Gynecologic Oncology Practice Questions

Q: Tumor marker of epithelial ovarian carcinoma is:

CA-125. ***CA-125*** - **CA-125 (Cancer Antigen 125)** is the most widely used and validated tumor marker for detecting and monitoring **epithelial ovarian carcinoma**. - Elevated levels are found in approximately 80% of women with epithelial ovarian cancer, making it useful in guiding treatment decisions and assessing recurrence. *Alpha feto protein* - **Alpha-fetoprotein (AFP)** is primarily elevated in **germ cell tumors** of the ovary (e.g., endodermal sinus tumor) or in hepatocellular carcinoma and some testicular cancers, not epithelial ovarian carcinoma. - Its presence usually indicates a different histological subtype of ovarian malignancy. *Beta HCG* - **Beta-human chorionic gonadotropin (β-hCG)** is a tumor marker utilized for detecting **germ cell tumors**, particularly **choriocarcinoma** and some embryonal carcinomas, as well as pregnancy. - It is not typically elevated in epithelial ovarian carcinoma. *LDH* - **Lactate dehydrogenase (LDH)** is a general marker of **tissue damage or high cell turnover**, elevated in many cancers, including dysgerminoma (an ovarian germ cell tumor), but it is not specific for epithelial ovarian carcinoma. - Due to its lack of specificity, LDH alone is not considered the primary tumor marker for epithelial ovarian cancer.

Q: What is the age group distribution for vulval cancer?

Both age groups (35-55 and 65-85 years). ***Both age groups (35-55 and 65-85 years)*** - Vulval cancer demonstrates a **bimodal age distribution**, meaning it presents with two distinct peaks of incidence. - The first peak occurs in younger women, typically aged **35-55 years**, often associated with **HPV infection** and vulvar intraepithelial neoplasia (VIN). - The second peak is seen in older women, aged **65-85 years**, where the disease is more commonly linked to **chronic inflammatory conditions** such as lichen sclerosus, often without HPV involvement. - This bimodal pattern reflects the **two distinct pathogenic pathways** of vulval cancer: HPV-related and non-HPV-related disease. *65-85 years* - While this age group represents a significant peak of vulval cancer incidence, particularly in cases **unrelated to HPV**, it does not encompass the entire distribution. - Focusing solely on this age range would **miss cases occurring in younger women**, which are increasingly recognized due to HPV-related disease. *35-55 years* - This age group does indeed represent a distinct peak for vulval cancer, especially in cases linked to **Human Papillomavirus (HPV) infection**. - However, ignoring the incidence in older women would provide an **incomplete understanding** of the disease's overall epidemiology. *Not age specific* - Vulval cancer is definitely **age-specific** with distinct age group distributions. - The incidence is **not uniformly distributed** across all ages but rather shows an increased likelihood within specific age ranges, demonstrating clear bimodal peaks.

Q: Risk of endometrial cancer is least in:

Multipara. ***Multipara*** - **Multiparity** (having multiple successful pregnancies) is associated with a reduced risk of **endometrial cancer**. Each pregnancy provides a period of reduced estrogen exposure and increased progesterone, which is protective against endometrial hyperplasia. - The protective effect is thought to be cumulative, with **higher parity** correlating with a lower risk. *Late menopause* - **Late menopause** prolongs the duration of lifetime exposure to endogenous unopposed estrogen, which significantly increases the risk of **endometrial cancer**. - Estrogen stimulates **endometrial proliferation**, and continued exposure without the counter-regulatory effects of progesterone (as seen in later menopause) can lead to atypical hyperplasia and malignancy. *A positive family history* - A **positive family history** of endometrial cancer suggests a genetic predisposition, which is a significant **risk factor**. - Conditions like **Lynch syndrome** (hereditary non-polyposis colorectal cancer or HNPCC) are strongly associated with an increased risk of endometrial cancer. *Obesity* - **Obesity** is a major risk factor for **endometrial cancer** due to increased peripheral conversion of androgens to estrogens in adipose tissue. - This leads to higher levels of **unopposed estrogen**, promoting endometrial proliferation and increasing cancer risk.

Q: True about HPV vaccination -

Efficacy > 70% for cervical cancer. ***Efficacy > 70% for cervical cancer*** - HPV vaccines are highly effective, with **bivalent, quadrivalent, and nonavalent vaccines** demonstrating remarkable efficacy against **high-grade cervical lesions** and **cervical cancer**, often exceeding 70% and even up to 90% against types 16 and 18. - The primary goal of HPV vaccination is to **prevent cervical cancer** caused by high-risk HPV types. *Two types are available in market* - This statement is incorrect; currently, there are **three types of HPV vaccines** available globally: **bivalent (targeting HPV 16/18)**, **quadrivalent (targeting HPV 6/11/16/18)**, and **nonavalent (targeting 9 HPV types)**. - The availability of vaccine types may vary by region, but more than two formulations exist worldwide. *Given in women age group 20-40 years* - HPV vaccination is primarily recommended for **adolescents and young adults**, typically starting around **age 11-12 years**, with catch-up vaccinations recommended up to **age 26 years** for those not previously vaccinated. - While some guidelines extend recommendations for individuals up to **age 45** after shared clinical decision-making, it is not routinely given across the broad 20-40 age group as a primary target. *Primary dose consists of 2 doses* - This statement is **incomplete and not universally true**; the HPV vaccination schedule **varies by age at initiation**. - For adolescents aged **9-14 years**, a **two-dose schedule** (0, 6-12 months) is recommended. - For individuals aged **15 years and older**, a **three-dose schedule** (0, 1-2, 6 months) is required for complete protection. - Since the schedule is age-dependent and not uniformly 2 doses, this statement cannot be considered fully correct.

Q: Point A and point B Manchester locations are important for treatment of which cancer –

Cervix. ***Cervix*** - **Point A** and **Point B Manchester** locations are historical references used in **brachytherapy** for **cervical cancer**, defining critical dose points within the pelvis. - These points help guide the placement of radiation sources to ensure adequate tumor coverage while sparing surrounding healthy tissues. *Vagina* - While radiation therapy is used for vaginal cancer, the **Manchester system's Point A and B** are specifically defined for cervical anatomy, not primarily for vaginal tumors. - Different dosimetry systems or specific vaginal applicators are often used for vaginal brachytherapy. *Ovary* - Ovarian cancer is primarily treated with **surgery and chemotherapy**; external beam radiation is sometimes used, but brachytherapy with **Point A and B** is not a standard approach. - The anatomical location of the ovaries makes brachytherapy less suitable for delivering targeted, high-dose radiation compared to cervical cancer. *Uterus* - Endometrial (uterine) cancer treatment may involve brachytherapy, but it typically uses different applicators (e.g., **tandem and ovoids** or cylinders) and dose specifications that are distinct from the Manchester system's **Point A and B** for the cervix. - The geometry and treatment volumes for uterine brachytherapy are different due to the distinct anatomy and tumor spread patterns.

Q: Early age at first sexual intercourse is a risk factor for

Carcinoma cervix. ***Carcinoma cervix*** - **Early age of sexual debut** is a significant risk factor for cervical cancer due to increased exposure time to **human papillomavirus (HPV)**, the primary cause. - The immature transformation zone of the cervix in younger individuals is more vulnerable to HPV infection and subsequent dysplastic changes. *Carcinoma vagina* - While HPV can cause vaginal cancer, the association with **early sexual debut** is less direct and less prominent compared to cervical cancer. - Risk factors often include a history of **cervical cancer** or **cervical intraepithelial neoplasia (CIN)**. *Carcinoma ovary* - Ovarian cancer is primarily linked to **genetic factors** (e.g., BRCA mutations), **nulliparity**, and **endometriosis**. - There is no established link between **age of sexual debut** and the risk of ovarian cancer. *Carcinoma vulva* - Vulvar cancer is also associated with **HPV infection**, but its primary risk factors often include **lichen sclerosus**, **chronic irritation**, and **immunodeficiency**. - The link to **early sexual debut** is less strong compared to cervical cancer, which is almost exclusively HPV-driven and highly sensitive to infection duration.

Q: Most commonly associated human papilloma virus with Cancer Cervix is?

HPV 16. ***HPV 16*** - **HPV 16** is the most prevalent **high-risk HPV type** responsible for approximately 50-60% of all cervical cancer cases globally. - It contains oncogenes, particularly **E6 and E7**, which interfere with tumor suppressor proteins such as **p53 and Rb**, leading to uncontrolled cell growth. *HPV 36* - **HPV 36** is considered a **low-risk HPV type** and is not commonly associated with the development of cervical cancer. - Low-risk HPV types are typically linked to **genital warts** (condylomas) and generally do not cause malignant transformation. *HPV 32* - **HPV 32** is also classified as a **low-risk HPV type** and does not play a significant role in the etiology of cervical cancer. - Its presence is more often associated with **benign lesions** of the oral cavity or skin, rather than high-grade cervical dysplasia or cancer. *HPV 24* - **HPV 24** is another **low-risk HPV type** with no known significant association with cervical cancer. - Like other low-risk types, it is usually cleared by the immune system and does not persist to cause oncogenic changes.

Q: A postmenopausal diabetic woman presents with bleeding per vaginum. The most likely diagnosis is :

Malignancy of the endometrium. ***Malignancy of the endometrium*** - **Postmenopausal bleeding** is the classic presenting symptom of **endometrial cancer**, which must be ruled out in all such cases. - **Diabetes** is a known risk factor for endometrial cancer, along with obesity, hypertension, and unopposed estrogen exposure. *Malignancy of the vulva* - Vulvar cancer typically presents with a **pruritic lesion**, lump, or ulcer on the vulva, rather than solely with vaginal bleeding. - While bleeding can occur from an advanced vulvar lesion, it is not the primary or most common presentation for new onset postmenopausal bleeding. *Malignancy of the cervix* - Cervical cancer often presents with **postcoital bleeding** or irregular vaginal bleeding in premenopausal women, or less commonly, postmenopausal bleeding. - Screening with **Pap smears** typically detects precancerous changes or early cervical cancer, making it less likely to be the first presentation with postmenopausal bleeding in a well-screened population. *Malignancy of the ovary* - Ovarian cancer is often asymptomatic in its early stages and presents with non-specific symptoms like **abdominal distension**, bloating, or pelvic pain. - **Vaginal bleeding** is not a typical symptom of ovarian cancer, unless the tumor is very large, involves adjacent structures, or is a hormone-producing tumor.

Q: Possible conversion to choriocarcinoma after hydatidiform mole is denoted by all of the following, except:

Sub urethral nodule. ***Sub urethral nodule*** - A **suburethral nodule** is a sign of **metastatic choriocarcinoma**, indicating the disease has already converted and spread. - The question asks for signs indicating a *possible conversion* to choriocarcinoma, not an established metastatic disease. *More Theca lutein cysts* - **Theca lutein cysts** result from overstimulation of the ovaries by high levels of **hCG**, which is elevated in both hydatidiform mole and choriocarcinoma. - An increase in these cysts suggests persistent trophoblastic activity, raising suspicion for transition to choriocarcinoma. *Increase uterus size* - An **enlarging uterus** post-evacuation of a hydatidiform mole can indicate persistent trophoblastic tissue or the development of choriocarcinoma. - This suggests continued growth and abnormal proliferation of trophoblastic cells. *Rising hCG* - **Persistently rising or plateauing hCG levels** after evacuation of a hydatidiform mole are the most critical indicator of persistent gestational trophoblastic disease (GTD), including potential conversion to choriocarcinoma. - Serial hCG monitoring is essential for surveillance following a molar pregnancy to detect malignant transformation.

Question 1

Tumor marker of epithelial ovarian carcinoma is:

Accepted Answer

CA-125

Answer

Alpha feto protein

Answer

Beta HCG

Answer

LDH

Question 2

What is the age group distribution for vulval cancer?

Accepted Answer

Both age groups (35-55 and 65-85 years)

Answer

65-85 years

Answer

35-55 years

Answer

Not age specific

Question 3

A 37-year-old unmarried nulliparous woman, having regular intercourse, is on oral contraceptive pills. Her mother was diagnosed with carcinoma breast at 60 years of age, and her elder sister was diagnosed with carcinoma ovary at 40 years of age. What is the next line of management?

Accepted Answer

Genetic counseling and screening for BRCA

Answer

Prophylactic surgery

Answer

Stop taking oral contraceptive pills

Answer

Routine mammography

Question 4

Risk of endometrial cancer is least in:

Accepted Answer

Multipara

Answer

Late menopause

Answer

A positive family history

Answer

Obesity

Question 5

True about HPV vaccination -

Accepted Answer

Efficacy > 70% for cervical cancer

Answer

Two types are available in market

Answer

Given in women age group 20-40 years

Answer

Primary dose consists of 2 doses

Question 6

Point A and point B Manchester locations are important for treatment of which cancer –

Accepted Answer

Cervix

Answer

Vagina

Answer

Ovary

Answer

Uterus

Question 7

Early age at first sexual intercourse is a risk factor for

Accepted Answer

Carcinoma cervix

Answer

Carcinoma vagina

Answer

Carcinoma ovary

Answer

Carcinoma vulva

Question 8

Most commonly associated human papilloma virus with Cancer Cervix is?

Accepted Answer

HPV 16

Answer

HPV 36

Answer

HPV 32

Answer

HPV 24

Question 9

A postmenopausal diabetic woman presents with bleeding per vaginum. The most likely diagnosis is :

Accepted Answer

Malignancy of the endometrium

Answer

Malignancy of the vulva

Answer

Malignancy of the cervix

Answer

Malignancy of the ovary

Question 10

Possible conversion to choriocarcinoma after hydatidiform mole is denoted by all of the following, except:

Accepted Answer

Sub urethral nodule

Answer

More Theca lutein cysts

Answer

Increase uterus size

Answer

Rising hCG

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

On this page

Practice by Chapter

Want unlimited practice?