Gynecologic Oncology — MCQs

Gynecologic Oncology Indian Medical PG Practice Questions and MCQs

Question 791: Assuming that the other ovary is grossly normal, what is the likelihood that the contralateral ovary is involved in serous ovarian carcinoma?

A. 5%
B. 15%
C. 33% (Correct Answer)
D. 45%

Explanation: ***Correct: 33%*** - Up to **one-third of patients** with serous ovarian carcinoma involving one ovary will have **microscopic involvement** of the contralateral, grossly normal ovary. - This high rate of occult involvement often necessitates **bilateral oophorectomy** in surgical staging for serous ovarian carcinoma. *Incorrect: 5%* - This percentage significantly **underestimates the true incidence** of contralateral involvement in serous ovarian carcinoma. - Serous carcinoma is known for its tendency to be **multifocal** and spread early, even when the presenting lesion appears unilateral. *Incorrect: 15%* - While higher than 5%, 15% still **underestimates the frequent bilateral nature** of serous ovarian carcinoma, even when one ovary appears normal. - Studies consistently show **higher rates of occult contralateral disease**, particularly for serous histologic types. *Incorrect: 45%* - This percentage is **somewhat higher than the generally accepted rate** for contralateral microscopic involvement in grossly normal ovaries affected by serous carcinoma. - While bilateral involvement is common, a 45% rate might be more reflective of **macroscopic or readily apparent involvement** rather than purely occult disease.

Question 792: At which anatomical site does cervical carcinoma most commonly develop?

A. Squamo-columnar junction (transformation zone) (Correct Answer)
B. Cervical lip
C. Isthmus
D. Internal os

Explanation: ***Squamo-columnar junction (transformation zone)*** - The **squamo-columnar junction**, also known as the **transformation zone**, is the site where the columnar epithelium of the endocervix meets the squamous epithelium of the ectocervix. - This area is highly susceptible to oncogenic changes due to its active metaplasia and exposure to risk factors like **human papillomavirus (HPV)**. *Isthmus* - The **isthmus** is the narrow lower portion of the uterus, between the cervix and the body of the uterus. - While it is part of the uterine structure, it is not the primary site for the development of cervical carcinoma. *Cervical lip* - The term **cervical lip** usually refers to the borders of the external os or the everted portion of the cervix. - While it's part of the cervix, it's not specifically identified as the most common origin point for carcinoma compared to the active cellular changes occurring at the squamo-columnar junction. *Internal os* - The **internal os** is the opening between the endocervical canal and the uterine cavity. - While it's a critical anatomical landmark, it does not represent the most common area for the initial development of cervical cancer.

Question 793: Most common type of cervical cancer is:

A. Small cell carcinoma
B. Adenocarcinoma
C. Adenosquamous carcinoma
D. Squamous cell carcinoma (Correct Answer)

Explanation: ***Squamous cell carcinoma*** - This is by far the **most common type of cervical cancer**, accounting for approximately 70-80% of all cases. - It arises from the **squamous cells** on the exocervix, the outer part of the cervix that projects into the vagina. *Small cell carcinoma* - This is a **rare and highly aggressive** type of cervical cancer, accounting for less than 1% of cases. - It is associated with a **poor prognosis** and often requires intensive treatment. *Adenocarcinoma* - This type of cervical cancer accounts for about 10-20% of cases, making it the **second most common** type after squamous cell carcinoma. - It originates from the **glandular cells** of the endocervix, the inner part of the cervix. *Adenosquamous carcinoma* - This is a **rare mixed tumor** containing both squamous and glandular components, accounting for approximately 3-5% of cervical cancers. - It tends to have a **more aggressive behavior** and worse prognosis compared to pure adenocarcinoma or squamous cell carcinoma.

Question 794: Carcinosarcoma most commonly arises in which organ?

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

Explanation: ***Uterus*** - Carcinosarcoma, also known as **malignant mixed Müllerian tumor**, commonly arises in the uterus, characterized by both **carcinomatous and sarcomatous components** [1]. - It typically presents with **postmenopausal bleeding** and is often diagnosed in older women [1]. *Ovary* - While ovarian tumors can be malignant, **carcinosarcoma is not commonly found** in the ovary; ovarian tumors are more often serous or mucinous in nature. - Ovarian cancer tends to present with **nonspecific abdominal symptoms** rather than the classic features of carcinosarcoma. *Vagina* - Vaginal cancers are rare, and while **sarcoma may occur here**, carcinosarcoma predominantly involves the uterus rather than the vagina. - The types of vaginal malignancies tend to be more commonly **squamous cell carcinomas** or adenocarcinomas. *Cervix* - Cervical cancers are predominantly **squamous cell carcinomas** or adenocarcinomas, and carcinosarcoma is not typically associated with the cervix. - The cervix also has distinctive associated risk factors, such as **HPV infection**, which are not linked to carcinosarcoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1022-1024.

Question 795: In which of the following conditions is serial monitoring of β-HCG post-treatment most useful?

A. Hydatidiform mole (Correct Answer)
B. Choriocarcinoma
C. Ectopic pregnancy
D. None of the options

Explanation: ***Hydatidiform mole*** - Serial monitoring of **β-HCG** is **essential** after evacuation of a hydatidiform mole to detect **persistent gestational trophoblastic disease (GTD)** or malignant transformation. - **β-HCG** monitoring continues until three consecutive weekly negative values, then monthly for 6-12 months. - Persistently elevated or rising **β-HCG** levels after molar evacuation indicate the need for **chemotherapy** and possible progression to **invasive mole or choriocarcinoma** (occurs in 15-20% of complete moles). - This is the **classic indication** for serial β-HCG monitoring and represents the **primary surveillance** tool to detect malignant transformation early. *Choriocarcinoma* - While serial **β-HCG** monitoring is **absolutely critical** for choriocarcinoma during and after chemotherapy, this represents monitoring of **established malignancy** rather than surveillance for potential malignant transformation. - In choriocarcinoma, **β-HCG** is used to assess **treatment response** and confirm remission, with monitoring continuing for **12 months after normalization**. - The question emphasizes "most useful" - hydatidiform mole monitoring is considered the **primary/classic** indication because it involves **screening for occult malignancy** in all patients post-evacuation, whereas choriocarcinoma monitoring occurs after diagnosis is already established. *Ectopic pregnancy* - **β-HCG** is used to confirm resolution after treatment (medical or surgical), with levels monitored until they return to non-pregnant values. - Post-treatment monitoring focuses on ensuring **complete resolution** rather than detecting malignant transformation, making it less critical than GTD surveillance. - Monitoring is shorter-term and does not carry the same implications for malignancy risk. *None of the options* - Incorrect because serial **β-HCG** monitoring is **standard practice** and highly useful for hydatidiform mole follow-up to detect complications early.

Question 796: Which of the following screening methods is NOT effective for early detection of cancer in asymptomatic women?

A. USG in endometrial cancer
B. CA-125 for ovarian cancer (Correct Answer)
C. Pap smear for cervical cancer
D. Mammography for breast cancer

Explanation: ***CA-125 for ovarian cancer*** - **CA-125 lacks sufficient sensitivity and specificity** for screening asymptomatic women, leading to high rates of **false positives** and **false negatives**. - Major randomized trials (**UKCTOCS, PLCO**) demonstrated **no mortality benefit** from CA-125 screening and increased unnecessary invasive procedures. *USG in endometrial cancer* - **Transvaginal ultrasonography** effectively measures **endometrial thickness** and aids in risk stratification for symptomatic women. - While not used for population screening, it serves as a valuable **diagnostic adjunct** in evaluating postmenopausal bleeding and guiding biopsy decisions. *Pap smear for cervical cancer* - The **Pap smear** is the **gold standard** screening method that has dramatically reduced cervical cancer incidence and mortality. - It effectively detects **precancerous lesions** (CIN) and early cervical cancers, allowing for timely intervention and treatment. *Mammography for breast cancer* - **Mammography screening** is proven effective in reducing **breast cancer mortality** by 20-40% in women aged 50-69 years. - It can detect **early-stage breast cancers** and **microcalcifications** before they become palpable, enabling early treatment.

Question 797: Which of the following is not true for endodermal sinus tumor:

A. It produces hCG which is a useful tumor marker (Correct Answer)
B. It is the second most common malignant germ cell tumor of the ovary
C. Schiller-Duval body is the characteristic histological feature
D. Surgical staging and unilateral salpingo-oophorectomy is generally the treatment of choice

Explanation: **It produces hCG which is a useful tumor marker** - Endodermal sinus tumor (Yolk sac tumor) primarily produces **alpha-fetoprotein (AFP)**, which is the characteristic and highly useful tumor marker for monitoring disease activity and treatment response. - **Human chorionic gonadotropin (hCG)** is typically produced by **choriocarcinoma** and some mixed germ cell tumors, not usually by pure endodermal sinus tumors. *It is the second most common malignant germ cell tumor of the ovary* - **Dysgerminoma** is the most common malignant germ cell tumor of the ovary, accounting for about half of all cases. - **Endodermal sinus tumor** is indeed the second most common, making up approximately 15-20% of malignant ovarian germ cell tumors. *Schiller-Duval body is the characteristic histological feature* - **Schiller-Duval bodies** are pathognomonic histological features of endodermal sinus tumors. - These structures resemble primitive glomeruli with a central capillary surrounded by germ cells within a cystic space. *Surgical staging and unilateral salpingo-oophorectomy is generally the treatment of choice* - For early-stage disease, **unilateral salpingo-oophorectomy** is the standard surgical approach to preserve fertility when possible. - **Surgical staging** is crucial to determine the extent of the disease and guide subsequent management, which typically includes adjuvant chemotherapy.

Question 798: Which of the following is NOT an indication for postoperative radiotherapy in a case of carcinoma endometrium?

A. Positive lymph nodes
B. Endocervical involvement
C. Myometrial invasion >1/2 thickness
D. Tumor positive for estrogen receptors (Correct Answer)

Explanation: ***Tumor positive for estrogen receptors*** - A tumor being **positive for estrogen receptors** indicates a potential responsiveness to **hormonal therapy**, rather than an indication for postoperative radiotherapy. - While it guides treatment decisions, it does not suggest a need for radiation to reduce local recurrence risk, unlike other high-risk features. *Myometrial invasion >1/2 thickness* - **Deep myometrial invasion (>1/2 thickness)** is a significant **risk factor for recurrence** and metastases in endometrial carcinoma. - Radiotherapy is often indicated in such cases to improve **local control** and reduce recurrence. *Positive lymph nodes* - The presence of **positive lymph nodes** signifies regional spread of the cancer. - This is a strong indication for **adjuvant therapy**, including radiotherapy, to target residual disease and prevent recurrence. *Endocervical involvement* - **Endocervical stromal invasion** indicates a more aggressive tumor that has extended beyond the endometrium. - This finding is associated with a higher risk of **locoregional recurrence**, making postoperative radiotherapy a crucial component of treatment to improve outcomes.

Question 799: What is the current treatment of choice for choriocarcinoma?

A. Hysterectomy
B. Chemotherapy with Methotrexate (Correct Answer)
C. Radiotherapy
D. Observation

Explanation: ***Chemotherapy with Methotrexate*** - **Chemotherapy** is the cornerstone of treatment for choriocarcinoma due to its **high chemosensitivity**. - **Single-agent chemotherapy** with **methotrexate** or actinomycin D is highly effective for **low-risk disease**, while **multi-agent regimens** (EMA-CO protocol) are used for high-risk cases. - This systemic approach effectively targets the rapidly dividing **trophoblastic cells**, often achieving **cure rates exceeding 90%**. - Chemotherapy is preferred over surgery because choriocarcinoma typically has **widespread metastatic potential** even when the primary tumor appears localized. *Hysterectomy* - While hysterectomy may be considered in specific situations (intractable bleeding, isolated uterine disease in patients with completed fertility), it is **not the primary treatment of choice**. - The **high metastatic potential** of choriocarcinoma necessitates a **systemic treatment** approach rather than local surgical intervention alone. - Surgery alone would not address micrometastases commonly present at diagnosis. *Radiotherapy* - **Radiotherapy** is not a primary treatment for choriocarcinoma due to its **excellent chemosensitivity**. - It may be used adjunctively in special circumstances such as **brain metastases** for local control, but chemotherapy remains the definitive treatment. - The systemic nature of the disease makes local radiation therapy insufficient as sole treatment. *Observation* - **Choriocarcinoma** is an aggressive, rapidly progressive malignancy with **high metastatic potential**; therefore, **observation alone is inappropriate**. - Delaying active treatment could lead to widespread dissemination and significantly worsen prognosis. - Unlike some gestational trophoblastic diseases (e.g., complete mole), choriocarcinoma requires immediate chemotherapy.

Question 800: Villous pattern is lost in which condition?

A. Partial mole
B. Invasive mole
C. Hydatidiform mole
D. Choriocarcinoma (Correct Answer)

Explanation: ***Choriocarcinoma*** - Choriocarcinoma is a highly malignant tumor originating from trophoblastic tissue, characterized by the **absence of chorionic villi**. - Its microscopic appearance shows sheets of anaplastic cytotrophoblast and syncytiotrophoblast without a villous architecture, differentiating it from hydatidiform moles. *Invasive mole* - An invasive mole retains the **chorionic villi structure**, which is a defining feature that distinguishes it from choriocarcinoma. - While it exhibits an aggressive, infiltrative growth into the myometrium, the presence of villi is maintained. *Partial mole* - In a partial mole, **swollen chorionic villi** are still present but are interspersed with normal-appearing villi, and the trophoblastic proliferation is often focal. - The villous pattern, though abnormal, is not lost entirely, distinguishing it from choriocarcinoma. *Hydatidiform mole* - Hydatidiform moles (complete or partial) are characterized by the presence of **hydropic, swollen villi** with varying degrees of trophoblastic proliferation. - The **basic villous architecture** is preserved, although significantly altered and hydropic, unlike the complete absence of villi in choriocarcinoma.

Practice by Chapter

Cervical Cancer

Practice Questions

Endometrial Cancer

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Ovarian Cancer

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Vulvar and Vaginal Cancer

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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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