Gynecologic Oncology — MCQs

Gynecologic Oncology Indian Medical PG Practice Questions and MCQs

Question 721: Tumor marker of epithelial ovarian carcinoma is:

A. Alpha feto protein
B. CA-125 (Correct Answer)
C. Beta HCG
D. LDH

Explanation: ***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.

Question 722: What is the age group distribution for vulval cancer?

A. 65-85 years
B. 35-55 years
C. Not age specific
D. Both age groups (35-55 and 65-85 years) (Correct Answer)

Explanation: ***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.

Question 723: 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?

A. Prophylactic surgery
B. Stop taking oral contraceptive pills
C. Routine mammography
D. Genetic counseling and screening for BRCA (Correct Answer)

Explanation: ***Genetic counseling and screening for BRCA*** - The patient's family history is highly suggestive of a **hereditary breast and ovarian cancer (HBOC) syndrome**, specifically a BRCA gene mutation. - **Sister with ovarian cancer at age 40** is a major red flag—ovarian cancer at ≤50 years in a first-degree relative is a specific criterion for BRCA testing according to NCCN guidelines. - Additionally, the mother's breast cancer (even at 60) combined with the sister's early ovarian cancer creates a **two first-degree relatives with breast/ovarian cancer pattern** that further strengthens the indication for genetic testing. - **Genetic counseling** is essential to assess risk, discuss testing options, interpret results, and plan appropriate risk-reduction strategies. - BRCA1/2 mutations confer a **40-60% lifetime risk of ovarian cancer** and **70-80% lifetime risk of breast cancer**. *Prophylactic surgery* - **Risk-reducing bilateral salpingo-oophorectomy (RRSO)** and possibly bilateral mastectomy are important options for BRCA mutation carriers, but should only be considered **after** genetic counseling and confirmed identification of a pathogenic mutation. - Proceeding directly to surgery without genetic confirmation would be premature and potentially unnecessary. *Stop taking oral contraceptive pills* - **OCPs actually reduce ovarian cancer risk** by approximately 50% with long-term use, which is protective even in BRCA carriers. - While OCPs may have a minimal impact on breast cancer risk, the ovarian cancer risk reduction benefit generally outweighs this concern. - Stopping OCPs without further genetic risk assessment is not the appropriate next step. *Routine mammography* - Standard mammography screening is insufficient for high-risk individuals with likely BRCA mutations. - If BRCA mutation is confirmed, enhanced screening protocols are recommended: **annual MRI plus mammography starting at age 30**, or 10 years before the earliest breast cancer in the family. - The priority is genetic assessment first to determine if intensified screening is warranted.

Question 724: Risk of endometrial cancer is least in:

A. Late menopause
B. A positive family history
C. Obesity
D. Multipara (Correct Answer)

Explanation: ***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.

Question 725: True about HPV vaccination -

A. Efficacy > 70% for cervical cancer (Correct Answer)
B. Two types are available in market
C. Given in women age group 20-40 years
D. Primary dose consists of 2 doses

Explanation: ***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.

Question 726: Point A and point B Manchester locations are important for treatment of which cancer –

A. Vagina
B. Cervix (Correct Answer)
C. Ovary
D. Uterus

Explanation: ***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.

Question 727: Early age at first sexual intercourse is a risk factor for

A. Carcinoma vagina
B. Carcinoma ovary
C. Carcinoma cervix (Correct Answer)
D. Carcinoma vulva

Explanation: ***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.

Question 728: Most commonly associated human papilloma virus with Cancer Cervix is?

A. HPV 36
B. HPV 32
C. HPV 16 (Correct Answer)
D. HPV 24

Explanation: ***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.

Question 729: A postmenopausal diabetic woman presents with bleeding per vaginum. The most likely diagnosis is :

A. Malignancy of the vulva
B. Malignancy of the cervix
C. Malignancy of the endometrium (Correct Answer)
D. Malignancy of the ovary

Explanation: ***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.

Question 730: Possible conversion to choriocarcinoma after hydatidiform mole is denoted by all of the following, except:

A. More Theca lutein cysts
B. Sub urethral nodule (Correct Answer)
C. Increase uterus size
D. Rising hCG

Explanation: ***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.

Practice by Chapter

Cervical Cancer

Practice Questions

Endometrial Cancer

Practice Questions

Ovarian Cancer

Practice Questions

Vulvar and Vaginal Cancer

Practice Questions

Gestational Trophoblastic Disease

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Screening for Gynecologic Cancers

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Principles of Gynecologic Oncology Surgery

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Radiation Therapy in Gynecologic Malignancies

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Chemotherapy in Gynecologic Oncology

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Palliative Care in Gynecologic Oncology

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