of the following conditions?

Accepted Answer

Endodermal sinus tumor

Answer

Teratoma

Answer

Dysgerminoma

Answer

Choriocarcinoma

Question 10

A 22-year-old female underwent suction evacuation for molar pregnancy. Beta HCG levels are persistently high following evacuation. What is the next line of management?

Accepted Answer

Methotrexate

Answer

Follow up at 1 year

Answer

Monitor until HCG becomes 0

Answer

Hysterectomy

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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