Gynecologic Oncology Practice Questions

Q: Which of the following does not secrete a hormone?

Dysgerminoma. **Explanation:** The correct answer is **Dysgerminoma**. In gynecologic oncology, ovarian tumors are often classified by their ability to produce hormones (functioning tumors) or their lack thereof (non-functioning tumors). **1. Why Dysgerminoma is the correct answer:** Dysgerminoma is a germ cell tumor that is histologically identical to the male seminoma. It is considered a **non-functioning tumor** because it does not inherently secrete hormones. While it is a classic marker for **LDH (Lactate Dehydrogenase)**, it does not produce estrogen or androgens. Note: In rare cases, if it contains syncytiotrophoblastic giant cells, it may secrete low levels of hCG, but it is fundamentally categorized as non-hormonal. **2. Why the other options are incorrect:** * **Granulosa Cell Tumor:** A sex cord-stromal tumor known for secreting high levels of **Estrogen**. It often presents with precocious puberty in children or postmenopausal bleeding in adults. Inhibin B is its specific tumor marker. * **Theca Cell Tumor (Thecoma):** Also a sex cord-stromal tumor, these are almost always benign and are highly associated with **Estrogen** production, often leading to endometrial hyperplasia. * **Hilus Cell Tumor:** A subtype of Sertoli-Leydig cell tumors (pure Leydig cell tumor). These are potent secretors of **Androgens** (testosterone), leading to rapid virilization and hirsutism. Reinke crystals are a pathognomonic histological finding. **NEET-PG High-Yield Pearls:** * **Dysgerminoma:** Most common malignant germ cell tumor in pregnancy and Turner syndrome (gonadal dysgenesis). Highly radiosensitive. * **Tumor Markers:** Dysgerminoma (LDH), Yolk Sac Tumor (AFP), Choriocarcinoma (hCG), Granulosa Cell Tumor (Inhibin). * **Call-Exner Bodies:** Pathognomonic for Granulosa Cell Tumors.

Q: What is the treatment of choice in a patient with carcinoma cervix stage II?

All of the above. ### Explanation In the management of Carcinoma Cervix, **Stage II** is divided into IIA (no parametrial involvement) and IIB (parametrial involvement). The treatment approach for Stage II involves a combination of surgery and radiotherapy, often supplemented by chemotherapy to improve outcomes. **Why "All of the above" is correct:** The management of Stage II cervical cancer is multimodal: 1. **Extended Hysterectomy (Type II/III Radical Hysterectomy):** This is the surgical treatment of choice for **Stage IIA1** (lesion <4cm). It involves the removal of the uterus, cervix, upper vagina, and pelvic lymph nodes. 2. **Intracavitary Brachytherapy:** This is a crucial component of **Radiotherapy**, which is the primary treatment for **Stage IIA2 and IIB**. Radiotherapy consists of External Beam Radiation Therapy (EBRT) followed by Brachytherapy to deliver a high dose of radiation directly to the tumor. 3. **Chemotherapy:** For locally advanced stages (IIB onwards), **Concurrent Chemoradiotherapy (CCRT)** using Cisplatin is the gold standard. Chemotherapy acts as a radiosensitizer, enhancing the efficacy of radiation. **Analysis of Options:** * **A, B, and C** are all valid components of the management protocol depending on the specific sub-stage (IIA vs. IIB) and the patient's fitness for surgery. Since the question asks for the treatment of "Stage II" broadly, all listed modalities are utilized in its management. **High-Yield Clinical Pearls for NEET-PG:** * **Stage IIA:** Involvement of the upper 2/3rd of the vagina without parametrial involvement. * **Stage IIB:** Parametrial involvement (but not reaching the pelvic side wall). * **Treatment Cut-off:** Surgery is generally preferred up to Stage IIA1. From Stage IIA2 to IVA, **Concurrent Chemoradiotherapy (CCRT)** is the treatment of choice. * **Drug of Choice:** Cisplatin is the most common radiosensitizer used in cervical cancer.

Q: In cervical cancer, surgery is limited to patients with which stage?

Stage I to IIA. **Explanation:** In cervical cancer management, the primary treatment modality is determined by the clinical stage. Surgery is generally reserved for **early-stage disease (Stage I to IIA)**, where the tumor is confined to the cervix or the upper two-thirds of the vagina without involving the parametrium. **1. Why Stage I to IIA is correct:** At these stages, the disease is surgically resectable. Procedures like Radical Hysterectomy (Wertheim’s Hysterectomy) with pelvic lymphadenectomy can achieve clear margins and provide excellent survival rates. Once the cancer reaches **Stage IIB**, it involves the **parametrium**. Surgical clearance of the parametrium is difficult and often results in positive margins; therefore, these patients are better managed with Concurrent Chemoradiotherapy (CCRT). **2. Why other options are incorrect:** * **Stage IIB (Option B):** This stage marks the beginning of "locally advanced" disease. Parametrial involvement makes surgery technically challenging and increases morbidity without improving survival compared to radiotherapy. * **Stage IIIA/IIIB (Options C & D):** These stages involve the lower third of the vagina (IIIA) or extension to the pelvic wall/hydronephrosis (IIIB). These are strictly managed with radiotherapy as surgery is not curative. **High-Yield Clinical Pearls for NEET-PG:** * **Standard Surgery:** Type III Radical Hysterectomy (Meigs' operation) is the classic choice for Stage IB1 and IIA1. * **Fertility Sparing:** Radical Trachelectomy can be considered for Stage IA2 to IB1 in patients wishing to preserve fertility. * **Treatment of Choice for IIB to IVA:** Concurrent Chemoradiotherapy (Cisplatin-based) is the gold standard. * **Stage IVB:** Managed with palliative chemotherapy. * **Most common cause of death:** Uremia due to bilateral ureteric obstruction (post-renal failure).

Q: Which of the following statements about partial mole is false?

Can be reliably diagnosed by ultrasound in early gestation. **Explanation:** The correct answer is **D**. Unlike complete hydatidiform moles, which show a classic "snowstorm appearance" on ultrasound, **partial moles are difficult to diagnose reliably via ultrasound**, especially in early gestation. They often mimic a missed or incomplete abortion. Ultrasound may only show a thickened placenta with some cystic spaces or an increased gestational sac diameter, making histopathological examination the gold standard for diagnosis. **Analysis of Options:** * **Option A (True):** Partial moles are almost always **triploid (69, XXX or 69, XXY)**, resulting from the fertilization of a normal ovum by two sperm (dispermy). * **Option B (True):** The risk of persistent Gestational Trophoblastic Neoplasia (GTN) after a partial mole is very low (**<1-5%**), compared to 15-20% after a complete mole. Choriocarcinoma following a partial mole is extremely rare. * **Option C (True):** Most partial moles present clinically as a **missed or incomplete abortion**. Patients often undergo evacuation for a non-viable pregnancy, and the diagnosis of a partial mole is an incidental finding on pathology. **NEET-PG High-Yield Pearls:** * **Karyotype:** Complete Mole = 46,XX (Diploids); Partial Mole = 69,XXX/XXY (Triploid). * **Fetal Tissue:** Present in Partial Mole; Absent in Complete Mole. * **p57 Expression:** Partial moles are **p57 positive** (maternal DNA present), whereas complete moles are **p57 negative** (no maternal DNA). * **hCG Levels:** Markedly elevated in complete moles; only mildly elevated or normal in partial moles.

Question 1

What is the incidence of lymph node metastasis in carcinoma cervix stage II?

Accepted Answer

15-20%

Answer

5-10%

Answer

25-40%

Answer

50-60%

Question 2

A patient with a history of ovarian cancer is undergoing follow-up. Her CA125 level is elevated. What is the next best step in management?

Accepted Answer

PET scan

Answer

CT scan

Answer

MRI scan

Answer

Clinical examination and serial monitoring of CA125 levels

Question 3

Pap smear of a 45-year-old female shows CIN grade III. Which of the following is the next step in management?

Accepted Answer

Colposcopy directed biopsy

Answer

Punch biopsy

Answer

Large loop excision

Answer

Cone biopsy

Question 4

Which of the following does not secrete a hormone?

Accepted Answer

Dysgerminoma

Answer

Granulosa cell tumor

Answer

Hilus cell tumor

Answer

Theca cell tumor

Question 5

What is the cause of vaginal adenocarcinomas in children?

Accepted Answer

Administration of diethylstilbestrol (DES) to pregnant mothers

Answer

Virus

Answer

Hormonal changes

Answer

All of the above

Question 6

What is the treatment of choice in a patient with carcinoma cervix stage II?

Accepted Answer

All of the above

Answer

Extended hysterectomy

Answer

Chemotherapy

Answer

Intracavitatory brachytherapy

Question 7

A 25-year-old married nullipara undergoes laparoscopic cystectomy for an ovarian cyst which, on histopathology, reveals ovarian serous cystadenocarcinoma. What should be the next management?

Accepted Answer

Unilateral salpingo-oophorectomy

Answer

Serial Ca-125 measurement and follow-up

Answer

Hysterectomy and bilateral salpingo-oophorectomy

Answer

Radiotherapy

Question 8

In cervical cancer, surgery is limited to patients with which stage?

Accepted Answer

Stage I to IIA

Answer

Stage I to IIB

Answer

Stage I to IIIA

Answer

Stage I to IIIB

Question 9

CA 125 is elevated in all of the following conditions EXCEPT:

Accepted Answer

Polycystic ovarian disease

Answer

Tuberculosis

Answer

Endometriosis

Answer

Ovarian tumor

Question 10

Which of the following statements about partial mole is false?

Accepted Answer

Can be reliably diagnosed by ultrasound in early gestation

Answer

Usually associated with triploidy

Answer

Rarely causes persistent gestational trophoblastic neoplasia

Answer

Usually presents as missed abortions

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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