Gynecologic Oncology Practice Questions

Q: Carcinoma cervix is associated with all except:

Diabetes mellitus. **Explanation:** Carcinoma cervix is primarily an **infectious-driven malignancy**, with Human Papillomavirus (HPV) infection being the necessary precursor. The risk factors are generally associated with increased exposure to HPV or a compromised immune response to the virus. **Why Diabetes Mellitus is the correct answer:** Diabetes mellitus is **not** a recognized risk factor for cervical cancer. While diabetes is strongly associated with **Endometrial Carcinoma** (as part of the metabolic triad: obesity, diabetes, and hypertension), it does not play a direct role in the pathogenesis of cervical squamous cell carcinoma. **Analysis of other options:** * **Multiparity:** High parity is a known risk factor. It is thought that repeated cervical trauma during delivery and the hormonal changes of pregnancy (which may increase the vulnerability of the transformation zone) facilitate HPV persistence. * **Herpes Simplex Virus (HSV):** Specifically HSV-2 acts as a **co-factor**. While it doesn't cause cervical cancer alone, it promotes inflammation and facilitates the integration of HPV DNA into the host genome. * **Early Coitus:** Early age at first intercourse is a major risk factor because the adolescent cervix has a large area of **ectopy** (columnar epithelium), which is highly susceptible to HPV infection during the process of squamous metaplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Most common type:** Squamous cell carcinoma (80-85%). * **Most common HPV strains:** HPV 16 (most oncogenic) and HPV 18 (associated with adenocarcinoma). * **Other Risk Factors:** Smoking (doubles the risk), low socioeconomic status, multiple sexual partners, and long-term OCP use (>5 years). * **Protective Factor:** Barrier contraceptives (condoms) and male circumcision reduce the risk of HPV transmission.

Q: The best method to confirm the diagnosis of carcinoma cervix is:

Cervical biopsy. **Explanation:** The gold standard for the diagnosis of any malignancy, including carcinoma cervix, is histopathological examination. Therefore, a **Cervical Biopsy** is the best method to confirm the diagnosis. * **Why Cervical Biopsy is correct:** A biopsy provides a tissue sample that allows a pathologist to visualize cellular architecture, basement membrane invasion, and grading. In clinical practice, if a gross lesion is visible, a **punch biopsy** is performed. If no lesion is visible but screening is positive, a **colposcopy-directed biopsy** is the preferred approach. **Analysis of Incorrect Options:** * **Physical Examination (A):** While essential for clinical staging (FIGO staging), it cannot provide a definitive histological diagnosis. * **Pap Smear (B):** This is a **screening tool**, not a diagnostic one. It identifies cytological abnormalities (shed cells) but has a significant false-negative rate and cannot confirm invasion. * **Curettage (D):** Endocervical curettage (ECC) is used to sample the endocervical canal when the transformation zone is not fully visible, but it is not the primary method for confirming a suspected cervical growth. **High-Yield Clinical Pearls for NEET-PG:** * **Screening:** Pap smear (starts at age 21) or HPV DNA testing (preferred primary screen for ages 30-65). * **Staging:** Carcinoma cervix is staged **clinically** (FIGO Staging), though the 2018 update now allows the use of imaging and pathology where available. * **Schiller’s Test:** Uses Lugol’s iodine; cancerous cells are iodine-negative (remain pale/yellow) because they lack glycogen. * **Punch Biopsy:** The most common instrument used is the **Tischler biopsy forceps**.

Q: A unilateral ovarian tumor has spread to the peritoneum but not to the uterus. What is the FIGO staging of this ovarian neoplasm?

Stage IC. ### Explanation **Correct Answer: B. Stage IC** The FIGO staging for ovarian cancer is primarily surgical and pathological. According to the **FIGO 2014 classification**, Stage I is defined as a tumor limited to the ovaries or fallopian tubes. * **Stage IA:** Tumor limited to one ovary; capsule intact; no tumor on surface; no malignant cells in ascites/peritoneal washings. * **Stage IB:** Tumor limited to both ovaries; capsule intact; no tumor on surface; no malignant cells in washings. * **Stage IC:** Tumor limited to one or both ovaries **with any of the following**: * **IC1:** Surgical spill. * **IC2:** Capsule ruptured before surgery or **tumor on ovarian surface**. * **IC3:** Malignant cells in the ascites or **peritoneal washings**. In this question, the spread to the **peritoneum** (without involving pelvic organs like the uterus) implies positive peritoneal washings or surface involvement, placing it in **Stage IC**. **Why other options are incorrect:** * **Stage IB:** Requires involvement of *both* ovaries but with capsules intact and negative washings. * **Stage IIA:** Involves extension to the **uterus**, fallopian tubes, or ovaries. Since the question specifies the uterus is *not* involved, Stage IIA is excluded. * **Stage IIB:** Involves extension to other pelvic intraperitoneal tissues (e.g., bladder, rectum). **High-Yield Clinical Pearls for NEET-PG:** * **Most common spread:** Ovarian cancer spreads primarily via **exfoliation** (seeding) into the peritoneal cavity. * **Stage IC vs. Stage II:** If the tumor involves the **peritoneal surface** (washings), it is IC. If it involves **pelvic organs** (uterus/bladder), it is Stage II. If it involves **extrapelvic peritoneal surfaces** (omentum/small bowel), it is Stage III. * **CA-125:** Most useful for monitoring response to treatment rather than primary diagnosis.

Q: Metastases from a granulosa cell tumor most commonly involve which of the following?

The contralateral ovary. **Explanation:** Granulosa cell tumors (GCTs) are the most common type of malignant sex cord-stromal tumors. Unlike epithelial ovarian cancers, which frequently present with widespread peritoneal seeding, GCTs are typically diagnosed at an early stage (Stage I) and are characterized by an indolent clinical course. **Why the contralateral ovary is correct:** The most common site of spread for a granulosa cell tumor is the **contralateral ovary**. This occurs via local extension or lymphatic spread. Because GCTs are often confined to the ovaries at the time of diagnosis, involvement of the other ovary is the most frequent finding when the disease is not strictly unilateral. **Analysis of incorrect options:** * **The Mesentery (Option C):** While GCTs can spread to the peritoneum and mesentery (late-stage or recurrence), this is less common than involvement of the opposite ovary. * **The Liver (Option A):** Hematogenous spread to the liver parenchyma is rare and usually occurs only in advanced or recurrent cases. * **The Mediastinum (Option D):** Extra-abdominal spread to the mediastinum is extremely rare for GCTs, as these tumors tend to remain localized to the pelvis for long periods. **High-Yield Clinical Pearls for NEET-PG:** * **Tumor Marker:** **Inhibin B** is the most reliable marker for diagnosis and monitoring recurrence. * **Histology:** Look for **Call-Exner bodies** (small follicles filled with eosinophilic material) and "coffee-bean" nuclei. * **Clinical Presentation:** Often associated with **hyperestrogenism**, leading to precocious puberty in children or postmenopausal bleeding/endometrial hyperplasia in adults. * **Prognosis:** Generally excellent, but they are notorious for **late recurrences** (even 10–20 years after initial treatment).

Q: What is the treatment of choice for cervical intraepithelial neoplasia III with no colposcopic activity?

Conization. **Explanation:** **Cervical Intraepithelial Neoplasia III (CIN III)** represents high-grade squamous intraepithelial lesions (HSIL). When a colposcopic examination is considered "unsatisfactory" or shows **no colposcopic activity** (meaning the transformation zone or the extent of the lesion cannot be fully visualized), the primary goal is to rule out occult invasive carcinoma. **Why Conization is the Correct Choice:** Cold knife conization or LEEP (Loop Electrosurgical Excision Procedure) serves both a **diagnostic and therapeutic** purpose. Since the lesion's upper limit is not visible, a cone-shaped biopsy is mandatory to histologically evaluate the endocervical canal. This ensures that no microinvasive or invasive cancer is missed while simultaneously removing the CIN III lesion with clear margins. **Why Other Options are Incorrect:** * **A. Hysterectomy:** This is considered "overtreatment" as a primary step. Hysterectomy is only indicated for CIN III if there are coexisting gynecological issues (like fibroids), if margins remain positive after conization, or if the patient is post-menopausal and completed her family. * **B. Radiotherapy:** This is reserved for invasive cervical cancer (Stage IIB and above). It has no role in the management of pre-invasive lesions like CIN III. * **D. Follow up after 1 year:** CIN III is a high-grade lesion with a high risk of progression to malignancy. Observation is only acceptable for CIN I; CIN III requires active surgical intervention. **Clinical Pearls for NEET-PG:** * **Gold Standard for CIN III:** Excision (Conization/LEEP). * **Unsatisfactory Colposcopy:** Defined when the entire Squamocolumnar Junction (SCJ) is not visible. This is an absolute indication for conization. * **Treatment of Choice for CIN I:** Observation and repeat cytology in 6–12 months. * **Treatment of Choice for CIN II/III:** Ablation (if colposcopy is satisfactory) or Excision (if colposcopy is unsatisfactory).

Q: Which of the following is the most radiosensitive ovarian tumor?

Dysgerminoma. **Explanation:** **1. Why Dysgerminoma is the correct answer:** Dysgerminoma is the most common malignant germ cell tumor of the ovary and is uniquely characterized by its **extreme radiosensitivity**. It is the ovarian counterpart of the testicular seminoma. Because these tumors are highly sensitive to radiation, radiotherapy was historically the primary treatment. However, because dysgerminomas often affect young women of reproductive age, **platinum-based chemotherapy (BEP regimen)** is now the preferred treatment to preserve fertility, reserving radiotherapy for recurrent or resistant cases. **2. Why the other options are incorrect:** * **Dermoid Cyst (Mature Cystic Teratoma):** This is a benign germ cell tumor. It is composed of mature tissues (skin, hair, sebum) and is treated surgically (cystectomy); it is not radiosensitive. * **Serous Cystadenoma:** This is a benign epithelial tumor. Epithelial ovarian tumors, in general, are far less radiosensitive than germ cell tumors and are primarily managed with surgery. * **Endodermal Sinus Tumor (Yolk Sac Tumor):** While this is a malignant germ cell tumor, it is highly aggressive and primarily **chemosensitive**, not radiosensitive. It is characterized by elevated Alpha-Fetoprotein (AFP) and Schiller-Duval bodies. **3. Clinical Pearls for NEET-PG:** * **Tumor Marker:** Dysgerminoma is associated with elevated **LDH** (Lactic Dehydrogenase) and sometimes hCG. * **Microscopy:** Look for "large cells with clear cytoplasm and central nuclei, separated by fibrous septa containing **lymphocytes**." * **Most common malignant germ cell tumor in pregnancy:** Dysgerminoma. * **Associated Condition:** Often seen in patients with gonadal dysgenesis (Swyer Syndrome).

Q: Which of the following is NOT true about Sertoli cell tumors of the ovary?

They secrete female hormones.. **Explanation:** Sertoli cell tumors belong to the **Sex Cord-Stromal Tumor** group of ovarian neoplasms. These tumors are primarily virilizing because they are composed of cells that histologically resemble those found in the male testes. **1. Why Option B is the correct answer (The "NOT true" statement):** Sertoli cell tumors are classically associated with the production of **androgens** (testosterone and androstenedione), leading to defeminization and virilization. While some sex cord tumors like Granulosa cell tumors secrete estrogen (female hormones), pure Sertoli cell tumors do **not** typically secrete female hormones. Therefore, the statement that they secrete female hormones is incorrect. **2. Analysis of other options:** * **Option A:** They secrete male hormones. This is **true**. Clinical presentation often includes hirsutism, deepening of the voice, and clitoromegaly due to high testosterone levels. * **Option C:** They are also known as androblastomas. This is **true**. The term "Androblastoma" reflects their masculinizing nature and origin from the primitive sex cords. * **Option D:** They can be classified as gynandroblastomas. This is **true**. A gynandroblastoma is a rare subtype of sex cord-stromal tumor that contains both Sertoli-Leydig components and Granulosa-Theca components. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Presentation:** Secondary amenorrhea followed by virilization. * **Tumor Marker:** Elevated **Testosterone** levels; occasionally **Inhibin**. * **Histology:** Look for "hollow or solid tubules" lined by Sertoli cells. * **Age Group:** Usually occurs in young women (average age 25–30 years). * **Management:** Usually unilateral; conservative surgery (Unilateral Salpingo-oophorectomy) is often sufficient for Stage IA.

Q: A 29-year-old female, G2 P1A1, presents with 16 weeks of amenorrhea, lower abdominal pain, and vaginal bleeding. Ultrasonography shows a "snow storm" appearance. What is the most feasible method of treatment?

Suction evacuation. **Explanation:** The clinical presentation of 16 weeks amenorrhea, vaginal bleeding, and the classic **"snow storm" appearance** on ultrasonography is pathognomonic for a **Hydatidiform Mole (Molar Pregnancy)**. **1. Why Suction Evacuation is the Correct Answer:** Suction evacuation (suction curettage) is the **gold standard** and treatment of choice for molar pregnancies, regardless of the uterine size. It is preferred because it is effective, minimizes the risk of uterine perforation compared to sharp curettage, and preserves fertility in young patients. In this case, the patient is 29 years old and G2 P1A1, making fertility preservation a priority. **2. Why Other Options are Incorrect:** * **Misoprostol & Mifepristone (Medical Management):** These are contraindicated in molar pregnancies. Medical induction increases the risk of heavy hemorrhage and, more importantly, increases the risk of **trophoblastic embolization** to the lungs due to vigorous uterine contractions. * **Hysterectomy:** While hysterectomy is an option for women who have completed their family or are over 40 years old (as it reduces the risk of post-molar gestational trophoblastic neoplasia), it is not the "most feasible" or first-line method for a 29-year-old who likely desires future fertility. **Clinical Pearls for NEET-PG:** * **Diagnosis:** High serum β-hCG levels (often >100,000 mIU/mL) and "snow storm" appearance (vesicular echoes) on USG. * **Procedure:** Always perform suction evacuation under **Oxytocin cover** to prevent hemorrhage and reduce the risk of embolization. * **Follow-up:** Essential to monitor weekly β-hCG levels until they become undetectable for three consecutive weeks, then monthly for six months to rule out Gestational Trophoblastic Neoplasia (GTN). * **Theca Lutein Cysts:** Often associated with moles due to high hCG; these usually regress spontaneously after evacuation and do not require surgical removal.

Q: What is the tumour marker for Endodermal Sinus Tumour?

Alpha-fetoprotein. **Explanation:** **Endodermal Sinus Tumour (Yolk Sac Tumour)** is the most common malignant germ cell tumour in children and young adolescents. The correct answer is **Alpha-fetoprotein (AFP)** because these tumours histologically mimic the primitive yolk sac, which is the physiological site of AFP production during embryogenesis. Serum AFP levels are highly sensitive and specific for this condition, serving as a reliable tool for diagnosis, monitoring treatment response, and detecting recurrence. **Analysis of Incorrect Options:** * **A. CEA (Carcinoembryonic Antigen):** Primarily used for gastrointestinal malignancies (e.g., colorectal cancer) and certain mucinous ovarian tumours, but not germ cell tumours. * **B. HCG (Human Chorionic Gonadotropin):** This is the characteristic marker for **Choriocarcinoma** and is also elevated in Dysgerminomas (if syncytiotrophoblastic giant cells are present). * **D. Cytokeratin:** This is an immunohistochemical marker used to identify epithelial origins in pathology but is not a serum tumour marker used for clinical monitoring of Yolk Sac Tumours. **High-Yield Clinical Pearls for NEET-PG:** * **Schiller-Duval Bodies:** The pathognomonic histological feature of Endodermal Sinus Tumours (resembles a primitive glomerulus). * **Age Group:** Typically presents in young girls/women (median age ~18 years) as a rapidly growing pelvic mass. * **Other Markers:** * **Dysgerminoma:** LDH (most specific), HCG (occasional). * **Immature Teratoma:** AFP (occasional). * **Granulosa Cell Tumour:** Inhibin B (most specific).

Question 1

Carcinoma cervix is associated with all except:

Accepted Answer

Diabetes mellitus

Answer

Multiparity

Answer

Herpes simplex virus

Answer

Early coitus

Question 2

The best method to confirm the diagnosis of carcinoma cervix is:

Accepted Answer

Cervical biopsy

Answer

Physical examination

Answer

Pap smear

Answer

Curettage

Question 3

A unilateral ovarian tumor has spread to the peritoneum but not to the uterus. What is the FIGO staging of this ovarian neoplasm?

Accepted Answer

Stage IC

Answer

Stage IB

Answer

Stage IIA

Answer

Stage IIB

Question 4

Metastases from a granulosa cell tumor most commonly involve which of the following?

Accepted Answer

The contralateral ovary

Answer

The liver

Answer

The mesentery

Answer

The mediastinum

Question 5

A 50-year-old woman with a family history of breast cancer presents with a 6-month history of increasing abdominal girth. She reports vague abdominal pain for 1 year. She has no children and has never been pregnant. Bimanual pelvic examination reveals a 10-cm right adnexal mass. Percussion of the abdomen indicates ascites. Aspiration cytology of the ascites fluid reveals malignant papillary structures with psammoma bodies. A mutation in which of the following genes is most likely associated with this patient's malignant disease?

Accepted Answer

BRCA1

Answer

p53

Answer

Rb

Answer

VHL

Question 6

What is the treatment of choice for cervical intraepithelial neoplasia III with no colposcopic activity?

Accepted Answer

Conization

Answer

Hysterectomy

Answer

Radiotherapy

Answer

Follow up after 1 year

Question 7

Which of the following is the most radiosensitive ovarian tumor?

Accepted Answer

Dysgerminoma

Answer

Dermoid cyst

Answer

Serous cystadenoma

Answer

Endodermal sinus tumor

Question 8

Which of the following is NOT true about Sertoli cell tumors of the ovary?

Accepted Answer

They secrete female hormones.

Answer

They secrete male hormones.

Answer

They are also known as androblastomas.

Answer

They can be classified as gynandroblastomas.

Question 9

A 29-year-old female, G2 P1A1, presents with 16 weeks of amenorrhea, lower abdominal pain, and vaginal bleeding. Ultrasonography shows a "snow storm" appearance. What is the most feasible method of treatment?

Accepted Answer

Suction evacuation

Answer

Misoprostol administration

Answer

Hysterectomy

Answer

Mifepristone

Question 10

What is the tumour marker for Endodermal Sinus Tumour?

Accepted Answer

Alpha-fetoprotein

Answer

CEA

Answer

HCG

Answer

Cytokeratin

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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