Gynecologic Oncology Practice Questions

Q: What is Type IIIB Endometrial cancer according to FIGO staging?

Endometrial cancer with vaginal involvement. **Explanation:** The FIGO staging for endometrial cancer was significantly updated in 2023. Understanding the distinction between local, regional, and distant spread is crucial for NEET-PG. **Why the correct answer is right:** **Stage III** represents regional spread of the tumor. Specifically, **Stage IIIB** is defined by the involvement of the **vagina and/or the parametria**. This indicates that the cancer has extended beyond the uterus but remains within the pelvic structures adjacent to the primary site. **Analysis of incorrect options:** * **Option A (Cervical stroma):** This corresponds to **Stage II**. Stage I is confined to the corpus, while Stage II involves the cervical stroma but does not extend beyond the uterus. * **Option C (Uterine adnexa):** This corresponds to **Stage IIIA1**. Involvement of the adnexa (ovaries or fallopian tubes) or the uterine serosa (Stage IIIA2) constitutes Stage IIIA. * **Option D (Pelvic lymph nodes):** This corresponds to **Stage IIIC1**. If the cancer spreads to the pelvic lymph nodes, it is IIIC1; if it reaches the para-aortic lymph nodes, it is IIIC2. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Presentation:** Postmenopausal bleeding (PMB). * **Risk Factors:** Obesity, nulliparity, early menarche/late menopause, and Lynch Syndrome (HNPCC). * **Staging Method:** Endometrial cancer is **surgically staged**. * **2023 Update Note:** The new FIGO staging now incorporates histological grades and molecular markers (like POLE mutations or p53 status) into the staging criteria, but the anatomical definitions for Stage III remain a frequent exam focus.

Q: In pseudomyxoma peritonei, mucinous cyst-adenocarcinoma of which of the following organs is involved?

Ovary. **Explanation:** **Pseudomyxoma Peritonei (PMP)** is a clinical syndrome characterized by the accumulation of gelatinous, mucinous ascites ("jelly belly") within the peritoneal cavity. It typically results from the rupture of a mucinous tumor, leading to the seeding of mucus-secreting cells onto the peritoneal surfaces. **Why Ovary is Correct:** In females, the **ovary** is a classic primary site for mucinous cystadenocarcinomas that can lead to PMP. While modern pathology suggests that the majority of PMP cases actually originate from a primary **appendiceal** mucinous tumor (which then involves the ovaries secondarily), the ovary remains the most significant gynecological organ associated with this condition in standard medical examinations. When a mucinous ovarian tumor ruptures or undergoes surface extension, it leads to the characteristic intraperitoneal mucin accumulation. **Why Other Options are Incorrect:** * **Pancreas:** While the pancreas can develop mucinous cystic neoplasms, they rarely present as classic PMP; they are more likely to cause localized spread or biliary obstruction. * **Kidney:** Primary mucinous adenocarcinoma of the kidney is extremely rare and is not a recognized cause of PMP. * **Abdominal Testis:** There is no established clinical association between germ cell tumors or other malignancies of an undescended testis and the development of pseudomyxoma peritonei. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Source:** The **Appendix** is now considered the most common primary site for PMP (often via a low-grade appendiceal mucinous neoplasm - LAMN). * **Clinical Presentation:** Patients often present with increasing abdominal girth, "jelly belly" on laparotomy, and the "scalloping" of the liver surface on CT scan. * **Treatment:** The gold standard is **Cytoreductive Surgery (CRS)** combined with **Hyperthermic Intraperitoneal Chemotherapy (HIPEC)**, often referred to as the "Sugarbaker Procedure."

Q: In a patient who underwent post molar evacuation by dilatation and curettage, which of the following tests is used to define successful removal of H. Mole?

Beta HCG. **Explanation:** The correct answer is **Beta HCG (Option A)**. Hydatidiform mole (H. Mole) is a gestational trophoblastic disease characterized by the proliferation of trophoblastic tissue, which secretes Human Chorionic Gonadotropin (hCG). Following suction and evacuation, serial monitoring of serum Beta HCG is the **gold standard** for defining successful removal and ensuring the patient has not developed Gestational Trophoblastic Neoplasia (GTN). A successful removal is defined by a progressive decline in Beta HCG levels until they become undetectable. **Why other options are incorrect:** * **Per speculum examination (Option B):** While useful to check for vaginal metastases (theca lutein cysts or suburethral nodules), it cannot quantify the presence of residual microscopic trophoblastic tissue. * **Progesterone (Option C):** Progesterone levels are not specific to trophoblastic activity and play no role in the diagnosis or follow-up of molar pregnancies. * **USG (Option D):** Ultrasound is the investigation of choice for the **initial diagnosis** (showing a "snowstorm appearance"), but it is not sensitive enough to detect microscopic residual disease or define biochemical remission. **Clinical Pearls for NEET-PG:** * **Follow-up Protocol:** Serum Beta HCG should be monitored weekly until three consecutive samples are negative (<5 mIU/mL), then monthly for 6 months. * **GTN Diagnosis:** According to FIGO criteria, GTN is suspected if HCG levels plateau (4 values over 3 weeks) or rise (3 values over 2 weeks). * **Contraception:** Patients must be advised to use reliable contraception (preferably OCPs) during the follow-up period to avoid a new pregnancy, which would confuse HCG interpretation.

Q: A young lady presents with mild erosion of the cervix and a Pap smear shows dysplasia. What is the next step in management?

Antibiotics. **Explanation:** The correct management for a young lady with mild cervical erosion and dysplasia on a Pap smear is the administration of **antibiotics** first. **1. Why Antibiotics are the Correct Choice:** In clinical practice, inflammatory changes caused by infections (cervicitis) can mimic dysplastic changes on a Pap smear, leading to a "false positive" report of dysplasia. Cervical erosion (ectopy) is often associated with chronic infection. The standard protocol is to treat the underlying infection with a course of broad-spectrum antibiotics and then **repeat the Pap smear after 6 weeks**. If the dysplasia was merely inflammatory, the repeat smear will be normal, preventing unnecessary invasive procedures. **2. Analysis of Incorrect Options:** * **B. Colposcopy:** This is the next step only if dysplasia persists *after* treating the infection or if the initial smear shows high-grade changes (HSIL). * **C. Cryosurgery:** This is a treatment modality for confirmed persistent erosion or low-grade dysplasia (CIN 1). It should not be performed until a definitive histological diagnosis is made via biopsy. * **D. Conization:** This is a diagnostic and therapeutic surgical procedure reserved for high-grade dysplasia (CIN 2/3) or suspected microinvasive carcinoma. It is too invasive for an initial finding of mild dysplasia. **NEET-PG High-Yield Pearls:** * **Cervical Ectopy (Erosion):** It is a physiological condition where the columnar epithelium of the endocervix replaces the squamous epithelium of the ectocervix. It is common in pregnancy and women on OCPs. * **Inflammation Rule:** Always treat infection and repeat cytology before labeling a patient with "Cervical Intraepithelial Neoplasia" (CIN). * **Gold Standard:** While Pap smear is a screening tool, **Colposcopy-directed biopsy** is the gold standard for diagnosing cervical dysplasia.

Q: A 45-year-old woman presents to the gynecology department with prolonged vaginal bleeding. On examination, a cervical lesion is found that bleeds on touch. Her past history is insignificant. She had a Pap smear approximately 10 years ago, which was normal. What is the next best investigation?

Cervical punch biopsy. **Explanation:** The clinical presentation of a 45-year-old woman with **prolonged vaginal bleeding** and a **visible cervical lesion that bleeds on touch** is highly suspicious for **Cervical Carcinoma**. In any patient with a clinically visible growth or suspicious lesion on the cervix, the definitive next step is a **tissue diagnosis**. 1. **Why Cervical Punch Biopsy is correct:** A punch biopsy is the gold standard for diagnosing a visible cervical lesion. It allows for histological confirmation of malignancy and determines the cell type (Squamous cell vs. Adenocarcinoma). Note that if a lesion is visible, a Pap smear is unnecessary and may provide a false negative; direct biopsy is mandatory. 2. **Why other options are incorrect:** * **Hysteroscopy:** This is used to evaluate the uterine cavity (endometrium). While it helps in cases of abnormal uterine bleeding (AUB), it is not the primary investigation for a visible cervical growth. * **MRI Pelvis:** MRI is the investigation of choice for **staging** (evaluating tumor size and parametrial involvement) *after* malignancy has been histologically confirmed. It is not a diagnostic tool for the primary lesion. * **LEEP:** This is a diagnostic-cum-therapeutic procedure used for CIN (Cervical Intraepithelial Neoplasia) when the transformation zone is not fully visible or there is a discrepancy in cytology. It is not the initial step for a large, suspicious clinical growth. **Clinical Pearls for NEET-PG:** * **Most common symptom of Cervical Cancer:** Post-coital bleeding (though intermenstrual or prolonged bleeding is common). * **Screening vs. Diagnosis:** Pap smear/HPV DNA is for **screening** asymptomatic women; Biopsy is for **diagnosing** symptomatic women with a lesion. * **Staging:** Cervical cancer is staged **clinically** (FIGO staging), though the 2018 revision allows the use of imaging (MRI/CT) and pathology where available.

Question 1

A 29-year-old woman at 10 weeks gestation develops severe hyperemesis gravidarum. Ultrasound reveals a complete hydatidiform mole. Her serum hCG is 500,000 mIU/mL. She undergoes suction curettage. Two weeks post-procedure, her hCG is 50,000 mIU/mL. Four weeks post-procedure, it is 45,000 mIU/mL. Analyze these findings to determine the most appropriate next step.

Accepted Answer

Initiate single-agent methotrexate chemotherapy for gestational trophoblastic neoplasia

Answer

Continue weekly hCG monitoring as normal decline is occurring

Answer

Perform hysterectomy for definitive treatment

Answer

Repeat suction curettage for retained molar tissue

Answer

Begin multi-agent chemotherapy with EMA-CO regimen

Question 2

A middle-aged woman presented with a 6-month history of dull abdominal pain. A CT scan of the pelvis revealed a 7 cm mass involving the left ovary with irregular calcifications. The right fallopian tube and ovary were excised. What is the likely diagnosis?

Accepted Answer

Mature cystic teratoma

Answer

Mucinous cystadenoma

Answer

Choriocarcinoma

Answer

Dysgerminoma

Question 3

What is Type IIIB Endometrial cancer according to FIGO staging?

Accepted Answer

Endometrial cancer with vaginal involvement

Answer

Endometrial cancer invading cervical stroma

Answer

Endometrial cancer involving uterine adnexa

Answer

Endometrial cancer invading pelvic lymph nodes

Question 4

A 35-year-old woman presents for a routine gynecological examination. A Pap smear is performed and found to be normal. She is determined to be a low-risk case. Considering she has had normal smears for the last three consecutive years, at what intervals will you recommend Pap smear examinations for her?

Accepted Answer

Every 3 years

Answer

Annually

Answer

Every 2 years

Answer

Every 5 years

Question 5

In pseudomyxoma peritonei, mucinous cyst-adenocarcinoma of which of the following organs is involved?

Accepted Answer

Ovary

Answer

Pancreas

Answer

Kidney

Answer

Abdominal testis

Question 6

What is the treatment of choice for a young patient diagnosed with choriocarcinoma?

Accepted Answer

Chemotherapy

Answer

Hysterectomy

Answer

Chemotherapy followed by hysterectomy

Answer

Hysterectomy followed by chemotherapy

Question 7

In a young woman diagnosed with stage Ib cervical cancer, during a radical hysterectomy, which structure is typically preserved?

Accepted Answer

Periureteral tissues

Answer

Uterosacral and uterovesical ligaments

Answer

Pelvic lymph nodes

Answer

Upper third of the vagina

Question 8

In a patient who underwent post molar evacuation by dilatation and curettage, which of the following tests is used to define successful removal of H. Mole?

Accepted Answer

Beta HCG

Answer

Per speculum examination

Answer

Progesterone

Answer

USG

Question 9

A young lady presents with mild erosion of the cervix and a Pap smear shows dysplasia. What is the next step in management?

Accepted Answer

Antibiotics

Answer

Colposcopy

Answer

Cryosurgery

Answer

Conization

Question 10

A 45-year-old woman presents to the gynecology department with prolonged vaginal bleeding. On examination, a cervical lesion is found that bleeds on touch. Her past history is insignificant. She had a Pap smear approximately 10 years ago, which was normal. What is the next best investigation?

Accepted Answer

Cervical punch biopsy

Answer

Hysteroscopy

Answer

MRI scan of the pelvis

Answer

Loop electrosurgical excision procedure (LEEP)

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

On this page

Practice by Chapter

Want unlimited practice?