Gynecologic Oncology Practice Questions

Q: A 55-year-old female presents with abdominal pain, distension, ascites, and dyspnea. Her CA 125 levels are elevated. What is the most likely diagnosis?

Ovarian cancer. ### Explanation **Correct Option: A. Ovarian Cancer** The clinical presentation of abdominal pain, distension, and ascites in a postmenopausal woman is a classic "red flag" for **Epithelial Ovarian Cancer (EOC)**. Ascites in these patients often results from peritoneal carcinomatosis, where tumor cells disrupt lymphatic drainage and increase capillary permeability. The presence of **dyspnea** suggests a pleural effusion (likely Stage IV disease), forming part of the clinical picture of advanced malignancy. **CA-125** is the most significant tumor marker for EOC; while not specific (it can rise in endometriosis or PID), its elevation in a postmenopausal woman with a pelvic mass and ascites is highly suggestive of ovarian malignancy. **Incorrect Options:** * **B. Cervical Cancer:** Usually presents with post-coital or irregular vaginal bleeding. Ascites and elevated CA-125 are not typical primary features unless there is widespread intra-abdominal metastasis. * **C. Lung Cancer:** While it can cause dyspnea and pleural effusion, it would not typically present with a primary picture of ascites and elevated CA-125. * **D. Lymphoma:** Can cause ascites and lymphadenopathy, but CA-125 is not a standard marker for lymphoma, and the constellation of symptoms more strongly points toward a gynecological primary in this age group. **NEET-PG High-Yield Pearls:** * **Sister Mary Joseph Nodule:** A palpable nodule at the umbilicus representing metastasis from pelvic/abdominal cancers (most commonly Ovarian or Gastric). * **Meigs Syndrome:** A triad of Benign Ovarian Tumor (Fibroma), Ascites, and Right-sided Pleural Effusion. * **Staging:** Ovarian cancer is staged **surgically** (FIGO staging). * **Tumor Markers:** CA-125 is used for monitoring treatment response and recurrence rather than primary screening in the general population.

Q: Which of the following is NOT a management option for carcinoma of the breast during the second trimester of pregnancy?

Focal 3D. **Explanation:** The management of breast cancer during pregnancy (BCP) aims to provide standard oncological care while minimizing fetal risk. The correct answer is **Focal 3D (Radiotherapy)** because radiation therapy is generally **contraindicated** throughout pregnancy due to the high risk of fetal malformations, growth restriction, and childhood carcinogenesis, especially when the fetus is in close proximity to the field. **Analysis of Options:** * **A. Chemotherapy (FAC regimen):** Chemotherapy is contraindicated in the first trimester (teratogenic risk). However, it is considered **safe and standard** during the **second and third trimesters** (after 14 weeks). Doxorubicin, Cyclophosphamide, and 5-FU (FAC) is a commonly used regimen. * **B. Mastectomy:** This is the preferred surgical option in many cases because it often eliminates the immediate need for adjuvant radiotherapy, which must be delayed until postpartum. * **D. Breast-conservative surgery (BCS):** BCS is an option in the second trimester if the patient is willing to delay the mandatory follow-up radiotherapy until after delivery. **Clinical Pearls for NEET-PG:** 1. **Radiotherapy:** Always contraindicated during pregnancy; must be delayed until after delivery. 2. **Chemotherapy:** Safe after the 1st trimester. It must be stopped 3 weeks before the expected date of delivery to avoid neonatal neutropenia. 3. **Surgery:** Can be performed safely in all trimesters. 4. **Drugs to Avoid:** Methotrexate (antimetabolite/teratogenic), Tamoxifen (teratogenic/genitourinary risks), and Trastuzumab (causes oligohydramnios). 5. **Termination of pregnancy:** Does not improve maternal survival outcomes in breast cancer.

Q: Which of the following is true about granulosa cell tumors, EXCEPT?

The most common malignant tumor of the ovary. **Explanation:** The correct answer is **A (The most common malignant tumor of the ovary)** because this statement is false. The most common malignant ovarian tumors are **Serous Cystadenocarcinomas** (surface epithelial tumors). Granulosa cell tumors (GCTs) are rare, accounting for only 2–5% of all ovarian malignancies. They belong to the **Sex Cord-Stromal** category and are considered "low-grade" malignancies with a generally indolent course. **Analysis of other options:** * **B (Secretes hormones):** GCTs are functionally active tumors that primarily secrete **Estrogen**. This is a hallmark feature used for clinical diagnosis. * **C (Associated with endometrial hyperplasia):** Due to chronic, unopposed estrogen secretion, up to 25–50% of patients develop endometrial hyperplasia, and 5–10% may develop co-existing **Endometrial Carcinoma**. * **D (Chemotherapy sensitive):** While surgery is the primary treatment, GCTs are sensitive to chemotherapy (typically the **BEP regimen**: Bleomycin, Etoposide, and Cisplatin), which is used for advanced or recurrent stages. **NEET-PG High-Yield Pearls:** * **Pathognomonic Feature:** **Call-Exner bodies** (small follicles filled with eosinophilic material) seen on histology. * **Tumor Marker:** **Inhibin B** is the most reliable marker for diagnosis and monitoring recurrence. * **Clinical Presentation:** Often presents as **precocious puberty** in children (Juvenile type) or **postmenopausal bleeding** in older adults (Adult type). * **Nuclear Feature:** "Coffee-bean" nuclei (longitudinal nuclear grooves).

Q: CA-125 is a specific marker of:

Epithelial cell carcinoma of the ovary. **Explanation:** **CA-125 (Cancer Antigen 125)** is a high-molecular-weight glycoprotein produced by derivatives of the **coelomic epithelium** (including the peritoneum, pleura, pericardium, and the lining of the fallopian tubes, endometrium, and endocervix). It is the most widely used tumor marker for **Epithelial Ovarian Cancer (EOC)**, particularly the serous subtype. It is used for monitoring treatment response and detecting recurrence, though its utility as a screening tool is limited due to low specificity in premenopausal women. **Analysis of Incorrect Options:** * **A. Choriocarcinoma:** The specific marker is **beta-hCG** (Human Chorionic Gonadotropin). * **B. Teratoma:** Mature teratomas have no specific markers. However, **Immature Teratomas** may show elevated **AFP** (Alpha-fetoprotein) or LDH. * **D. Seminoma:** In females, the equivalent is **Dysgerminoma**. The characteristic marker is **LDH** (Lactate Dehydrogenase); some may also show mildly elevated beta-hCG. **High-Yield Clinical Pearls for NEET-PG:** * **Normal Value:** < 35 U/mL. * **Benign Elevations:** CA-125 can be elevated in non-malignant conditions like **Endometriosis** (most common benign cause), Pelvic Inflammatory Disease (PID), pregnancy, and fibroids. * **Other Ovarian Markers:** * **Yolk Sac Tumor:** AFP (Highly specific). * **Granulosa Cell Tumor:** Inhibin B. * **Mucinous Cystadenocarcinoma:** CEA and CA 19-9. * **RMI (Risk of Malignancy Index):** Uses CA-125 levels, ultrasound features, and menopausal status to predict the likelihood of malignancy.

Q: Lower urethral involvement of vulval carcinoma without inguinofemoral nodes is seen in which stage?

Stage II. **Explanation:** The staging of vulvar carcinoma follows the **FIGO (2021)** classification. The correct answer is **Stage II** because this stage is defined by a tumor of any size with extension to adjacent perineal structures, specifically the **lower 1/3 of the urethra**, lower 1/3 of the vagina, or the anus, provided there is **no regional lymph node involvement**. * **Stage I:** The tumor is confined to the vulva or perineum with no nodal involvement. It is subdivided into IA (≤2 cm, stromal invasion ≤1 mm) and IB (>2 cm or invasion >1 mm). * **Stage III:** This stage is characterized by **inguinofemoral lymph node metastasis**, regardless of the size of the primary tumor or local extension to the lower urethra/vagina. * **Stage IV:** This represents advanced disease involving the **upper** parts of the pelvic organs (upper 2/3 of the urethra, upper 2/3 of the vagina, bladder mucosa, or rectal mucosa) or distant metastasis. **High-Yield Clinical Pearls for NEET-PG:** * **Lymphatic Spread:** Vulvar cancer primarily spreads via the lymphatics to the **inguinofemoral nodes**. The "Sentinel Lymph Node" biopsy is indicated in Stage IB/II tumors <4 cm. * **The "Lower vs. Upper" Rule:** Involvement of the **lower 1/3** of the urethra/vagina is **Stage II**; involvement of the **upper 2/3** is **Stage IVA**. * **Most Common Type:** Squamous cell carcinoma (SCC) is the most common histological type, often associated with HPV (in younger patients) or Lichen Sclerosus (in elderly patients).

Q: Which of the following statements are true about a complete mole?

Presence of fetal parts and cardiac activity. In a **Complete Hydatidiform Mole**, the genetic material is entirely paternal (usually 46,XX), resulting from the fertilization of an "empty" egg by one or two sperm. This leads to generalized trophoblastic proliferation and diffuse swelling of chorionic villi. ### **Analysis of Options** * **A. Presence of fetal parts and cardiac activity (Correct):** In a complete mole, there is **no fetal tissue** or amniotic fluid. The presence of fetal parts, a fetus, or cardiac activity is characteristic of a **Partial Mole** (usually 69,XXY). * **B. Normal uterine size:** In complete moles, the uterus is typically **larger than the period of gestation** (in ~50% of cases) due to excessive trophoblastic proliferation and retained blood. * **C. Beta hCG doubling time:** In a normal pregnancy, hCG doubles every 48–72 hours. In molar pregnancies, hCG levels are **abnormally high** (often >100,000 mIU/mL) and do not follow the standard doubling curve. * **D. Pre-eclampsia at < 24 weeks:** This is a **classic feature** of a complete mole. Developing hypertension/proteinuria in the first or early second trimester is a pathognomonic "red flag" for gestational trophoblastic disease. ### **NEET-PG High-Yield Pearls** * **USG Appearance:** "Snowstorm appearance" or "Bunch of grapes." * **Theca Lutein Cysts:** Often present bilaterally due to massive hCG stimulation. * **Karyotype:** Complete Mole (46,XX/XY; Paternal only) vs. Partial Mole (69,XXY; Triploid). * **Risk of Malignancy:** Complete moles have a higher risk (15–20%) of progressing to Choriocarcinoma compared to partial moles (<5%). * **Management:** Suction and evacuation is the treatment of choice.

Q: What is the increased risk of ovarian cancer above normal in a woman with a non-autosomal dominant genotype who has one first-degree relative with ovarian cancer?

2-3 times. **Explanation:** The risk of developing ovarian cancer is significantly influenced by family history, even in the absence of high-penetrance genetic syndromes like BRCA1 or BRCA2. **1. Why Option A is Correct:** In the general population, the lifetime risk of ovarian cancer is approximately **1.4% to 1.6%**. For a woman with **one first-degree relative** (mother, sister, or daughter) affected by ovarian cancer, the risk increases to approximately **3% to 5%**. This represents a **2-3 fold increase** over the baseline population risk. This "non-autosomal dominant" scenario usually implies a polygenic inheritance or shared environmental factors rather than a single high-risk gene mutation. **2. Why Other Options are Incorrect:** * **Option B (5 times):** This risk level is typically associated with having **two first-degree relatives** affected, where the lifetime risk climbs to approximately 7%. * **Options C & D (10-20 times):** These high risks are reserved for **hereditary syndromes**. A woman with a **BRCA1 mutation** has a 40-50% lifetime risk (approx. 30 times the baseline), and a **BRCA2 mutation** carrier has a 15-25% risk (approx. 10-15 times the baseline). **Clinical Pearls for NEET-PG:** * **Most common type:** Epithelial ovarian cancer (90%). * **Protective factors:** Combined Oral Contraceptive Pills (COCPs) – 5 years of use reduces risk by 50%; breastfeeding; and multiparity. * **Screening:** There is currently **no effective screening** tool for the general population (CA-125 and TVS have low positive predictive value). * **Lynch Syndrome (HNPCC):** Associated with a 10-12% lifetime risk of ovarian cancer.

Question 1

A 55-year-old female presents with abdominal pain, distension, ascites, and dyspnea. Her CA 125 levels are elevated. What is the most likely diagnosis?

Accepted Answer

Ovarian cancer

Answer

Cervical cancer

Answer

Lung cancer

Answer

Lymphoma

Question 2

Which of the following is NOT a management option for carcinoma of the breast during the second trimester of pregnancy?

Accepted Answer

Focal 3D

Answer

Chemotherapy with doxorubicin, cyclophosphamide, and 5-FU

Answer

Mastectomy

Answer

Breast-conservative surgery

Question 3

Bilateral hydronephrosis is seen in which of the following conditions?

Accepted Answer

Carcinoma cervix stage 3 or 4

Answer

Vaginal carcinoma

Answer

Hepatic cirrhosis

Answer

Colon cancer

Question 4

Which of the following is true about granulosa cell tumors, EXCEPT?

Accepted Answer

The most common malignant tumor of the ovary

Answer

It secretes hormones

Answer

Associated with endometrial hyperplasia

Answer

Chemotherapy sensitive

Question 5

CA-125 is a specific marker of:

Accepted Answer

Epithelial cell carcinoma of the ovary

Answer

Choriocarcinoma

Answer

Teratoma

Answer

Seminoma

Question 6

Lower urethral involvement of vulval carcinoma without inguinofemoral nodes is seen in which stage?

Accepted Answer

Stage II

Answer

Stage I

Answer

Stage III

Answer

Stage IV

Question 7

Pseudomyxoma peritonei is typically associated with which of the following conditions?

Accepted Answer

Mucinous ovarian carcinoma

Answer

Thecoma of the ovary

Answer

Carcinoid tumor of the appendix

Answer

Mesothelioma

Question 8

Which of the following statements are true about a complete mole?

Accepted Answer

Presence of fetal parts and cardiac activity

Answer

Normal uterine size

Answer

Beta hCG doubling time is 7-10 days

Answer

Pre-eclampsia at < 24 weeks

Question 9

What is the increased risk of ovarian cancer above normal in a woman with a non-autosomal dominant genotype who has one first-degree relative with ovarian cancer?

Accepted Answer

2-3 times

Answer

5 times

Answer

10 times

Answer

20 times

Question 10

A unilateral ovarian tumour with visible peritoneal implants belongs to which stage?

Accepted Answer

Stage IIIB

Answer

Stage IB

Answer

Stage IC

Answer

Stage IIA

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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