Gynecologic Oncology Practice Questions

Q: What is the recommended approach for adjuvant treatment in endometrial carcinoma stage IA, grade I?

No adjuvant treatment. ***No adjuvant treatment*** - **Stage IA, Grade I endometrial carcinoma** is considered a **low-risk disease** with an excellent prognosis following surgery alone. - The risk of recurrence is minimal, making **adjuvant therapy unnecessary** and not beneficial for improving survival outcomes. *Radiotherapy* - Adjuvant radiotherapy is typically reserved for **higher-risk endometrial cancers** (e.g., higher grade, deeper myometrial invasion, lymphovascular space invasion) to reduce locoregional recurrence. - For **stage IA, grade I disease**, the potential benefits of radiotherapy do not outweigh the risks of its side effects. *Chemotherapy* - Chemotherapy is generally used for **advanced or high-risk endometrial cancers**, often those with systemic spread or specific histological subtypes (e.g., serous, clear cell). - It is **not indicated** for early-stage, low-grade disease like stage IA, grade I, as it offers no survival benefit in this setting. *Chemotherapy plus radiotherapy* - This combined modality approach is reserved for **high-risk endometrial cancers**, often those with extensive disease or aggressive features, to target both local and systemic disease. - For **stage IA, grade I endometrial cancer**, this combination would be **overtreatment**, exposing the patient to significant toxicity without additional benefit.

Q: Which of the following is the least likely site for metastasis in cases of vulvar cancer?

Paraaortic nodes. ***Paraaortic nodes*** - **Paraaortic nodes** are typically involved only in advanced or very widespread metastatic disease of the vulva, usually after involvement of more proximal lymphatic basins or direct tumor extension. - The **lymphatic drainage** of the vulva primarily follows a defined pathway, making direct spread to paraaortic nodes less common than to other regional nodes. *Urethra* - The **urethra** can be a site of local invasion or direct extension from a vulvar tumor, especially if the tumor is located near the clitoris or anterior vulva. - Direct spread to adjacent structures is a common route of tumor progression in many cancers, including vulvar cancer. *Deep inguinal nodes* - The **deep inguinal lymph nodes** are a common secondary site of metastasis, receiving lymphatic drainage from superficial inguinal nodes and sometimes directly from vulvar tissue. - Involvement of these nodes indicates more advanced regional spread than superficial inguinal node involvement alone, but still follows the primary lymphatic pathways. *Superficial inguinal nodes* - The **superficial inguinal lymph nodes** are the **primary drainage site** for the vulva and are the most common site for initial lymphatic metastasis. - Their involvement is a critical factor in staging vulvar cancer and guiding treatment decisions.

Q: What is the recommended treatment for stage III B cervical cancer?

Combined chemoradiation (chemotherapy + radiotherapy). ***Combined chemoradiation (chemotherapy + radiotherapy)*** - For **Stage IIB-IVA cervical cancer**, combined chemoradiation is the standard of care, offering superior outcomes compared to either modality alone. - The combination of **cisplatin-based chemotherapy** and **external beam radiation therapy (EBRT)**, often followed by **brachytherapy**, improves local control and survival rates. *Radical hysterectomy (Wertheim's operation)* - **Radical hysterectomy** is generally reserved for **early-stage cervical cancer (IA2-IIA)** that is surgically resectable. - In Stage IIIB disease, the tumor has spread to the **pelvic sidewall** and/or involves the **lower third of the vagina**, making surgical resection highly unlikely to achieve negative margins and posing a high risk of complications. *Radiotherapy (external beam)* - While **radiotherapy** is a crucial component of treatment for locally advanced cervical cancer, using it as a standalone treatment for Stage IIIB is **less effective** than combined chemoradiation. - Concurrent chemotherapy, particularly with **cisplatin**, sensitizes tumor cells to radiation, thereby **enhancing the efficacy of radiotherapy** and improving survival. *Chemotherapy (intravenous)* - **Chemotherapy alone** is generally insufficient for curing locally advanced cervical cancer due to its limited ability to eradicate macroscopic disease. - It is primarily used here as a **radiosensitizer** to augment the effects of radiation therapy, not as a primary monotherapy.

Q: In which of the following conditions is therapeutic conization MOST specifically indicated as the standard treatment approach?

Microinvasive carcinoma of the cervix. ***Microinvasive carcinoma of the cervix*** - **Therapeutic conization** is the definitive standard treatment for **microinvasive carcinoma (Stage IA1)**, serving as both diagnostic and potentially curative management. - It allows precise assessment of depth of invasion, lymphovascular space invasion (LVSI), and margin status while preserving fertility. - This is the **most specifically indicated** condition where conization is the standard therapeutic approach, not just diagnostic. *Severe Cervical Intraepithelial Neoplasia (CIN III) requiring excision* - CIN III can be treated with multiple excisional methods including **LEEP, cold knife conization, or laser ablation**. - Conization is one option among several, not the most specifically indicated single approach. *Benign cervical metaplasia* - **Benign cervical metaplasia** is a normal physiological process of squamous epithelium replacing columnar epithelium. - No treatment is required; surgical intervention would be inappropriate and cause unnecessary harm. *High-grade cervical dysplasia with unsatisfactory colposcopy* - Unsatisfactory colposcopy (transformation zone not fully visible) with high-grade dysplasia requires diagnostic excision, typically via conization. - However, in this context, conization is performed primarily for **diagnostic purposes** (to visualize and assess the full extent of disease and rule out invasion) rather than as the specific **therapeutic standard**. - Unlike microinvasive carcinoma where conization is the established therapeutic approach, here it addresses a diagnostic limitation.

Q: Which ovarian tumour can present with menorrhagia ?

Granulosa cell tumour. ***Granulosa cell tumour*** - This tumour secretes **estrogen**, which can lead to **endometrial hyperplasia** and subsequently cause **menorrhagia** (heavy or prolonged menstrual bleeding). - Its hormonal activity is a key differentiator from other ovarian tumours that typically do not cause such menstrual irregularities. *Dermoid cyst* - Also known as a **mature cystic teratoma**, it is a benign germ cell tumor that rarely causes hormonal disturbances. - While it can present with pelvic pain or a mass, it generally does not directly cause **menorrhagia**. *Epithelial ovarian cancer* - These are the most common type of ovarian cancer, but they typically present with non-specific symptoms such as **abdominal bloating**, **pelvic pain**, or changes in bowel habits. - They are not usually associated with **estrogen production** leading to **menorrhagia**. *Yolk sac tumour* - This is a rare, malignant germ cell tumour that is typically seen in young women and produces **alpha-fetoprotein (AFP)**. - It does not produce hormones that directly cause **menorrhagia** but can lead to rapid tumor growth and abdominal symptoms.

Q: Which of the following conditions can lead to elevated CA-125 levels?

All of the options. ***All of the options*** - **CA-125** is a tumor marker primarily associated with **ovarian cancer**, but it is **not specific** and can be elevated in various benign and malignant conditions. - All three conditions listed—**abdominal tuberculosis**, **cervical cancer**, and **endometriosis**—can cause elevated CA-125 levels, making this marker useful for monitoring but not diagnostic of a specific condition. **Abdominal tuberculosis:** - Causes peritoneal inflammation and ascites, leading to significant **CA-125 elevation** - Can mimic ovarian cancer clinically, making differentiation challenging - CA-125 levels may be markedly elevated (often >500 U/mL) **Cervical cancer:** - Particularly in **advanced stages** with peritoneal involvement, can elevate CA-125 - Elevation occurs due to adjacent tissue involvement and inflammatory response - Less commonly associated with CA-125 than ovarian pathology, but well-documented **Endometriosis:** - One of the most **common benign causes** of elevated CA-125 - Ectopic endometrial tissue and associated inflammation trigger CA-125 production - Levels typically moderate (35-200 U/mL) but can be higher with extensive disease

Q: What is the primary function of CA-125 in clinical practice?

CA-125: A glycoprotein, tumor marker for ovarian cancer. ***CA-125: A glycoprotein, tumor marker for ovarian cancer*** - **CA-125** is a **glycoprotein** that serves as a **tumor marker**, primarily recognized for its association with **ovarian cancer**. - While not exclusively specific to ovarian cancer, elevated levels are frequently observed in women with this malignancy, making it useful in diagnosis and monitoring [1]. *CA-125: Tumor marker specific only for ovarian cancer* - **CA-125** is **not specific only for ovarian cancer**; its levels can be elevated in various benign conditions [3]. - Conditions such as **endometriosis**, **pelvic inflammatory disease**, **uterine fibroids**, and even menstruation can cause elevated CA-125 levels. *CA-125: Diagnostic marker that confirms ovarian cancer diagnosis* - **CA-125** is **not a diagnostic marker that confirms ovarian cancer**; a definitive diagnosis requires a biopsy and histopathological examination [1]. - Its utility lies in aiding the **diagnosis**, monitoring **treatment response**, and detecting **recurrence**, but it cannot confirm the disease on its own [2]. *CA-125: Used primarily for screening healthy women for ovarian cancer* - **CA-125** is **not recommended for screening healthy women** due to its low specificity and sensitivity [1]. - Using CA-125 for general population screening would lead to a high rate of **false positives**, resulting in unnecessary invasive procedures.

Q: Which of the following does not meet the criteria for conservative surgery in patients with ovarian carcinoma?

FIGO stage II disease. ***FIGO stage II disease*** - **Conservative surgery** (fertility-sparing surgery) for ovarian carcinoma is generally limited to **early-stage disease**, specifically **FIGO stage IA**. - **FIGO stage II** involves tumor extension beyond the ovaries to other pelvic structures, necessitating more aggressive surgical management, typically including **bilateral salpingo-oophorectomy** and **hysterectomy**. *Young patient with no or few children* - This criterion supports considering conservative surgery as it indicates a desire to preserve **fertility**. - **Fertility preservation** is a primary goal when electing conservative management for ovarian cancer. *Well differentiated serous tumor* - **Well-differentiated tumors** (low grade) are associated with a better prognosis and lower risk of recurrence, making conservative surgery a safer option. - This characteristic suggests a less aggressive tumor biology, further supporting the choice of **fertility-sparing surgery**. *No infiltration of capsule, lymphatics or mesoovarium* - The absence of infiltration into these structures indicates a **confined tumor**, reducing the risk of microscopic spread and recurrence. - This criterion is essential for ensuring that conservative surgery adequately removes all disease and prevents dissemination, thus confirming **early-stage disease**.

Q: Carcinoma endometrium with involvement of the vaginal wall is included in which stage ?

IIIB. ***IIIB*** - **Stage IIIB** for endometrial carcinoma specifically includes tumor involvement of the **vaginal wall** or parametrium, but not the bladder or rectum. - This staging criterion is based on the **FIGO (International Federation of Gynecology and Obstetrics)** staging system, which is used for gynecological cancers. *IIIA* - **Stage IIIA** typically refers to tumor invasion of the **serosa** of the uterus or **adnexa** (ovaries or fallopian tubes). - It does not involve the vaginal wall, differentiating it from IIIB. *IIIC* - **Stage IIIC** indicates regional lymph node metastasis, specifically **pelvic** or **para-aortic lymph nodes**, regardless of the extent of local spread. - While lymph node involvement often co-occurs with advanced local disease, the presence of vaginal wall involvement alone does not automatically classify it as IIIC unless lymph node metastases are confirmed. *IVA* - **Stage IVA** denotes tumor invasion of the **bladder** or **bowel mucosa**. - This stage represents more extensive local spread than vaginal wall involvement, directly invading adjacent pelvic organs.

Q: What is the treatment for stage IB1 cervical cancer?

Wertheim's hysterectomy (radical hysterectomy). ***Wertheim's hysterectomy (radical hysterectomy)*** - For **stage IB1** cervical cancer, **radical hysterectomy** (Type III/Wertheim's procedure) with pelvic lymphadenectomy is one of the two standard treatment options. - This procedure removes the uterus, cervix, parametrium, upper vagina, and pelvic lymph nodes to achieve clear margins and assess nodal involvement. - Preferred in **younger women** desiring to preserve ovarian function and sexual function, and in centers with surgical expertise. - Both radical surgery and chemoradiotherapy have **equivalent survival outcomes** for stage IB1. *Chemoradiotherapy* - **Definitive chemoradiotherapy** (concurrent cisplatin-based chemotherapy with external beam radiation plus brachytherapy) is the **other standard first-line treatment** for stage IB1 cervical cancer. - It is preferred in patients who are **poor surgical candidates**, have medical comorbidities, or prefer non-surgical management. - Also the treatment of choice for **locally advanced disease** (stages IB2, IIA2, IIB-IVA). *Radiation therapy* - **Radiation alone** (without concurrent chemotherapy) has inferior outcomes compared to chemoradiotherapy for stages IB1 and above. - May be used only in patients who cannot tolerate chemotherapy. *Chemotherapy* - **Chemotherapy alone** is not curative for localized cervical cancer. - Used for **recurrent or metastatic disease** (stage IVB) in combination with bevacizumab.

Question 1

What is the recommended approach for adjuvant treatment in endometrial carcinoma stage IA, grade I?

Accepted Answer

No adjuvant treatment

Answer

Radiotherapy

Answer

Chemotherapy

Answer

Chemotherapy plus radiotherapy

Question 2

Which of the following is the least likely site for metastasis in cases of vulvar cancer?

Accepted Answer

Paraaortic nodes

Answer

Urethra

Answer

Deep inguinal nodes

Answer

Superficial inguinal nodes

Question 3

What is the recommended treatment for stage III B cervical cancer?

Accepted Answer

Combined chemoradiation (chemotherapy + radiotherapy)

Answer

Radical hysterectomy (Wertheim's operation)

Answer

Radiotherapy (external beam)

Answer

Chemotherapy (intravenous)

Question 4

In which of the following conditions is therapeutic conization MOST specifically indicated as the standard treatment approach?

Accepted Answer

Microinvasive carcinoma of the cervix

Answer

Severe Cervical Intraepithelial Neoplasia (CIN III) requiring excision

Answer

Benign cervical metaplasia

Answer

High-grade cervical dysplasia with unsatisfactory colposcopy

Question 5

Which ovarian tumour can present with menorrhagia ?

Accepted Answer

Granulosa cell tumour

Answer

Dermoid cyst

Answer

Epithelial ovarian cancer

Answer

Yolk sac tumour

Question 6

Which of the following conditions can lead to elevated CA-125 levels?

Accepted Answer

All of the options

Answer

Abdominal tuberculosis

Answer

Cervical cancer

Answer

Endometriosis

Question 7

What is the primary function of CA-125 in clinical practice?

Accepted Answer

CA-125: A glycoprotein, tumor marker for ovarian cancer

Answer

CA-125: Tumor marker specific only for ovarian cancer

Answer

CA-125: Diagnostic marker that confirms ovarian cancer diagnosis

Answer

CA-125: Used primarily for screening healthy women for ovarian cancer

Question 8

Which of the following does not meet the criteria for conservative surgery in patients with ovarian carcinoma?

Accepted Answer

FIGO stage II disease

Answer

No infiltration of capsule, lymphatics or mesoovarium

Answer

Well differentiated serous tumor

Answer

Young patient with no or few children

Question 9

Carcinoma endometrium with involvement of the vaginal wall is included in which stage ?

Accepted Answer

IIIB

Answer

IIIA

Answer

IIIC

Answer

IVA

Question 10

What is the treatment for stage IB1 cervical cancer?

Accepted Answer

Wertheim's hysterectomy (radical hysterectomy)

Answer

Chemotherapy

Answer

Radiation therapy

Answer

Chemoradiotherapy

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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