Screening for Gynecologic Cancers — MCQs
Which of the following screening methods is NOT effective for early detection of cancer in asymptomatic women?
Use of OCPs is known to protect against the following malignancies except:
Which drug is most appropriate for reducing risk of ovarian cancer in a BRCA1 positive woman not planning for children?
A Post-Menopausal woman complains of spotting per vaginum after 5 years of menopause. USG reveals endometrial thickness of 7 mm and an intramural fibroid of size 3cm. Next step in management is?
A 45-year-old woman presents with a history of cervical erosion and spotting for the past 2 months. What is the next best step?
Laparoscopy is the diagnostic procedure of choice for:
Screening is not useful in which carcinoma
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 33-year-old female presents with heavy menstrual bleeding for 6 months. On examination, no abnormalities were found, and an ultrasound also appeared normal. After failing non-hormonal treatment, what is the next appropriate management step?
Which one of the following methods is NOT used for cervical cancer screening?
Screening for Gynecologic Cancers Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following screening methods is NOT effective for early detection of cancer in asymptomatic women?
- A. Office endometrial washing for endometrial cancer
- B. USG in endometrial cancer
- C. CA-125 for ovarian cancer (Correct Answer)
- D. Pap smear for cervical cancer
Explanation: ***CA-125 for ovarian cancer*** - While elevated in some ovarian cancers, **CA-125 lacks sufficient sensitivity and specificity** as a stand-alone screening tool for early detection in asymptomatic women. - Its use for general population screening has **not been shown to reduce mortality** from ovarian cancer and can lead to **false positives** and unnecessary invasive procedures. - Major trials (UKCTOCS, PLCO) have not demonstrated mortality benefit from CA-125 screening. *Office endometrial washing for endometrial cancer* - While this involves collecting cells from the uterine lining for cytological analysis, **endometrial washing/cytology has poor sensitivity** and is not established as an effective screening method. - However, it has shown **some promise in research settings** for high-risk individuals, though it is not a standard or widely recommended screening approach. - **Endometrial biopsy** remains the gold standard for diagnosis in symptomatic women, but routine screening of asymptomatic women is not recommended. *USG in endometrial cancer* - **Transvaginal ultrasonography (TVUS)** can effectively measure **endometrial thickness** and is valuable for evaluating postmenopausal bleeding. - While not used for population-based screening of asymptomatic women, it aids in **risk stratification** and guiding further investigation like biopsy in symptomatic patients. - When used appropriately in symptomatic women, TVUS is a useful diagnostic adjunct. *Pap smear for cervical cancer* - The **Pap smear** is a highly effective and widely adopted screening method for **cervical cancer**, detecting precancerous and cancerous changes in cervical cells. - Its widespread use has **significantly reduced the incidence and mortality rates** of cervical cancer due to its ability to identify abnormalities early, allowing for timely intervention. - This is the gold standard for cancer screening with proven mortality benefit.
Question 2: Use of OCPs is known to protect against the following malignancies except:
- A. Colorectal carcinomas
- B. Carcinoma cervix (Correct Answer)
- C. Ovarian carcinoma
- D. Endometrial carcinoma
Explanation: ***Carcinoma cervix*** - While oral contraceptive pills (OCPs) offer protection against some cancers, they are **not protective against cervical cancer**. - In fact, long-term use of OCPs is considered a **risk factor for cervical cancer**, especially in conjunction with human papillomavirus (HPV) infection. *Colorectal carcinomas* - OCP use has been consistently associated with a **reduced risk of colorectal cancer**. - The protective effect is thought to be mediated by various hormonal mechanisms, including their impact on **bile acid metabolism** and **estrogen receptors in the colon**. *Ovarian carcinoma* - OCPs provide significant and **long-lasting protection against ovarian cancer**. - This protective effect is believed to be due to the **suppression of ovulation**, thereby reducing the continuous trauma and repair of the ovarian epithelium. *Endometrial carcinoma* - OCPs are known to offer substantial **protection against endometrial cancer**. - The progestin component in combined OCPs effectively **counteracts the proliferative effects of estrogen** on the endometrium, reducing the risk of hyperplasia and subsequent cancer.
Question 3: Which drug is most appropriate for reducing risk of ovarian cancer in a BRCA1 positive woman not planning for children?
- A. Gonadotropin-releasing hormone
- B. Oral contraceptive pills (Correct Answer)
- C. Tamoxifen
- D. Progesterone IUD
Explanation: ***Oral contraceptive pills*** **Oral contraceptive pills (OCPs)** are the most appropriate pharmacological intervention for **reducing ovarian cancer risk in BRCA1/2 carriers** who do not plan to have children. - OCPs **suppress ovulation**, and this reduction in ovulatory cycles is associated with a **~50% decrease in epithelial ovarian cancer risk** in BRCA mutation carriers - The protective effect increases with **longer duration of use** (5+ years provides maximum benefit) - This is a **well-established, evidence-based strategy** supported by multiple large cohort studies and meta-analyses - OCPs are recommended by major guidelines (NCCN, ACOG) for ovarian cancer risk reduction in this population prior to risk-reducing salpingo-oophorectomy *Gonadotropin-releasing hormone* **GnRH agonists or antagonists** are not recommended for long-term ovarian cancer prevention in BRCA carriers. - Primarily used for **infertility treatments, endometriosis management**, and uterine fibroid treatment through temporary ovarian suppression - **Not established as effective** for ovarian cancer risk reduction - **Not suitable for long-term use** due to significant side effects (bone loss, menopausal symptoms) - Lack of evidence supporting their role in cancer prevention *Tamoxifen* **Tamoxifen** is a **selective estrogen receptor modulator (SERM)** used for breast cancer prevention and treatment, not ovarian cancer prevention. - Effective for **reducing breast cancer risk** in high-risk women (including BRCA carriers) - **Does not reduce ovarian cancer risk** and has no protective effect against epithelial ovarian cancer - May **slightly increase endometrial cancer risk** (relative risk ~2-3) - Not indicated for ovarian cancer risk reduction *Progesterone IUD* A **levonorgestrel-releasing intrauterine device (IUD)** provides excellent contraception and manages heavy menstrual bleeding, but does not reduce ovarian cancer risk. - Acts **locally on the endometrium** with minimal systemic hormonal effects - **Does not reliably suppress ovulation** (only 5-15% of cycles are anovulatory) - **No established protective effect** against ovarian cancer - While useful for contraception and menstrual management, it lacks the ovulation suppression needed for cancer risk reduction
Question 4: A Post-Menopausal woman complains of spotting per vaginum after 5 years of menopause. USG reveals endometrial thickness of 7 mm and an intramural fibroid of size 3cm. Next step in management is?
- A. CA 125 levels
- B. Paps smear and follow up
- C. Myomectomy
- D. Endometrial biopsy (Correct Answer)
Explanation: ***Endometrial biopsy*** - Post-menopausal **vaginal bleeding** or spotting, especially with an **endometrial thickness of ≥ 4-5 mm** on ultrasound, is highly suspicious for endometrial hyperplasia or carcinoma and warrants an endometrial biopsy for definitive diagnosis. - An endometrial biopsy is crucial to rule out endometrial malignancy, as this is the primary concern in such presentations. *CA 125 levels* - **CA 125** is primarily used as a tumor marker for **ovarian cancer** surveillance and response to treatment, not for initial diagnosis of post-menopausal bleeding or endometrial pathology. - Elevated CA 125 can be found in various benign conditions as well and is not specific enough to guide the initial management of post-menopausal bleeding without tissue sampling. *Paps smear and follow up* - A **Pap smear** screens for **cervical abnormalities** and **cervical cancer**, not endometrial pathology. - While it's part of routine gynecological care, it will not address the investigation of post-menopausal bleeding originating from the uterus. *Myomectomy* - **Myomectomy** is a surgical procedure to remove **uterine fibroids**, typically when they are causing symptoms like heavy menstrual bleeding or pressure. - In a post-menopausal woman with spotting, the intramural fibroid may or may not be directly responsible, and the priority is to exclude **endometrial cancer** before considering fibroid-specific interventions.
Question 5: A 45-year-old woman presents with a history of cervical erosion and spotting for the past 2 months. What is the next best step?
- A. LBC + HPV (Correct Answer)
- B. Pap smear + HSV
- C. Pap smear + HBV
- D. LBC + HSV
Explanation: ***LBC + HPV*** - Cervical erosion and spotting are concerning for **cervical intraepithelial neoplasia (CIN)** or **cervical cancer**, making **Liquid-Based Cytology (LBC)** the appropriate screening method. - **Human Papillomavirus (HPV) testing** is crucial as persistent high-risk HPV infection is the primary cause of cervical cancer and helps in risk stratification and management. *Pap smear + HSV* - A **routine Pap smear** (conventional cytology) is less sensitive than LBC for detecting abnormal cervical cells and is generally being phased out by LBC. - **Herpes Simplex Virus (HSV)** causes genital herpes and is not directly associated with cervical cancer, thus testing for it in this context is not the most appropriate immediate next step. *Pap smear + HBV* - As mentioned, a **routine Pap smear** is not the preferred method for cervical cancer screening compared to LBC. - **Hepatitis B Virus (HBV)** causes liver disease and is entirely unrelated to cervical pathology; therefore, testing for it would be irrelevant to the patient's symptoms. *LBC + HSV* - While **LBC** is the correct advanced cytology method, adding **HSV testing** is not indicated as HSV does not cause cervical cancer or intraepithelial lesions that present with cervical erosion and spotting. - Focus should be on identifying potential malignancy or pre-malignant changes with HPV co-testing, not sexually transmitted infections unrelated to cancer risk.
Question 6: Laparoscopy is the diagnostic procedure of choice for:
- A. Ca rectum
- B. Endometriosis (Correct Answer)
- C. Ca cervix
- D. Ca uterus
Explanation: ***Endometriosis*** - Laparoscopy allows for direct visualization of **endometrial implants** outside the uterus, which is crucial for diagnosis and staging. - It also allows for **biopsy confirmation** and potential treatment (excision or ablation) of endometriotic lesions during the same procedure. *Ca rectum* - The primary diagnostic procedure for **rectal cancer** is usually **colonoscopy** with biopsy. - **Laparoscopy** may be used for staging **rectal cancer** but it is not the initial diagnostic procedure of choice. *Ca cervix* - The primary diagnostic procedure for **cervical cancer** is a **colposcopy** with directed biopsy of suspicious lesions. - **Laparoscopy** is not typically used for the initial diagnosis of **cervical cancer** but may be used for staging in advanced cases. *Ca uterus* - The primary diagnostic procedure for **uterine cancer** (endometrial cancer) is an **endometrial biopsy** or **dilation and curettage (D&C)**. - **Laparoscopy** may be used for surgical staging of **uterine cancer** but is not the initial diagnostic procedure.
Question 7: Screening is not useful in which carcinoma
- A. Testicular carcinoma (Correct Answer)
- B. Carcinoma prostate
- C. Carcinoma colon
- D. Carcinoma breast
Explanation: Testicular carcinoma - **Testicular cancer** typically presents as a painless mass, and **self-examination** is often emphasized for early detection rather than formal screening programs due to low incidence and variable benefits. - While early detection is important, population-wide screening for testicular cancer is **not recommended** due to its rarity and lack of evidence for improved outcomes compared to opportunistic detection. *Carcinoma prostate* - **Prostate cancer screening** using **PSA (prostate-specific antigen)** testing and digital rectal examinations is routinely performed, though its benefits and risks are debated [1]. - Early detection aims to identify potentially aggressive cancers, but also leads to **overdiagnosis and overtreatment** of indolent lesions [1]. *Carcinoma colon* - **Colorectal cancer screening** is highly effective and widely recommended through methods like **colonoscopy**, fecal occult blood testing, and sigmoisingoscopy. - Screening aims to detect **polyps** before they become cancerous or find cancer at an early, treatable stage, significantly reducing mortality. *Carcinoma breast* - **Breast cancer screening** using **mammography** is a well-established and highly effective method for early detection in women. - Early detection allows for timely treatment, significantly improving prognosis and reducing breast cancer mortality.
Question 8: 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 9: A 33-year-old female presents with heavy menstrual bleeding for 6 months. On examination, no abnormalities were found, and an ultrasound also appeared normal. After failing non-hormonal treatment, what is the next appropriate management step?
- A. Perform endometrial sampling.
- B. Initiate hormonal therapy. (Correct Answer)
- C. Consider hysterectomy.
- D. Perform dilation and curettage (D&C).
Explanation: ***Initiate hormonal therapy.*** - For unexplained **heavy menstrual bleeding (HMB)** in a young woman with a normal workup, hormonal therapy (e.g., combined oral contraceptives, progestin-only pills, or a progestin-releasing IUD) is the first-line medical treatment after non-hormonal options fail. - These treatments stabilize the **endometrial lining** and reduce blood flow, effectively managing symptoms. *Perform endometrial sampling.* - **Endometrial sampling** is typically reserved for women at higher risk of endometrial hyperplasia or cancer, such as those over 45 with HMB, or younger women with persistent irregular bleeding, risk factors for endometrial cancer (e.g., obesity, PCOS), or unresponsive to initial medical therapy. - In this 33-year-old with normal ultrasound and no other identified risk factors, the likelihood of endometrial pathology is low, making sampling less urgent as a *next* step. *Consider hysterectomy.* - **Hysterectomy** is a definitive surgical procedure usually reserved for severe, persistent HMB that has failed all less invasive medical and surgical treatments, or for cases where there is significant uterine pathology (e.g., large fibroids, adenomyosis) not present here. - It is an irreversible procedure and generally not considered early in the management of heavy menstrual bleeding in a 33-year-old without uterine abnormalities. *Perform dilation and curettage (D&C).* - A **D&C** is a procedure to remove tissue from the uterus, often used for diagnostic purposes (like endometrial sampling) or to remove retained products of conception. - While it can temporarily reduce bleeding by removing some endometrial lining, it is not a long-term solution for treating abnormal uterine bleeding and is typically not indicated as a primary therapeutic step for chronic HMB in the absence of acute severe bleeding or suspected pathology requiring tissue removal.
Question 10: Which one of the following methods is NOT used for cervical cancer screening?
- A. VILI
- B. VIA
- C. Cervical biopsy (Correct Answer)
- D. Pap smear
Explanation: ***Cervical biopsy*** - A **cervical biopsy** is a diagnostic procedure performed after an abnormal screening result to confirm the presence of **precancerous** or **cancerous** cells. - It involves removing a tissue sample for histological examination and is not a primary screening method. *VILI* - **Visual Inspection with Lugol's Iodine** (**VILI**) is a method used for cervical cancer screening, particularly in low-resource settings. - It involves applying **Lugol's iodine** to the cervix, where normal glycogen-rich cells stain brown, while abnormal, glycogen-deficient cells remain unstained (yellow). *VIA* - **Visual Inspection with Acetic Acid** (**VIA**) is a cost-effective screening method for cervical cancer, especially in settings where cytology is not readily available. - After applying **acetic acid** to the cervix, abnormal areas with high nuclear-to-cytoplasmic ratio and increased protein content rapidly coagulate the mucus and turn white. *Pap smear* - A **Pap smear** (Papanicolaou test) is a widely used and validated screening test for cervical cancer. - It involves collecting cells from the cervix to detect **dysplastic** or **premalignant changes** and is effective in reducing cervical cancer incidence and mortality.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free