Gynecologic Oncology Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Gynecologic Oncology. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Gynecologic Oncology Indian Medical PG Question 1: In a suspected case of ovarian cancer, imaging work-up is required for all of the following EXCEPT:
- A. Characterization of lesion
- B. Assess resectability
- C. Detection of adnexal lesion
- D. Staging (Correct Answer)
Gynecologic Oncology Explanation: ***Staging***
- **Clinical staging** for ovarian cancer is primarily surgical, meaning the definitive stage is determined during exploratory laparotomy rather than pre-operative imaging.
- While imaging helps assess the extent of disease, the final **FIGO stage** relies on direct visualization and biopsy or resection of suspicious lesions during surgery.
*Characterization of lesion*
- Imaging modalities like **ultrasound**, **CT**, or **MRI** are crucial for determining features such as **cyst vs. solid**, size, septations, and presence of ascites, helping to differentiate benign from malignant masses.
- This characterization guides the initial management plan, including the need for surgery or further investigations.
*Assess resectability*
- Imaging is essential to evaluate the **extent of tumor spread**, particularly to assess for widespread peritoneal carcinomatosis, bowel involvement, or distant metastases.
- This information helps surgeons plan for optimal **cytoreductive surgery** and determine if a complete resection is feasible.
*Detection of adnexal lesion*
- The initial detection of an adnexal mass often occurs via imaging, typically **transvaginal ultrasound**, when a patient presents with symptoms or during a routine examination.
- Imaging confirms the presence and location of the lesion, which is the first step in the diagnostic work-up for suspected ovarian cancer.
Gynecologic Oncology Indian Medical PG Question 2: What is the stage of endometrial carcinoma when it involves the cervix?
- A. Stage 1: Cancer confined to the uterus.
- B. Stage 3: Cancer has spread beyond the uterus but not beyond the pelvis.
- C. Stage 2: Cancer has spread to the cervix. (Correct Answer)
- D. Stage 4: Cancer has spread to distant sites.
Gynecologic Oncology Explanation: ***Stage 2: Cancer has spread to the cervix***
- According to the **FIGO 2009 staging system** for endometrial carcinoma (applicable at the time of this exam), involvement of the cervix with **stromal invasion** without extending beyond the uterus into the parametrium is classified as **Stage II**.
- This stage indicates that the cancer remains within the confines of the uterus but has spread from the uterine corpus to the **cervical stroma**.
- **Note:** FIGO staging was updated in 2023, but this question reflects the 2009 criteria used at the time.
*Stage 1: Cancer confined to the uterus*
- This stage indicates that the cancer is **limited to the uterine corpus (body of the uterus)**, with no spread to the cervix or beyond.
- Stage 1 is further subdivided based on the **depth of myometrial invasion**, but the cervix is not involved at this stage.
*Stage 3: Cancer has spread beyond the uterus but not beyond the pelvis*
- Stage 3 involves spread **beyond the uterus but is still confined to the pelvis**, including parametrial involvement, vaginal or serosal invasion, or pelvic/paraaortic lymph node involvement.
- This stage represents more extensive local or regional spread than simply cervical involvement.
*Stage 4: Cancer has spread to distant sites*
- This is the most advanced stage, indicating that the cancer has spread to **distant organs** (e.g., lungs, bone) or involves the **bladder or bowel mucosa**.
- Stage 4 represents a systemic disease rather than localized pelvic spread.
Gynecologic Oncology Indian Medical PG Question 3: Which of the following are favourable factors in prognosis of ovarian malignancy?
1. Older age group
2. Well-differentiated tumour
3. Smaller tumour volume
4. Younger age group
Select the correct answer using the code given below.
- A. 1, 3 and 4
- B. 2, 3 and 4 (Correct Answer)
- C. 1, 2 and 4
- D. 1, 2 and 3
Gynecologic Oncology Explanation: ***2, 3 and 4***
- **Well-differentiated tumours** indicate less aggressive cell growth and a better prognosis due to their similarity to normal tissue and slower metastatic potential.
- **Smaller tumour volume** implies less disease burden, making the cancer more amenable to treatment and reducing the likelihood of widespread metastasis.
- **Younger age group** is often associated with better overall health, greater tolerance to aggressive treatments, and a more robust immune response, contributing to a better prognosis in ovarian cancer.
*1, 3 and 4*
- **Younger age group**, **well-differentiated tumour**, and **smaller tumour volume** are indeed favorable prognostic factors.
- However, **older age group** is generally associated with a poorer prognosis in ovarian malignancy due to increased comorbidities and decreased tolerance to aggressive therapies.
*1, 2 and 4*
- While **well-differentiated tumours** and **younger age group** are favorable, **older age group** is typically a poor prognostic indicator.
- This option incorrectly includes older age as a favorable factor and omits **smaller tumour volume**, which is a significant positive prognosticator.
*1, 2 and 3*
- This option incorrectly lists **older age group** as a favorable factor, which usually indicates a poorer prognosis.
- It also includes **well-differentiated tumour** and **smaller tumour volume**, which are indeed favorable, but is flawed by the inclusion of older age.
Gynecologic Oncology Indian Medical PG Question 4: Consider the following statements regarding Carcinoma Cervix:
1. Clinical staging is done
2. Treatment if provided in stage I leads to survival rate of 80–90 %
3. Surgery is preferred in young women with stage III disease
4. HPV is considered to be the causative agent Which of the statements given above are correct?
- A. 1, 2, 3 and 4
- B. 3 and 4 only
- C. 1 and 2 only
- D. 1, 2 and 4 only (Correct Answer)
Gynecologic Oncology Explanation: ***1, 2 and 4 only***
- **Clinical staging** is the primary method for staging cervical cancer using the FIGO system, as opposed to surgical staging used for other gynecological cancers.
- Early detection and treatment in **Stage I** cervical cancer offer excellent prognoses, with survival rates often reported between **80-90%**.
- **Human Papillomavirus (HPV)** is the established causative agent for nearly all cases of cervical cancer, particularly high-risk subtypes like HPV-16 and HPV-18.
*1, 2, 3 and 4*
- This option is incorrect because it includes statement 3, which is false.
- **Stage III** cervical cancer represents locally advanced disease with parametrial involvement or pelvic wall extension, making it unsuitable for primary surgical management.
- Stage III disease is managed with **concurrent chemoradiation** (cisplatin-based chemotherapy with external beam radiation and brachytherapy), not surgery, regardless of patient age.
*3 and 4 only*
- This option is incorrect as it includes the false statement 3 about surgery in Stage III disease.
- It also omits the correct statements regarding **clinical staging** (statement 1) and the excellent **survival rates** in Stage I (statement 2).
*1 and 2 only*
- This option is incomplete as it correctly identifies that **clinical staging** is used and that **Stage I treatment offers good survival**.
- However, it fails to include statement 4, which correctly identifies **HPV as the causative agent** of cervical cancer—a fundamental fact in cervical cancer etiology.
Gynecologic Oncology Indian Medical PG Question 5: What is the most appropriate next step in management for a patient with a Stage III ovarian cancer with partial response to platinum-based chemotherapy?
- A. Bevacizumab
- B. Perform surgery (Correct Answer)
- C. Switch to radiotherapy
- D. Continue regimen
Gynecologic Oncology Explanation: ***Perform surgery (Interval Debulking Surgery)***
- In **Stage III ovarian cancer**, after an initial partial response to **platinum-based chemotherapy**, **interval debulking surgery** is the standard next step to remove residual disease.
- This approach aims to reduce tumor burden to an optimal level (< 1 cm residual disease), which has been shown to improve overall survival in multiple trials (EORTC 55971, GOG-152).
- Performed after 3-4 cycles of neoadjuvant chemotherapy when the patient has demonstrated response and is medically fit for surgery.
*Bevacizumab*
- **Bevacizumab** is an **anti-angiogenic agent** used in ovarian cancer, typically as part of frontline maintenance therapy or for recurrent disease, not as the immediate next step after partial response to primary chemotherapy when surgery is feasible.
- While it can be incorporated into maintenance treatment post-surgery, it's not the primary next step after partial response when interval debulking surgery is indicated.
*Switch to radiotherapy*
- **Radiotherapy** has a limited role in the primary treatment of advanced ovarian cancer due to its widespread peritoneal nature.
- It is sometimes used for localized recurrence or symptom palliation, but not as a standard next step after partial response to chemotherapy in Stage III disease.
*Continue regimen*
- Continuing the same regimen after only a **partial response** is generally not the most effective strategy when further tumor reduction via surgery is possible.
- The goal in advanced ovarian cancer is **maximal cytoreduction**, and if residual disease is present after neoadjuvant chemotherapy, interval debulking surgery is preferred over continued chemotherapy alone.
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