Gynecologic Oncology Practice Questions

Q: What is true about carcinoma in women?

Pap smear reduces the incidence of cervical cancer.. ### Explanation **Correct Option: A. Pap smear reduces the incidence of cervical cancer.** The Pap smear is a highly effective screening tool designed to detect **pre-invasive lesions** (Cervical Intraepithelial Neoplasia - CIN). By identifying and treating these precancerous changes before they progress to invasive disease, the Pap smear directly reduces the **incidence** (new cases) of cervical cancer. This is a form of secondary prevention that has significantly lowered mortality rates in developed countries. **Analysis of Incorrect Options:** * **Option B & C:** According to recent epidemiological data (GLOBOCAN 2020/2022), **Breast cancer** has overtaken cervical cancer to become the **most common malignancy** among Indian women. While cervical cancer remains a major health burden and was historically the leader, it now ranks second. * **Option D:** In Indian women, the most common cancers in descending order are **Breast > Cervix > Ovary > Lip/Oral cavity**. Lung cancer is not the second or third most common malignancy in this demographic. **High-Yield Clinical Pearls for NEET-PG:** * **Screening Guidelines (ACOG/FOGSI):** Screening typically begins at age 21 (or 25 in some guidelines). Between 30–65 years, the preferred method is **Co-testing** (Pap smear + HPV DNA testing) every 5 years. * **Transformation Zone:** The most common site for cervical cancer and the area targeted during a Pap smear. * **Bethesda System:** Used for reporting cervical cytology (e.g., LSIL, HSIL). * **Vaccination:** The HPV vaccine (e.g., Cervavac, Gardasil) is most effective when administered to girls aged 9–14 years, providing primary prevention against high-risk strains (HPV 16 and 18).

Q: A 38-year-old woman presents with painless post-coital bleeding. She had a cone biopsy for carcinoma in situ five years ago. Her last smear was three months ago, following this. Her last period was six weeks ago. What is the most probable diagnosis?

Carcinoma of cervix. **Explanation:** The clinical presentation of **painless post-coital bleeding** in a woman with a history of cervical intraepithelial neoplasia (CIN/Carcinoma in situ) is a classic "red flag" for **Cervical Carcinoma**. 1. **Why Option A is correct:** Post-coital bleeding is the most common presenting symptom of cervical cancer. This patient has a significant risk factor: a history of carcinoma in situ treated with a cone biopsy. Despite the procedure, she remains at higher risk for recurrence or progression to invasive disease. The fact that her last smear was only three months ago does not rule out malignancy, as cytology has a known false-negative rate, and invasive lesions can sometimes be missed if they are endocervical or rapidly progressing. 2. **Why the other options are incorrect:** * **Ectopic Pregnancy:** While she is six weeks post-LMP, ectopic pregnancy typically presents with abdominal pain and vaginal spotting/bleeding, not specifically post-coital bleeding. * **Endometrial Carcinoma:** This usually presents as post-menopausal bleeding. In a 38-year-old, it is rare unless there are specific risk factors like PCOS, obesity, or Lynch syndrome. * **Uterine Fibroids:** These typically present with heavy menstrual bleeding (menorrhagia) or pelvic pressure, rather than contact (post-coital) bleeding. **High-Yield Clinical Pearls for NEET-PG:** * **Most common symptom of Cervical Cancer:** Post-coital bleeding. * **Most common histological type:** Squamous cell carcinoma (80-85%). * **Screening:** PAP smear is a screening tool, but the definitive diagnosis of cervical cancer is always made via **Biopsy**. * **Risk Factors:** Early age at first intercourse, multiple sexual partners, and persistent high-risk HPV infection (Types 16 and 18).

Q: Which type of Human Papillomavirus (HPV) is most commonly associated with causing cervical cancer?

16. **Explanation:** Cervical cancer is primarily caused by persistent infection with high-risk strains of **Human Papillomavirus (HPV)**. Among these, **HPV 16** is the most oncogenic and prevalent subtype, accounting for approximately **50-60%** of all cervical squamous cell carcinomas worldwide. **Why Option C is correct:** HPV 16 has a high affinity for the transformation zone of the cervix. Its oncogenicity is driven by the overexpression of oncoproteins **E6 and E7**, which degrade the tumor suppressor proteins **p53 and pRb**, respectively, leading to uncontrolled cell cycle progression. **Analysis of Incorrect Options:** * **Options A (6) and B (11):** These are "low-risk" HPV types. They are rarely associated with malignancy but are responsible for over 90% of cases of **Anogenital Warts (Condyloma Acuminata)** and Recurrent Respiratory Papillomatosis. * **Option D (18):** This is the second most common high-risk type, accounting for about 10-15% of cases. It is specifically associated with a higher proportion of **Cervical Adenocarcinomas** and often exhibits more aggressive clinical behavior than HPV 16. **High-Yield Clinical Pearls for NEET-PG:** * **Most common HPV overall:** HPV 16 (Squamous cell carcinoma). * **Most common HPV in Adenocarcinoma:** HPV 18. * **Vaccination:** The Quadrivalent vaccine (Gardasil) covers types 6, 11, 16, and 18. The Nonavalent vaccine adds types 31, 33, 45, 52, and 58. * **Screening:** Co-testing (Pap smear + HPV DNA testing) is the preferred screening method for women aged 30–65.

Q: Which virus is associated with cervical cancer?

Human Papillomavirus (HPV). **Explanation:** **Human Papillomavirus (HPV)** is the primary etiological agent for cervical cancer, identified in over 99% of cases. The oncogenic potential lies in the high-risk strains (primarily **HPV 16 and 18**), which integrate their DNA into the host genome. This leads to the overexpression of oncoproteins **E6 and E7**. E6 binds to and degrades the **p53** tumor suppressor protein, while E7 inactivates the **Retinoblastoma (Rb)** protein, resulting in uncontrolled cell cycle progression and malignant transformation. **Analysis of Incorrect Options:** * **HIV (Option B):** While HIV is a significant risk factor because it causes immunosuppression (allowing HPV to persist), it does not directly transform cervical cells. Cervical cancer is an AIDS-defining illness. * **EBV (Option C):** Associated with Burkitt lymphoma, Nasopharyngeal carcinoma, and Hodgkin lymphoma, but not cervical cancer. * **HTLV (Option D):** Specifically HTLV-1 is associated with Adult T-cell leukemia/lymphoma (ATLL) and tropical spastic paraparesis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common strains:** HPV 16 (most common overall, associated with Squamous Cell Carcinoma) and HPV 18 (strongly associated with Adenocarcinoma). * **Low-risk strains:** HPV 6 and 11 cause genital warts (Condyloma acuminata) but have low oncogenic potential. * **Screening:** The transformation zone is the most common site for carcinogenesis; PAP smear screens for cytological changes. * **Vaccination:** The ideal age for the HPV vaccine is 9–14 years (before sexual debut). The quadrivalent vaccine (Gardasil) targets types 6, 11, 16, and 18.

Q: Ovarian fibroma develops from which part of the ovary?

Stroma. **Explanation:** Ovarian tumors are classified based on their tissue of origin. **Ovarian Fibroma** is a benign tumor that arises from the **ovarian stroma** (specifically the spindle-shaped fibroblastic cells). It belongs to the broader category of **Sex Cord-Stromal Tumors**, but specifically originates from the stromal component rather than the sex cords. **Analysis of Options:** * **D. Stroma (Correct):** Fibromas are composed of bundles of collagen-producing spindle cells derived from the specialized ovarian stroma. They are the most common benign solid tumors of the ovary. * **A. Epithelium:** Surface epithelial tumors (e.g., Serous or Mucinous cystadenomas) arise from the mesothelial lining of the ovary. * **B. Germ cells:** These arise from oocytes (e.g., Teratoma, Dysgerminoma, Yolk sac tumor). * **C. Sex cord:** While often grouped together, "Sex cord" specifically refers to cells that support the germ cells (Granulosa and Sertoli cells). Fibromas are purely stromal in origin. **High-Yield Clinical Pearls for NEET-PG:** * **Meigs Syndrome:** A classic triad consisting of a **benign ovarian fibroma**, **ascites**, and **right-sided pleural effusion**. The symptoms resolve completely after the removal of the tumor. * **Gorlin Syndrome:** Also known as Nevoid Basal Cell Carcinoma Syndrome; it is associated with bilateral ovarian fibromas in young patients. * **Gross Appearance:** They are typically solid, firm, white/pearly-grey masses (resembling a uterine fibroid). * **Microscopy:** Characterized by "intersecting bundles of spindle cells" and "Storch’s pattern" (whirl-like arrangement). Unlike Thecomas, Fibromas are hormonally inactive (they do not produce estrogen).

Q: A patient presents with bilateral ovarian carcinoma with a breech in the capsular wall, ascites, peritoneal metastasis, and positive cytology. What is the stage of the carcinoma?

Stage Ic. **Explanation:** The staging of ovarian carcinoma follows the **FIGO (International Federation of Gynecology and Obstetrics)** classification. This case describes a tumor limited to the ovaries (Stage I) but with specific features that upgrade it to **Stage Ic**. **Why Stage Ic is correct:** Stage I is defined as growth limited to the ovaries or fallopian tubes. It is subdivided into: * **Ia:** One ovary/tube involved, capsule intact, no tumor on surface, negative washings. * **Ib:** Both ovaries/tubes involved, capsule intact, no tumor on surface, negative washings. * **Ic:** Tumor limited to one or both ovaries/tubes **PLUS** any of the following: * **Ic1:** Surgical spill. * **Ic2:** Capsule ruptured before surgery (breech in the wall) or tumor on surface. * **Ic3:** Malignant cells in the ascites or peritoneal washings (positive cytology). Since the patient has a capsular breech and positive cytology, it fits the criteria for Stage Ic. **Why other options are incorrect:** * **Stage II:** Involves pelvic extension (uterus, tubes, bladder, or rectum) below the pelvic brim. * **Stage III:** Involves spread to the peritoneum outside the pelvis and/or metastasis to retroperitoneal lymph nodes. (Note: While the question mentions "peritoneal metastasis," in the context of Stage I/II, this usually refers to microscopic seeding or washings; gross extrapelvic peritoneal spread would be Stage III). * **Stage IV:** Distant metastasis (e.g., pleural effusion with positive cytology, parenchymal liver/spleen metastasis). **High-Yield Clinical Pearls for NEET-PG:** * **Most common presentation:** Most ovarian cancers are diagnosed at **Stage III**. * **Prognostic Factor:** Positive peritoneal cytology (Ic3) is a significant poor prognostic indicator in early-stage disease. * **CA-125:** While useful for monitoring epithelial tumors, it is not used for staging; staging is strictly **surgical-pathological**.

Q: A patient with carcinoma of the ovary presents with a left supraclavicular lymph node. What is the clinical stage of this cancer?

Stage IV. **Explanation:** The clinical staging of Ovarian Cancer follows the **FIGO (International Federation of Gynecology and Obstetrics) system**. **Why Stage IV is correct:** Stage IV represents **distant metastasis** (excluding peritoneal metastases). According to the FIGO 2014 classification, Stage IV is subdivided into: * **Stage IV-A:** Pleural effusion with positive cytology. * **Stage IV-B:** Parenchymal metastases (liver/spleen) and **extra-abdominal lymph node involvement**. A **left supraclavicular lymph node** (also known as Virchow’s node) is located outside the abdominal cavity; therefore, its involvement signifies distant hematogenous or lymphatic spread, classifying the disease as **Stage IV-B**. **Why other options are incorrect:** * **Stage I:** Growth is limited strictly to the ovaries or fallopian tubes. * **Stage II:** Growth involves one or both ovaries with pelvic extension (below the pelvic brim) or primary peritoneal cancer. * **Stage III:** Growth involves one or both ovaries with cytologically/histologically confirmed spread to the peritoneum **outside the pelvis** and/or metastasis to the **retroperitoneal (pelvic/paraaortic) lymph nodes**. Since supraclavicular nodes are extra-abdominal, they exceed Stage III criteria. **High-Yield Clinical Pearls for NEET-PG:** * **Most common mode of spread:** Seeding/Exfoliation into the peritoneal cavity (Transcoelomic). * **Most common site of distant metastasis:** Pleura (presents as malignant pleural effusion). * **Lymphatic drainage:** Primary drainage is via the infundibulopelvic ligament to the **paraaortic lymph nodes**. * **Sister Mary Joseph’s Nodule:** Metastasis to the umbilicus, also indicative of advanced disease.

Question 1

What is true about carcinoma in women?

Accepted Answer

Pap smear reduces the incidence of cervical cancer.

Answer

Cervical cancer is the most common malignancy in Indian women.

Answer

Breast cancer is the most common malignancy in Indian women.

Answer

Next to cervical cancer, lung carcinoma is the next most common malignancy.

Question 2

Ultrasound of a 36 year old gravida reveals small grape-like cystic structures without evidence of a developing embryo. What is the most likely diagnosis?

Accepted Answer

The genotype of the mole is 46XXX and is completely paternal in origin.

Answer

The genotype of the mole is triploid.

Answer

hCG levels are markedly decreased.

Answer

Serum levels of alpha-fetoprotein are elevated.

Question 3

A 56-year-old woman presents with a 3-month history of vaginal bleeding. A cervical Pap smear reveals malignant, glandular epithelial cells. This patient most likely has a neoplasm originating in which of the following anatomic locations?

Accepted Answer

Cervix

Answer

Endometrium

Answer

Ovary

Answer

Vagina

Question 4

A 38-year-old woman presents with painless post-coital bleeding. She had a cone biopsy for carcinoma in situ five years ago. Her last smear was three months ago, following this. Her last period was six weeks ago. What is the most probable diagnosis?

Accepted Answer

Carcinoma of cervix

Answer

Ectopic pregnancy

Answer

Endometrial carcinoma

Answer

Uterine fibroids

Question 5

Which type of Human Papillomavirus (HPV) is most commonly associated with causing cervical cancer?

Accepted Answer

16

Answer

6

Answer

11

Answer

18

Question 6

Which virus is associated with cervical cancer?

Accepted Answer

Human Papillomavirus (HPV)

Answer

Human Immunodeficiency Virus (HIV)

Answer

Epstein-Barr Virus (EBV)

Answer

Human T-lymphotropic Virus (HTLV)

Question 7

Ovarian fibroma develops from which part of the ovary?

Accepted Answer

Stroma

Answer

Epithelium

Answer

Germ cells

Answer

Sex cord

Question 8

A 50-year-old woman underwent debulking surgery for advanced epithelial ovarian cancer. What standard adjuvant therapy is recommended for this patient?

Accepted Answer

Paclitaxel and carboplatin for six cycles

Answer

Paclitaxel and carboplatin for six cycles and radiotherapy

Answer

Paclitaxel for six cycles and radiotherapy

Answer

Radiotherapy alone

Question 9

A patient presents with bilateral ovarian carcinoma with a breech in the capsular wall, ascites, peritoneal metastasis, and positive cytology. What is the stage of the carcinoma?

Accepted Answer

Stage Ic

Answer

Stage IIc

Answer

Stage IIIc

Answer

Stage IVc

Question 10

A patient with carcinoma of the ovary presents with a left supraclavicular lymph node. What is the clinical stage of this cancer?

Accepted Answer

Stage IV

Answer

Stage III

Answer

Stage II

Answer

Stage I

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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