Gynecologic Oncology — MCQs

Gynecologic Oncology Indian Medical PG Practice Questions and MCQs

Question 81: A 40-year-old woman has CIN 2. What is the next step in management?

A. Colposcopy (Correct Answer)
B. Cryotherapy
C. Conization
D. Hysterectomy

Explanation: ### Explanation **Correct Answer: A. Colposcopy** The management of Cervical Intraepithelial Neoplasia (CIN) depends on the grade of the lesion and the adequacy of the initial evaluation. **CIN 2** is considered a high-grade squamous intraepithelial lesion (HSIL). According to standard protocols (ASCCP guidelines), the immediate next step for a biopsy-confirmed CIN 2 or CIN 3 is **Colposcopy** to assess the extent of the lesion and the visibility of the Squamocolumnar Junction (SCJ). In clinical practice, if a screening pap smear shows HSIL, colposcopy is mandatory to obtain a directed biopsy. If the biopsy then confirms CIN 2, the colposcopy findings determine whether the patient undergoes local ablation or excisional procedures. **Why other options are incorrect:** * **B. Cryotherapy:** This is an ablative method. It is only indicated if the entire lesion is visible, the SCJ is fully seen, and there is no evidence of endocervical involvement or malignancy. It is not the "next step" before a full colposcopic assessment. * **C. Conization (Excisional Procedure):** This is indicated if the colposcopy is "unsatisfactory" (SCJ not visible), if there is a discrepancy between cytology and biopsy, or if microinvasion is suspected. It is a treatment step, not the immediate diagnostic next step. * **D. Hysterectomy:** This is an over-treatment for CIN 2. It is only considered for CIN 3 in specific cases (e.g., completed family size with co-existing uterine pathology) and is never the first-line management. **High-Yield Clinical Pearls for NEET-PG:** * **CIN 1:** Usually managed by observation (repeat PAP in 1 year) as most regress spontaneously. * **CIN 2 & 3:** Grouped as "High-grade"; require treatment (Ablation vs. Excision). * **Ablation (Cryo/Laser):** Used only if the SCJ is **visible** and no suspicion of invasion. * **Excision (LEEP/Cold Knife Conization):** Mandatory if the SCJ is **not visible** or the lesion extends into the endocervical canal.

Question 82: Which of the following would be the earliest symptom of Ca cervix?

A. Pain
B. Postcoital bleeding (Correct Answer)
C. Metrorrhagia
D. Menorrhagia

Explanation: **Explanation:** **1. Why Postcoital Bleeding is Correct:** Carcinoma of the cervix typically originates at the **Transformation Zone**. As the malignant cells proliferate, they create a friable, vascularized lesion on the ectocervix. Because these neoplastic blood vessels are fragile and lack a proper basement membrane, minor mechanical trauma—specifically during sexual intercourse—causes them to rupture. Therefore, **postcoital bleeding** is classically regarded as the earliest and most specific clinical symptom of cervical cancer in sexually active women. **2. Analysis of Incorrect Options:** * **Pain (Option A):** This is a **late feature** of Ca cervix. Pain typically signifies advanced disease (Stage IIIB or IV), indicating involvement of the pelvic side walls, nerve plexus compression, or hydronephrosis. * **Metrorrhagia (Option C):** While intermenstrual bleeding occurs as the tumor grows and undergoes spontaneous surface necrosis, it usually follows the initial phase of contact bleeding (postcoital). * **Menorrhagia (Option D):** Heavy menstrual bleeding is rarely a primary symptom of cervical cancer. It is more characteristic of uterine pathologies like fibroids, adenomyosis, or endometrial hyperplasia. **3. Clinical Pearls for NEET-PG:** * **Most common symptom:** Abnormal vaginal bleeding (often intermenstrual or postcoital). * **Most common sign:** A growth or ulcer on the cervix that bleeds on touch (friable). * **Screening Gold Standard:** Pap smear (cytology) is for screening; however, the **confirmatory diagnosis** is always via **Colposcopy-directed biopsy**. * **Triad of advanced Ca Cervix:** Unilateral leg edema, sciatic pain, and hydronephrosis (indicates pelvic wall involvement). * **Note:** In postmenopausal women, the earliest symptom may present as a foul-smelling serosanguinous discharge.

Question 83: Endometrial cancer is associated with all EXCEPT:

A. Fibromyoma
B. Endometrial hyperplasia
C. Dysgerminoma (Correct Answer)
D. Granulosa cell tumor

Explanation: **Explanation:** The core concept behind the development of **Type I Endometrial Carcinoma** (the most common variety) is **unopposed estrogen stimulation**. To answer this question, one must identify which condition does *not* contribute to an increased estrogenic state. * **Why Dysgerminoma is the correct answer:** Dysgerminoma is a germ cell tumor of the ovary, typically seen in young women. It is **hormonally inert** (it does not produce estrogen). While it may produce LDH or occasionally hCG (if syncytiotrophoblast cells are present), it has no association with endometrial proliferation or cancer. * **Why the other options are associated:** * **Granulosa Cell Tumor:** This is a sex cord-stromal tumor that **secretes high levels of estrogen**. This chronic estrogenic exposure leads to endometrial hyperplasia and, in approximately 5–15% of cases, progresses to endometrial carcinoma. * **Endometrial Hyperplasia:** Specifically "Atypical Hyperplasia" (Endometrial Intraepithelial Neoplasia) is the direct **precursor lesion** for Type I endometrial cancer due to prolonged estrogenic stimulation. * **Fibromyoma (Leiomyoma):** While not a precursor, fibroids are frequently **co-associated** with endometrial cancer because both are estrogen-dependent conditions. They often coexist in patients with obesity, nulliparity, or polycystic ovary syndrome (PCOS). **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Obesity (peripheral conversion of androstenedione to estrone), Lynch Syndrome (HNPCC), Tamoxifen use, and Nulliparity. * **Protective Factors:** Combined Oral Contraceptive Pills (COCPs), smoking (decreases estrogen levels, though harmful otherwise), and multiparity. * **Most common subtype:** Endometrioid adenocarcinoma. * **Investigation of choice:** Fractional Curettage or Pipelle Biopsy (Gold Standard for diagnosis).

Question 84: 69XXY represents which of the following conditions?

A. Complete mole
B. Partial mole (Correct Answer)
C. Down syndrome
D. None of the above

Explanation: **Explanation:** The correct answer is **B. Partial mole**. **1. Understanding the Correct Answer:** A partial hydatidiform mole is characterized by **triploidy**, most commonly resulting from **dispermy** (two sperm fertilizing a single normal haploid ovum). This results in a total of 69 chromosomes. The most frequent karyotype is **69,XXX**, followed by **69,XXY** (as seen in the question) and rarely 69,XYY. Pathologically, partial moles show focal trophoblastic proliferation, scalloped chorionic villi, and the presence of fetal tissues or red blood cells. **2. Why Incorrect Options are Wrong:** * **A. Complete mole:** These are typically **diploid (46,XX or 46,XY)**. They occur when an "empty" egg (lacking maternal chromosomes) is fertilized by one sperm that duplicates its DNA (90%) or by two sperm (10%). There is no fetal tissue present. * **C. Down syndrome:** This is a **trisomy (47,XX+21 or 47,XY+21)**, meaning there is an extra copy of chromosome 21, not an entire extra set of chromosomes (triploidy). **3. NEET-PG High-Yield Pearls:** * **Karyotype:** Complete Mole = 46,XX (Most common); Partial Mole = 69,XXX or 69,XXY. * **Fetal Tissue:** Present in Partial Mole; Absent in Complete Mole. * **Malignant Potential:** Higher in Complete Mole (15–20%) compared to Partial Mole (<5%). * **hCG Levels:** Markedly elevated in Complete Mole; only mildly elevated in Partial Mole. * **Snowstorm Appearance:** Classic ultrasound finding for Complete Mole. Partial moles often appear as an incomplete spontaneous abortion.

Question 85: Recurrence of gestational trophoblastic tumor can be associated with all except?

A. Enlarged uterus
B. Persistent lutein cysts in ovaries
C. Plateau of hCG (Correct Answer)
D. Sub urethral nodule

Explanation: ### Explanation The diagnosis of **Gestational Trophoblastic Neoplasia (GTN)** or recurrence is based on specific FIGO criteria regarding Beta-hCG levels. **Why "Plateau of hCG" is the correct answer:** A **plateau of hCG** (defined as four values within ±10% over three weeks) is a diagnostic criterion for the **initial diagnosis** of GTN following a molar pregnancy, not a sign of **recurrence**. Recurrence refers to the reappearance of disease after hCG levels have already normalized (<5 mIU/mL) for a period. In cases of recurrence, hCG levels will **rise** again rather than plateau. **Analysis of Incorrect Options:** * **Enlarged Uterus:** Recurrence often involves the growth of trophoblastic tissue within the myometrium (Choriocarcinoma or Invasive Mole), leading to asymmetrical uterine enlargement and irregular vaginal bleeding. * **Persistent Lutein Cysts:** High levels of hCG (produced by the recurring tumor) cause hyperstimulation of the ovaries, leading to the formation or persistence of **Theca Lutein cysts**. * **Sub-urethral Nodule:** Choriocarcinoma is highly vascular and spreads hematogenously. The **vagina** (specifically the sub-urethral area) is a common site for metastatic deposits, appearing as bluish, friable nodules that bleed easily. **Clinical Pearls for NEET-PG:** * **FIGO Criteria for GTN:** 1. hCG plateau for 3 weeks. 2. hCG rise (>10%) for 2 weeks. 3. Histological diagnosis of choriocarcinoma. 4. Persistent hCG 6 months after molar evacuation. * **Most common site of metastasis:** Lungs (80%), followed by the Vagina (30%). * **Treatment:** GTN is highly chemosensitive. Low-risk cases (WHO score ≤6) are treated with **Methotrexate**, while high-risk cases (score ≥7) require **EMA-CO** regimen.

Question 86: Which is the commonest malignancy of the ovary?

A. Serous type (Correct Answer)
B. Mucinous type
C. Dermoid cyst
D. Granulosa cell tumor

Explanation: **Explanation:** Ovarian tumors are classified based on their tissue of origin into Epithelial, Germ Cell, and Sex Cord-Stromal tumors. **Surface Epithelial-Stromal tumors** are the most common category, accounting for approximately 90% of all ovarian malignancies. **Why Serous type is correct:** Among epithelial tumors, the **Serous type** is the most frequent. It accounts for about 50–60% of all epithelial ovarian cancers. These tumors are often bilateral and are frequently diagnosed at an advanced stage. They are histologically characterized by the presence of **Psammoma bodies** (concentric calcifications). **Why other options are incorrect:** * **Mucinous type:** These are the second most common epithelial tumors (approx. 10–15%). They are typically large, multiloculated, and less likely to be bilateral compared to serous tumors. * **Dermoid cyst (Mature Cystic Teratoma):** This is a Germ Cell tumor. While it is the **most common benign ovarian tumor** in young women, it is rarely malignant (only 1–2% undergo malignant transformation, usually to Squamous Cell Carcinoma). * **Granulosa cell tumor:** This is a Sex Cord-Stromal tumor. It is much rarer than epithelial tumors and is known for producing estrogen, often leading to endometrial hyperplasia. **High-Yield Clinical Pearls for NEET-PG:** * **Most common ovarian tumor overall:** Dermoid cyst (Benign). * **Most common malignant ovarian tumor:** Serous cystadenocarcinoma. * **Most common Germ Cell tumor:** Dermoid cyst. * **Most common malignant Germ Cell tumor:** Dysgerminoma. * **Tumor Marker:** CA-125 is the primary marker for epithelial ovarian tumors (especially serous).

Question 87: Which female genital malignancy is most common in pregnancy?

A. Ovarian cancer
B. Vaginal/vulvar cancer
C. Endometrial cancer
D. Cervical cancer (Correct Answer)

Explanation: **Explanation:** **Cervical cancer** is the most common gynecologic malignancy diagnosed during pregnancy, with an estimated incidence of 1 to 10 per 10,000 pregnancies. The primary reason for this high frequency is the **overlap in age demographics**: the peak incidence of cervical intraepithelial neoplasia (CIN) and early-stage cervical cancer coincides with the peak reproductive years of women. Furthermore, routine prenatal care involves a mandatory pelvic examination and often a Pap smear, leading to increased detection of asymptomatic cases. **Analysis of Incorrect Options:** * **Ovarian Cancer:** This is the second most common gynecologic malignancy in pregnancy. While adnexal masses are frequently discovered via routine ultrasound, the majority are functional cysts or benign dermoids rather than malignancies. * **Vaginal/Vulvar Cancer:** These are extremely rare in women of reproductive age, as they typically occur in postmenopausal women or are associated with chronic HPV/VIN/LSIL, which take years to progress. * **Endometrial Cancer:** This is virtually incompatible with pregnancy. The hormonal environment of pregnancy (high progesterone) is protective against endometrial proliferation, and the presence of a gestational sac makes the development of endometrial carcinoma physiologically improbable. **High-Yield Clinical Pearls for NEET-PG:** * **Most common stage:** Most cases diagnosed in pregnancy are **Stage IB1**. * **Diagnostic approach:** Colposcopy is safe in pregnancy, but **endocervical curettage (ECC) is strictly contraindicated**. * **Biopsy:** Only performed if invasion is suspected. * **Management:** For early-stage disease diagnosed after 24 weeks, treatment can often be delayed until fetal maturity is reached. * **Mode of delivery:** Vaginal delivery is generally avoided in visible cervical lesions to prevent hemorrhage and potential tumor seeding in the episiotomy scar.

Question 88: Which of the following is characteristic of a hydatidiform mole?

A. Is associated with molar pregnancy
B. Recurrence is 2%
C. Shows a 'snow storm' appearance on ultrasound
D. All the above (Correct Answer)

Explanation: A hydatidiform mole (molar pregnancy) is a type of Gestational Trophoblastic Disease (GTD) resulting from abnormal fertilization, leading to the proliferation of trophoblastic tissue. **Explanation of Options:** * **A. Is associated with molar pregnancy:** Hydatidiform mole is the histological hallmark of a molar pregnancy. It is categorized into **Complete Mole** (46,XX or 46,XY; no fetal parts) and **Partial Mole** (69,XXX or 69,XXY; fetal parts present). * **B. Recurrence is 2%:** After one molar pregnancy, the risk of recurrence in a subsequent pregnancy is approximately **1–2%**. If a woman has two prior molar pregnancies, the risk increases significantly to about 15–20%. * **C. Shows a 'snow storm' appearance on ultrasound:** This is the classic sonographic description of a complete mole. The multiple echogenic foci interspersed with small cystic spaces (representing hydropic villi) create a "snowstorm" or "bunch of grapes" appearance. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Histopathology is the definitive diagnosis, but Ultrasound is the initial investigation of choice. * **Biochemical Marker:** Serum **beta-hCG** levels are characteristically markedly elevated (often >100,000 mIU/mL in complete moles). * **Clinical Presentation:** The most common symptom is painless vaginal bleeding. Other features include uterine size greater than gestational age, hyperemesis gravidarum, and early-onset preeclampsia (before 20 weeks). * **Management:** Suction and Evacuation (S&E) is the treatment of choice. Follow-up with weekly hCG levels is mandatory to rule out Gestational Trophoblastic Neoplasia (GTN).

Question 89: Which of the following is a serum marker for ovarian carcinoma?

A. CA-125 (Correct Answer)
B. Fibronectin
C. Acid Phosphatase
D. PSA

Explanation: **Explanation:** **Correct Option: A. CA-125** Cancer Antigen 125 (CA-125) is the most widely used serum tumor marker for **epithelial ovarian cancer**, particularly the serous subtype. It is a high-molecular-weight glycoprotein produced by derivatives of the coelomic epithelium (pleura, pericardium, and peritoneum). While it is used for monitoring treatment response and detecting recurrence, its utility as a screening tool is limited due to low sensitivity in early stages and low specificity in premenopausal women. **Incorrect Options:** * **B. Fibronectin:** This is a glycoprotein involved in cell adhesion. In obstetrics, **Fetal Fibronectin (fFN)** is used as a biochemical marker to predict the risk of preterm labor, not ovarian malignancy. * **C. Acid Phosphatase:** Historically used as a marker for **prostate cancer** (specifically Prostatic Acid Phosphatase), though it has largely been replaced by PSA. * **D. PSA (Prostate-Specific Antigen):** This is the gold-standard screening and monitoring marker for **prostate adenocarcinoma**. **High-Yield Clinical Pearls for NEET-PG:** * **Specificity:** CA-125 can be elevated in benign conditions like endometriosis, PID, pregnancy, and fibroids, making it less specific in younger patients. * **Germ Cell Tumors (GCT):** Remember specific markers for GCTs: * **Yolk Sac Tumor:** Alpha-fetoprotein (AFP). * **Dysgerminoma:** LDH (and sometimes hCG). * **Choriocarcinoma:** beta-hCG. * **Granulosa Cell Tumor:** Inhibin B. * **Meigs Syndrome:** Characterized by the triad of benign ovarian fibroma, ascites, and pleural effusion; CA-125 can be elevated here despite the tumor being benign.

Question 90: Dysgerminoma is classified as which type of ovarian tumor?

A. Epithelial ovarian tumor
B. Sex cord stromal tumor
C. Germ cell tumor (Correct Answer)
D. Metastatic ovarian tumor

Explanation: **Explanation:** **Dysgerminoma** is the most common malignant **Germ Cell Tumor (GCT)** of the ovary. These tumors originate from the primordial germ cells of the ovary, which are the same cells that give rise to oocytes. Dysgerminoma is the female histological counterpart of the testicular seminoma. **Analysis of Options:** * **Option C (Correct):** Germ cell tumors (GCTs) account for 15-20% of all ovarian neoplasms. Dysgerminoma is the most frequent malignant GCT, typically occurring in young women (adolescents and those in their 20s). * **Option A (Incorrect):** Epithelial tumors (e.g., Serous, Mucinous) arise from the surface epithelium of the ovary. They are the most common type of ovarian cancer overall but usually occur in postmenopausal women. * **Option B (Incorrect):** Sex cord-stromal tumors (e.g., Granulosa cell tumor, Sertoli-Leydig tumor) arise from the ovarian stroma or primitive sex cords. * **Option D (Incorrect):** Metastatic tumors (e.g., Krukenberg tumor) are secondary cancers spreading to the ovary, most commonly from the gastrointestinal tract. **High-Yield Clinical Pearls for NEET-PG:** 1. **Tumor Markers:** Dysgerminoma is characteristically associated with elevated **LDH (Lactate Dehydrogenase)** and sometimes **Alkaline Phosphatase**. Unlike other GCTs, hCG and AFP are usually normal (unless mixed components are present). 2. **Radiosensitivity:** It is highly radiosensitive and chemosensitive, boasting an excellent prognosis even in advanced stages. 3. **Association:** It is the most common ovarian malignancy found in patients with **gonadal dysgenesis** (e.g., Swyer syndrome). 4. **Microscopy:** Features large, clear cells with central nuclei ("fried egg" appearance) separated by fibrous septa containing lymphocytes.

Practice by Chapter

Cervical Cancer

Practice Questions

Endometrial Cancer

Practice Questions

Ovarian Cancer

Practice Questions

Vulvar and Vaginal Cancer

Practice Questions

Gestational Trophoblastic Disease

Practice Questions

Screening for Gynecologic Cancers

Practice Questions

Principles of Gynecologic Oncology Surgery

Practice Questions

Radiation Therapy in Gynecologic Malignancies

Practice Questions

Chemotherapy in Gynecologic Oncology

Practice Questions

Palliative Care in Gynecologic Oncology

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free