Gynecologic Oncology — MCQs
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Which of the following ovarian neoplasms is MOST commonly associated with pseudomyxoma peritonei when it arises from ovarian primaries?
Which of the following pre-malignant conditions of the vulva is characterized by well-defined erythematous lesions with a smooth, shiny appearance?
Which of the following is the MOST significant risk factor for carcinoma of the cervix?
In which stage of cervical cancer is brachytherapy primarily utilized?
All of the following investigations are used in FIGO staging of carcinoma cervix except:
Gynecologic Oncology Indian Medical PG Practice Questions and MCQs
Question 801: Which of the following ovarian neoplasms is MOST commonly associated with pseudomyxoma peritonei when it arises from ovarian primaries?
- A. Ovarian dermoid
- B. Ovarian Cyst
- C. Serous cystadenocarcinoma
- D. Mucinous cystadenocarcinoma (Correct Answer)
Explanation: ***Mucinous cystadenocarcinoma*** - **Mucinous cystadenocarcinoma** of the ovary can produce large amounts of mucin, which can rupture and spread throughout the peritoneal cavity, leading to **pseudomyxoma peritonei**. - When pseudomyxoma peritonei originates from ovarian primary tumors, it is most frequently associated with this specific type of ovarian cancer, characterized by its **mucin-secreting epithelial cells**. *Ovarian Cyst* - An **ovarian cyst** is a general term for a fluid-filled sac within the ovary and is typically **benign**. - While some cysts may contain mucinous material, simple ovarian cysts are not inherently malignant and do not commonly cause **pseudomyxoma peritonei**. *Ovarian dermoid* - An **ovarian dermoid**, or mature cystic teratoma, consists of tissues from all three germ layers and often contains hair, teeth, or sebaceous material. - Though they can rupture and cause chemical peritonitis, they are **rarely associated with pseudomyxoma peritonei**, which specifically involves mucin. *Serous cystadenocarcinoma* - **Serous cystadenocarcinoma** is the most common type of ovarian cancer but typically produces a watery, serous fluid rather than mucin. - While it can spread widely throughout the peritoneum, it does not lead to **pseudomyxoma peritonei**, which is characterized by the accumulation of gelatinous mucinous material.
Question 802: Which of the following pre-malignant conditions of the vulva is characterized by well-defined erythematous lesions with a smooth, shiny appearance?
- A. Lichen sclerosus
- B. Leukoplakia
- C. Vulval intraepithelial neoplasia
- D. Paget's disease of the vulva (Correct Answer)
Explanation: ***Paget's disease of the vulva*** - This condition presents as **well-defined, erythematous lesions** with a **smooth, shiny appearance** due to the presence of intraepithelial adenocarcinoma cells. - The lesions may also be associated with **pruritus** and can sometimes have a white, macerated, or eczematous appearance. *Vulval intraepithelial neoplasia* - VIN typically presents as **single or multifocal lesions** that can be white, red, or pigmented but are often **raised and warty** rather than smooth and shiny. - The appearance is highly variable and can be subtle, sometimes only detected on colposcopy after application of acetic acid. *Lichen sclerosus* - This is a chronic inflammatory dermatosis causing **thin, white, parchment-like skin** with characteristic **cigarette paper wrinkling** and atrophy, not erythematous and smooth lesions. - It often leads to architectural distortion and severe pruritus, and is associated with an increased risk of vulvar squamous cell carcinoma. *Leukoplakia* - Leukoplakia is a clinical term referring to any **white patch or plaque** on the mucous membrane that cannot be scraped off. - It describes a **gross appearance** rather than a specific diagnosis, and can be seen in various conditions, including lichen sclerosus or VIN, but itself is not characterized by erythema or shininess.
Question 803: Which of the following is the MOST significant risk factor for carcinoma of the cervix?
- A. Multiparity
- B. HIV infection
- C. None of the options (Correct Answer)
- D. Smoking
Explanation: ***None of the options*** - The **MOST significant risk factor** for cervical carcinoma is **persistent infection with high-risk HPV types** (especially HPV 16 and 18), which is found in >99% of cervical cancers and is considered the **necessary cause**. - Since **HPV infection** is not listed among the options, none of the given choices represents the most significant risk factor. - While HIV, smoking, and multiparity are all associated with increased cervical cancer risk, they are **secondary factors** that work primarily by affecting HPV persistence or acting as co-factors. *HIV infection* - **HIV infection** is an important risk factor as it compromises immune surveillance and reduces the ability to clear **HPV infections**, leading to persistent high-risk HPV and progression to CIN and invasive cancer. - However, HIV increases risk **through its effect on HPV persistence**, not as an independent primary cause. - Without HPV, HIV alone does not cause cervical cancer. *Smoking* - **Smoking** is an independent co-factor that increases cervical cancer risk, with tobacco carcinogens found in cervical mucus acting synergistically with **HPV**. - It is a secondary risk factor, not the primary cause. *Multiparity* - **Multiparity** shows a weak association with cervical cancer risk, possibly related to hormonal changes or increased HPV exposure. - It is the least significant among the listed factors and is not a primary driver of cervical carcinogenesis.
Question 804: In which stage of cervical cancer is brachytherapy primarily utilized?
- A. Stage IVB cervical cancer
- B. Stage II-III cervical cancer (Correct Answer)
- C. Stage IA cervical cancer
- D. Stage Ib1 cervical cancer
Explanation: ***Stage II-III cervical cancer*** - **Brachytherapy** is a crucial component of definitive chemoradiation in locally advanced cervical cancer, targeting the uterus and cervix. - This stage often involves **regional spread** to parametrial tissues or lower vagina, requiring combined external beam radiation therapy (EBRT) and brachytherapy for optimal local control. - **Chemoradiation with brachytherapy is the PRIMARY treatment modality** for Stage II-III, making this the stage where brachytherapy is most prominently utilized. *Stage IVB cervical cancer* - This stage involves **distant metastases**, where the primary treatment strategy shifts towards **palliative systemic therapy** (chemotherapy or immunotherapy). - While localized radiation might be used for symptom control, **brachytherapy** alone is not curative and not the primary treatment modality. *Stage IA cervical cancer* - This stage represents very **early-stage disease** confined to the cervix, typically treated with **surgical excision** (e.g., cone biopsy or hysterectomy). - Radiotherapy, including brachytherapy, is generally reserved for patients who are not surgical candidates or for those with high-risk features post-surgery. *Stage Ib1 cervical cancer* - This stage involves a **tumor confined to the cervix** (visible lesion ≤2 cm), with **two equal treatment options**: **radical hysterectomy** OR **definitive chemoradiation** with brachytherapy. - While brachytherapy is used when radiation is chosen for Ib1, it serves as an ALTERNATIVE to surgery rather than the PRIMARY modality, unlike in Stage II-III where radiation is the standard first-line treatment.
Question 805: All of the following investigations are used in FIGO staging of carcinoma cervix except:
- A. Cystoscopy
- B. Proctoscopy
- C. Intravenous pyelography
- D. CECT (Correct Answer)
Explanation: ***CECT*** - While CECT (Contrast-Enhanced Computed Tomography) is a valuable tool for assessing **tumor size** and **metastasis** in cervical cancer, the traditional FIGO (International Federation of Gynecology and Obstetrics) staging system relies primarily on **clinical examination** and specific imaging/procedural findings, not routine CECT. - FIGO staging is largely **clinical** and does not formally require CECT for staging decisions, though it may be used for treatment planning. - **Note:** The 2018 FIGO revision allows advanced imaging (CT/MRI/PET) to be incorporated if available, but the traditional investigations (IVP, cystoscopy, proctoscopy) remain the standard baseline for staging. *Intravenous pyelography* - **Hydronephrosis** due to ureteral obstruction (indicating advanced disease) is a criterion for Stage IIIB in FIGO staging. - IVP (Intravenous Pyelography) is used to detect hydronephrosis, which helps in differentiating between Stage IIB and Stage IIIB disease. - This is a **traditional FIGO staging investigation**. *Cystoscopy* - **Bladder involvement** with bullous edema or tumor infiltration directly into the bladder mucosa is a criterion for Stage IVA. - Cystoscopy is performed to visually inspect the bladder for such involvement. - This is a **traditional FIGO staging investigation**. *Proctoscopy* - **Rectal involvement** with bullous edema or tumor infiltration directly into the rectal mucosa is also a criterion for Stage IVA. - Proctoscopy is used to visually examine the rectum for signs of tumor extension. - This is a **traditional FIGO staging investigation**.
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