Gynecologic Oncology Practice Questions

Q: What does LEEP stand for in the management of cervical lesions?

Loop electrosurgical excision procedure. ***Loop electrosurgical excision procedure*** - **LEEP** is an acronym for **loop electrosurgical excision procedure**, a common method used to remove abnormal cells from the cervix - This procedure plays a crucial role in treating **high-grade cervical dysplasia** (CIN 2-3) and early-stage cervical cancer - It is both **diagnostic** (provides tissue for histopathology) and **therapeutic** (removes abnormal tissue) - The procedure uses a thin wire loop heated by electrical current to excise abnormal cervical tissue *Loop electromagnetic excision procedure* - Incorrect terminology; the "E" in **LEEP** stands for **electrosurgical**, not electromagnetic - Electromagnetic procedures are not standard for cervical lesion management *Loop electrodiagnostic excision procedure* - Incorrect terminology; while LEEP does provide diagnostic tissue, the "E" stands for **electrosurgical**, which describes the cutting technique - The term "electrodiagnostic" is not used in this context *Loop electrochemical excision procedure* - Incorrect terminology; the procedure uses **electrical current** for cutting and coagulation, not electrochemical reactions - The "E" in LEEP specifically refers to **electrosurgical** technique

Q: What is the most common site of sarcoma botryoides?

Vagina. ***Vagina*** - Sarcoma botryoides is a specific variant of **embryonal rhabdomyosarcoma** that characteristically arises from the **vagina**, specifically the anterior vaginal wall, in young girls (typically under 8 years). - Its presentation as a **grape-like polypoid mass** protruding from the vagina is a classic clinical finding. - This is the **most common site** for sarcoma botryoides, making it the correct answer. *Also called embryonal rhabdomyosarcoma* - While sarcoma botryoides is a **subtype of embryonal rhabdomyosarcoma**, this statement describes the classification, not the anatomical site. - Embryonal rhabdomyosarcoma can occur in various locations (head/neck, genitourinary tract, extremities), but sarcoma botryoides specifically refers to the variant with **mucosal origin**, most commonly in the vagina. *It presents with blood stained watery vaginal discharge* - This is a **clinical presentation/symptom**, not an anatomical site. - Blood-stained discharge occurs due to **ulceration** and **tumor necrosis** of the vaginal mass, and is indeed a common presenting feature. *It can be treated with VAC regime* - The **VAC (Vincristine, Actinomycin D, Cyclophosphamide)** regimen is the standard chemotherapy protocol for rhabdomyosarcoma, including sarcoma botryoides. - This statement describes the **treatment modality**, not the most common site of origin.

Q: What is the next step in investigating a 45 year old female with post coital bleeding and abnormal appearing cervix on speculum examination?

Colposcopy. ***Colposcopy*** - Colposcopy is the appropriate next step to **directly visualize the cervical abnormality under magnification** and identify suspicious areas for targeted biopsy. - This allows for precise, **colposcopy-guided biopsies** of abnormal areas, which is crucial for **histopathological diagnosis** of potential cervical pathology including dysplasia or cancer. - It provides better visualization of the transformation zone and helps determine the extent of any lesion. *Dilatation and curettage* - This procedure involves scraping the uterine lining and is primarily used for diagnosing conditions affecting the **endometrium**, not cervical abnormalities. - It would not provide visualization or targeted biopsy of a cervical lesion. *Conisation* - Conisation is both a diagnostic and therapeutic procedure to remove a cone-shaped piece of cervical tissue. - It is typically performed **after** colposcopy and biopsy have confirmed significant dysplasia or cancer, not as the initial investigative step. - Performing conisation without prior colposcopic assessment risks inadequate margins or unnecessary tissue removal. *Hysteroscopy* - Hysteroscopy is a procedure to visualize the **inside of the uterine cavity** and is used to investigate intrauterine conditions like polyps, fibroids, or endometrial abnormalities. - It does not provide visualization of the cervix and would not help investigate cervical pathology causing post-coital bleeding.

Q: Most common cause of vulval carcinoma?

HPV infection. ***HPV infection*** - **Human Papillomavirus (HPV)**, particularly high-risk strains like HPV 16 and 18, is the most significant risk factor and cause of most vulvar squamous cell carcinomas. - HPV leads to **dysplastic changes** in the vulvar epithelium (vulvar intraepithelial neoplasia, VIN) that can progress to invasive cancer. *EBV infection* - **Epstein-Barr Virus (EBV)** is primarily associated with lymphomas (e.g., Burkitt lymphoma, Hodgkin lymphoma) and nasopharyngeal carcinoma, not vulvar carcinoma. - While EBV can cause various cancers, there is no direct link establishing it as a common cause of vulvar malignancy. *Herpes genitalis infection* - **Herpes Simplex Virus (HSV)** causes painful genital lesions but is not a recognized cause of vulvar carcinoma. - HSV infection is not associated with the cellular changes that lead to squamous cell cancer development. *Syphilis infection* - **Syphilis**, caused by *Treponema pallidum*, can lead to genital ulcers (chancres) and other systemic manifestations but is not a known cause of vulvar carcinoma. - While chronic inflammation is a risk factor for some cancers, syphilis does not directly induce the genetic mutations typical of vulvar cancer.

Q: Extramammary Paget's disease of the vulva is most commonly associated with which other cancer?

Vulvar cancer. ***Vulvar cancer*** - **Extramammary Paget's disease (EMPD)** frequently presents in the vulvar region and is associated with an underlying **adenocarcinoma** in up to 30% of cases. - The disease involves intraepithelial adenocarcinoma cells that can spread locally and, in some instances, indicates a synchronous or metachronous **internal malignancy**, often of genitourinary or gastrointestinal origin, but primarily vulvar adenocarcinoma in this context. *Vaginal cancer* - While Paget's disease can occur in other anogenital areas, its association with **primary vaginal cancer** is much less common compared to vulvar involvement. - **Vaginal Paget's disease** is rare and usually represents secondary spread from a vulvar primary or an underlying bladder/urethral carcinoma. *Cervical cancer* - **Paget's disease** is not typically associated with **cervical cancer**. Cervical cancers are predominantly squamous cell carcinomas or adenocarcinomas arising from the transformation zone. - While cervical adenocarcinoma can present with similar cells to Paget's, it is a distinct entity and not a common association. *Uterine cancer* - **Uterine cancer**, primarily endometrial carcinoma, has no direct or common association with **Paget's disease**. - Paget's disease primarily affects the skin and can be associated with underlying gland cancers, but these are generally in proximity to the epidermal involvement rather than distant uterine sites.

Q: Poor prognostic factor for hydatidiform mole is -

WHO score > 8. ***WHO score > 8*** - A **WHO score > 8** (more specifically, WHO/FIGO score ≥7) indicates **high-risk gestational trophoblastic neoplasia (GTN)**, which is associated with a poor prognosis and requires multi-agent chemotherapy. - The WHO prognostic scoring system incorporates various factors: age, prior pregnancy outcome, antecedent pregnancy type, interval from index pregnancy, pre-treatment hCG level, largest tumor size, site of metastases, and number of metastases. - This is the **strongest poor prognostic indicator** among the options listed. *Prior molar pregnancy* - A **prior molar pregnancy** increases the *risk* of developing another molar pregnancy (recurrence risk ~1-2%), but it is **not a component of the WHO prognostic scoring system** and is not a poor prognostic factor for the outcome of current GTN. - The history affects surveillance requirements but doesn't dictate the difficulty of treating the current episode. *Metastasis to lung* - **Lung metastases** are actually among the **better prognostic sites** for metastatic GTN in the WHO scoring system. - Lung and vaginal metastases score only 1 point, whereas liver and brain metastases (true poor prognostic sites) score 4 points each. - While any metastasis indicates more advanced disease, isolated lung metastases generally have a *good prognosis* with appropriate chemotherapy, with cure rates >90%. *No prior chemotherapy* - The *absence* of **prior chemotherapy** is a **favorable prognostic factor**, not a poor one. - Patients who have *failed* prior chemotherapy or have received ≥2 drugs previously score 2-4 points in the WHO system, indicating worse prognosis. - No prior chemotherapy (scores 0 points) means better treatment response and outcomes.

Q: Which of the following is the PRIMARY risk factor for cervical carcinoma?

Human papilloma virus. ***Human papilloma virus*** - **High-risk HPV types**, particularly **HPV 16 and 18**, are the primary causative agent of cervical carcinoma, responsible for over 90% of cases. - HPV infection is the **most significant and essential risk factor**, leading to persistent changes in cervical cells that can progress to **dysplasia** and eventually **invasive cancer**. - Cervical cancer is considered an **HPV-associated malignancy**, making HPV the central etiological factor. *Smoking* - **Smoking** is an important cofactor that increases the risk of cervical carcinoma in women with HPV infection, but it is not the primary cause. - Smoking impairs the immune system's ability to clear HPV infections and promotes progression of HPV-induced lesions. - Without HPV infection, smoking alone does not cause cervical cancer. *Low socioeconomic status* - **Low socioeconomic status** is an indirect risk factor associated with reduced access to healthcare and **cervical cancer screening** (Pap smears). - It does not directly cause cervical cancer but leads to delayed diagnosis and treatment, resulting in poorer outcomes. *All of the options* - While all listed factors influence cervical carcinoma risk, **Human papillomavirus (HPV)** is the primary and essential causative agent. - The other factors are cofactors or indirect associations, not primary causes.

Q: Which of the following statements is true regarding placental site trophoblastic disease?

It secretes human placental lactogen. ***It secretes human placental lactogen*** - Placental site trophoblastic tumor (PSTT) characteristically consists of intermediate trophoblasts which secrete **human placental lactogen (hPL)**. - Unlike choriocarcinoma, PSTT secretes relatively low levels of **human chorionic gonadotropin (hCG)**. *Has a highly malignant potential* - PSTT generally has a **good prognosis** if the disease is confined to the uterus, with a survival rate of over 95%. - It has a low metastatic potential compared to choriocarcinoma, with metastases occurring in only about 15% of cases. *Mainly contains syncytiotrophoblasts* - PSTT is composed predominantly of **intermediate trophoblasts** that infiltrate the myometrium, rather than syncytiotrophoblasts or cytotrophoblasts. - The distinctive feature is the proliferation of these intermediate trophoblasts at the implantation site. *The treatment of choice is hysterectomy followed by chemotherapy* - **Hysterectomy** is generally the primary treatment for PSTT confined to the uterus, and it often cures the disease. - **Chemotherapy** is usually reserved for metastatic or recurrent disease, or in cases of extensive local invasion, and is not a routine follow-up after an uncomplicated hysterectomy.

Q: Which of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?

Cervical intraepithelial Neoplasia. ***Cervical intraepithelial neoplasia (CIN)*** - CIN has a high success rate with treatment (e.g., **cryotherapy**, **LEEP**), often completely eradicating the dysplastic cells and preventing progression to **invasive cervical cancer**. - The effectiveness of screening via **Pap smears** allows for early detection and intervention, significantly reducing cancer risk. *Ductal carcinoma in situ (DCIS) of breast* - While treatable, DCIS carries a higher risk of recurrence and progression to **invasive breast cancer** in the same or contralateral breast compared to CIN. - Treatment often involves **lumpectomy** with or without radiation, and sometimes **total mastectomy**, reflecting its more serious potential. *Lobular carcinoma in situ (LCIS) of breast* - LCIS is largely considered a **risk indicator** for future invasive cancer in either breast, rather than a direct precursor that inevitably progresses. - Management often involves **close surveillance** or **chemoprevention**, as surgical excision does not prevent cancer development in other areas of the breast. *Vaginal intraepithelial neoplasia (VAIN)* - While treatable, VAIN is less common and often coexists with or follows **cervical or vulvar neoplasia**, indicating a broader field defect due to **HPV**. - Recurrence rates post-treatment can be significant, and patients often require long-term follow-up due to the continued risk of progression.

Q: What is the most common cause of death in cervical cancer?

Renal failure. ***Renal failure*** - As cervical cancer progresses, it can invade surrounding structures, including the **ureters**. - **Ureteral obstruction** leads to **hydronephrosis** and ultimately **renal failure**, which is a common cause of death. *Infection* - While infections can occur due to immunosuppression or compromised tissue integrity in advanced cancer, they are generally **not the most common direct cause of death**. - Infections are often secondary complications rather than the primary mode of mortality. *Haemorrhage* - Local invasion of blood vessels by advanced cervical cancer can cause **significant bleeding** (haemorrhage). - While potentially life-threatening, it is **less frequent** as a direct cause of death compared to renal failure. *Metastasis to vital organs* - Cervical cancer can metastasize to distant organs like the lungs, liver, or bone; however, direct organ failure solely due to metastases is **less common than renal complications** from local tumor spread. - The impact of metastases often contributes to overall decline but is not the most frequent immediate cause of death.

Question 1

What does LEEP stand for in the management of cervical lesions?

Accepted Answer

Loop electrosurgical excision procedure

Answer

Loop electromagnetic excision procedure

Answer

Loop electrodiagnostic excision procedure

Answer

Loop electrochemical excision procedure

Question 2

What is the most common site of sarcoma botryoides?

Accepted Answer

Vagina

Answer

It presents with blood stained watery vaginal discharge

Answer

It can be treated with VAC regime

Answer

Also called embryonal rhabdomyosarcoma

Question 3

What is the next step in investigating a 45 year old female with post coital bleeding and abnormal appearing cervix on speculum examination?

Accepted Answer

Colposcopy

Answer

Dilatation and curettage

Answer

Conisation

Answer

Hysteroscopy

Question 4

Most common cause of vulval carcinoma?

Accepted Answer

HPV infection

Answer

EBV infection

Answer

Herpes genitalis infection

Answer

Syphilis infection

Question 5

Extramammary Paget's disease of the vulva is most commonly associated with which other cancer?

Accepted Answer

Vulvar cancer

Answer

Vaginal cancer

Answer

Cervical cancer

Answer

Uterine cancer

Question 6

Poor prognostic factor for hydatidiform mole is -

Accepted Answer

WHO score > 8

Answer

Prior molar pregnancy

Answer

Metastasis to lung

Answer

No prior chemotherapy

Question 7

Which of the following is the PRIMARY risk factor for cervical carcinoma?

Accepted Answer

Human papilloma virus

Answer

Smoking

Answer

Low socioeconomic status

Answer

All of the options

Question 8

Which of the following statements is true regarding placental site trophoblastic disease?

Accepted Answer

It secretes human placental lactogen

Answer

Has a highly malignant potential

Answer

Mainly contains syncytiotrophoblasts

Answer

The treatment of choice is hysterectomy followed by chemotherapy

Question 9

Which of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?

Accepted Answer

Cervical intraepithelial Neoplasia

Answer

Ductal carcinoma in situ of breast

Answer

Lobular carcinoma in situ of breast

Answer

Vaginal intraepithelial neoplasia

Question 10

What is the most common cause of death in cervical cancer?

Accepted Answer

Renal failure

Answer

Infection

Answer

Haemorrhage

Answer

Metastasis to vital organs

Gynecologic Oncology — MCQs

Gynecologic Oncology — MCQs

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