Gynecologic Cancer MCQ : Multiple Choice Questions and Answers

Question 1 : Currently, it is believed that epithelial ovarian cancer arises primarily from:

a) Ovarian surface epithelium
b) Visceral peritoneum
c) Occult tubal malignancy
d) Appendiceal adenocarcinoma

Answer : Occult tubal malignancy

Question 2 : What percentage of epithelial ovarian cancers are caused by familial syndromes :

a) 5-10
b) 10-20
c) 20-30
d) Up to 50

Answer : 5-10%

Question 3 : Which of the following is not true about cancers of the uterine body :

a) There are two types , endometrioid and serious which are known as type I and II respectively
b) Type I cancers are estrogen related
c) Type II cancers are estrogen related
d) LOH in chromosome 17p is found in 100% of uterine serous carcinomas

Answer : Type II cancers are estrogen related

Question 4 : HPV is a “necessary” factor for development of cervix cancer :

a) True
b) False

Answer : True

Question 5 : Most cervical cancers arise :

a) From endocervix
b) From ectocervix
c) From os of cervix
d) At the junction of ecto and endocervix

Answer : At the junction of ecto and endocervix

Question 6 : The FIGO staging of cervix cancer is based on:

a) Contrast enhanced CT scan of pelvis
b) Hysteroscopy with MRI of pelvis
c) Clinical examination without imaging
d) MRI pelvis with chest radiography

Answer : Clinical examination without imaging

Question 7 : Bevacizumab is a combination with chemotherapy is approved for the treatment of cervix cancer :

a) True
b) False

Answer : True

Question 8 : What is the treatment of choice for stage 1 vaginal squamous cell carcinoma :

a) Radiotherapy
b) Total vaginectomy
c) Partial vaginectomy followed by radiation
d) Concurrent chemoradiation followed by surgery of residual lesion

Answer : radiotherapy

Question 9 : Which of the following does not increase the risk of endometrial cancer :

a) Increased progesterone activity
b) Early menarche and late meopause
c) Anovulatory menstrual cycles
d) Obesity

Answer :  Increased progesterone activity

Question 10 : The cutoff thickness of endometrium on ultrasound, above which it is considered abnormal is :

a) 3 mm
b) 4 mm
c) 5 mm
d) 6 mm

Answer : 5 mm 

Question 11 : The risk of progression of simple hyperplasia of endometrium to endometrial cancer is :

a) 1%
b) 5%
c) 10%
d) 0%

Answer : 1% 

Question 12 : Which of the following is not an adverse prognostic factor in endometrial cancer :

a) Increased depth of myometrial invasion
b) Cervical stromal involvement
c) Adnexal involvement
d) None of the above

Answer :  none of the above

Question 13 : The most appropriate treatment of stage III endometrial cancer is :

a) Concurrent chemoradiation
b) Concurrent chemoradiation followed by four cycles of paclitaxel plus carboplatin
c) Concurrent chemoradiation followed by intravaginal brachytherapy
d) Induction chemo followed by radiation and four cycles of paclitaxel and carboplatin

Answer : Concurrent chemoradiation followed by four cycles of paclitaxel plus carboplatin

Question 14 : Which of the following statements is not true about uterine leiomyosarcomas

a) They are the most common of the uterine sarcomas
b) Most cases transition from benign leiomyoma to leiomyosarcoma
c) Usually present as stage I disease
d) For stage I disease lymph node dissection is not required

Answer : Most cases transition from benign leiomyoma to leiomyosarcoma

Question 15 : All of the following are true about complete hydatidiform mole except :

a) They are usually diploid and have a 46,XY karyotype
b) All of its chromosomes are of paternal origin
c) Both of the above
d) Neither 1 nor 2

Answer :  They are usually diploid and have a 46,XX. About 10% of CHM may have a 46,XX karyotype too.

Question 16 : Choriocarcinoma is highly invasive, very vascular and has cytotrophoblasts and syncytiotrophoblasts with villi:

a) True
b) False

Answer : False

Question 17 : Which of the following is not a diagnostic criterion of complete hydatidiform mole :

a) A plateau in β-hCG values plus or minus 10% on four tests over 3 weeks
b) A ≥10% increase in β-hCG levels for three or more tests over at least 2 weeks
c) Persistence of β-hCG levels for >3 months after molar evacuation
d) Histologic evidence of choriocarcinoma

Answer : Persistence of β-hCG levels for >3 months after molar evacuation

Question 18 : The most common site of metastases in choriocarcinoma is :

a) Lungs
b) Vagina
c) Pelvis
d) Brain

Answer : Lungs 

Question 19 : Which subunit of hCG is to be measured in cases of gestational trophoblastic neoplasia :

a) Alpha
b) Beta
c) Both of the above

Answer : beta

Question 20 : Low-Risk GTN includes patients with both nonmetastatic (stage 1) and metastatic GTN (stages II and III) whose prognostic score is <7 . What is the most commonly used therapeutic option in these patients :

a) Methotrexate with folinic acid
b) Dactinomycin
c) EMA-CO regimen
d) EMA-EP regimen

Answer : Methotrexate with folinic acid

Question 21 : High-risk GTN is defined as patients who are suffering from stage II and III disease whose prognostic scores are >6 and all patients with stage IV disease. Following the multiagent chemotherapy protocol, EMACO, recommended by international societies, what percentage of patients are expected to have an incomplete response or relapse:

a) 30-40%
b) 5-10%
c) 50%
d) <5%

Answer : 30-40%

Question 22 : What is the treatment of choice for placental site trophoblastic tumors of stage I : 

a) Hysterectomy
b) Chemotherapy with EMAEP
c) Radiation followed by EMAEP
d) Hysterectomy followed by brachytherapy

Answer : Hysterectomy

Question 23 : BRCA 1 and 2 mutations are responsible for what percentage of high grade serous ovarian carcinomas:

a) 10-15
b) 5-10
c) 20-30
d) <5

Answer : 10-15%

Question 24 : Which of the following is not a risk factor for  development of ovarian cancer :

a) Family history of ovarian cancer
b) OCP use
c) Nulliparity
d) Germline BRCA mutations

Answer : OCT use

Question 25 : What is the risk of development of primary peritoneal carcinoma in patients with germline BRCA 1/2 Mutation, after undergoing risk reduction salpingooophrectomy (rrSO):

a) 1.8-2%
b) 2.8-4%
c) 1.9-6%
d) 5-10%

Answer : 1.8-2%

Question 26 : What is ROCA:

a) Risk of Ovarian Cancer Algorithm
b) Rapid Onsite Cancer Assessment
c) Risk of Colorectal cancer Algorithm
d) None of the above

Answer : Risk of Ovarian Cancer Algorithm

Question 27 : Which of the following statements is true about OCP use and ovarian cancer :

a) OCP use reduces risk of ovarian cancer by 10% to 12% after 1 year of use
b) OCP use reduces risk of ovarian cancer by 50% after 5 years of use
c) Both of the above
d) Neither 1 nor 2

Answer : Both of the above

Question 28 : Which of the following is not a criterion for referral to a gynecologic oncologist of premenopausal women with a suspicious pelvic mass :

a) CA 125 level > 200 U/mL
b) Ascites
c) Abdominal or distant metastases
d) One or more first-degree relatives with breast
e) none of the above

Answer : none of the above

Question 29 : What does ROMA score include:

a) CA 125
b) HE4
c) Both of the above
d) Neither 1 nor 2

Answer : both of the above

Question 30 : In a woman with epithelial ovarian cancer FIGO stage IA or IB, grade I or 2 malignancies, adjuvant chemotherapy is not indicated following comprehensive surgical staging :

a) True
b) False

Answer : True

Question 31 : Which of the following is not true about germ cell tumors of ovary :

a) Their median age of presentation is around 20 years
b) They are almost always unilateral and are very chemosensitive
c) In these cases fertility-preserving surgery can be done even when metastases are present
d) Schiller-Duval bodies are found in dysgerminoma

Answer : Schiller-Duval bodies are found in dysgerminoma

Question 32 : Sex cord stromal tumors are rare. Which of the following is an estrogen secreting SCST:

a) Granulosa cell tumor
b) Sertoli-Leydig tumors
c) Both of the above
d) Neither 1 nor 2

Answer : Granulosa cell tumor

Question 33 : What is the most appropriate definition of optimal cytoreduction in a case of ovarian cancer :

a) When surgery leaves behind no gross residual disease
b) When surgery leaves behind <2 cm of disease
c) When surgery involves en-bloc resection of omentum along with the adnexa
d) When microscopic margins are negative for malignant cells

Answer :  When surgery leaves behind no gross residual disease

Question 34 : What were the findings of the LION study (Lymphadenectomy in Ovarian Neoplasms):

a) Patients who undergo optimal cytoreduction should not undergo lymphadenectomy if they have clinically negative lymph nodes
b) Patients who undergo optimal cytoreduction should undergo lymphadenectomy if they have clinically negative lymph nodes
c) Patients who undergo optimal cytoreduction should undergo lymphadenectomy if they have clinically positive lymph nodes
d) Patients who undergo optimal cytoreduction should not undergo lymphadenectomy if they have clinically positive lymph nodes

Answer : Patients who undergo optimal cytoreduction should not undergo lymphadenectomy if they have clinically negative lymph nodes

Question 35 : In the JGOG trial which of the following conclusions were made :

a) Weekly paclitaxel achieves greater efficacy compared with 3 weekly paclitaxel
b) Weekly paclitaxel achieves lesser efficacy compared with 3 weekly paclitaxel
c) Weekly paclitaxel achieves similar efficacy compared with 3 weekly paclitaxel
d) none of the above

Answer : Weekly paclitaxel achieves greater efficacy compared with 3 weekly paclitaxel

Question 36 : Which of the following is true :

a) A patient of ovarian cancer has platinum sensitive relapse if the disease free interval is 12 months or more
b) A patient of ovarian cancer has partially platinum sensitive relapse if the disease free interval is 6-12 months
c) A patient of ovarian cancer has platinum resistant relapse if the disease free interval is less than 6 months
d) all of the above

Answer : all of the above

Question 37 : Which of the following trials studied the use of bevacizumab in the adjuvant setting in patients of ovarian cancer :

a) GOG 218
b) OCEANS
c) AURELIA
d) all of the above

Answer : GOG 218

Question 38 : What is the preferred treatment option for a borderline malignant ovarian tumor, post optimal cytoreduction and no invasive implants :

a) 3 cycles of chemo
b) 3-6 cycles of chemo
c) Observation
d) Endocrine therapy

Answer : observation