Gynecologic Oncology Practice Questions

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

33%. ***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.

Q: Most common type of cervical cancer is:

Squamous cell carcinoma. ***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.

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

Squamo-columnar junction (transformation zone). ***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.

Q: Carcinosarcoma most commonly arises in which organ?

Uterus. ***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.

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

CA-125 for ovarian cancer. ***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.

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

It produces hCG which is a useful tumor marker. **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.

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

Tumor positive for estrogen receptors. ***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.

Q: What is the current treatment of choice for choriocarcinoma?

Chemotherapy with Methotrexate. ***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.

Q: Villous pattern is lost in which condition?

Choriocarcinoma. ***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.

Question 1

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

Accepted Answer

33%

Answer

5%

Answer

15%

Answer

45%

Question 2

Most common type of cervical cancer is:

Accepted Answer

Squamous cell carcinoma

Answer

Small cell carcinoma

Answer

Adenocarcinoma

Answer

Adenosquamous carcinoma

Question 3

At which anatomical site does cervical carcinoma most commonly develop?

Accepted Answer

Squamo-columnar junction (transformation zone)

Answer

Cervical lip

Answer

Isthmus

Answer

Internal os

Question 4

Carcinosarcoma most commonly arises in which organ?

Accepted Answer

Uterus

Answer

Cervix

Answer

Vagina

Answer

Ovary

Question 5

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

Accepted Answer

Hydatidiform mole

Answer

Choriocarcinoma

Answer

Ectopic pregnancy

Answer

None of the options

Question 6

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

Accepted Answer

CA-125 for ovarian cancer

Answer

USG in endometrial cancer

Answer

Pap smear for cervical cancer

Answer

Mammography for breast cancer

Question 7

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

Accepted Answer

It produces hCG which is a useful tumor marker

Answer

It is the second most common malignant germ cell tumor of the ovary

Answer

Schiller-Duval body is the characteristic histological feature

Answer

Surgical staging and unilateral salpingo-oophorectomy is generally the treatment of choice

Question 8

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

Accepted Answer

Tumor positive for estrogen receptors

Answer

Positive lymph nodes

Answer

Endocervical involvement

Answer

Myometrial invasion >1/2 thickness

Question 9

What is the current treatment of choice for choriocarcinoma?

Accepted Answer

Chemotherapy with Methotrexate

Answer

Hysterectomy

Answer

Radiotherapy

Answer

Observation

Question 10

Villous pattern is lost in which condition?

Accepted Answer

Choriocarcinoma

Answer

Partial mole

Answer

Invasive mole

Answer

Hydatidiform mole

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

On this page

Practice by Chapter

Want unlimited practice?