Gynaecological Oncology

Topics in this chapter

• Cervical Cancer and Precancer
• Endometrial Cancer and Hyperplasia
• Ovarian Epithelial Cancer
• Ovarian Germ Cell and Stromal Tumors
• Gestational Trophoblastic Disease
• Vulvar Cancer and Intraepithelial Neoplasia
• Gynaecologic Cancer Staging and Treatment

Practice questions

1. Question 1Q-F34F18

   A 45-year-old nulliparous woman presents with abnormal uterine bleeding. Transvaginal ultrasonography reveals an endometrial thickness of 14 mm. Endometrial biopsy shows complex atypical hyperplasia. Which of the following is the most appropriate initial management for this patient, assuming she has completed childbearing?

   1. A.Total hysterectomy with bilateral salpingo-oophorectomy
   2. B.High-dose oral progestins (Megestrol acetate)
   3. C.Levonorgestrel-releasing intrauterine system (LNG-IUS)
   4. D.Serial endometrial biopsies every 3 months
   See the answer and solution
2. Question 2Q-9EBB0C

   A 58-year-old postmenopausal woman is diagnosed with stage IA, grade 1 endometrioid adenocarcinoma of the endometrium following a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Pelvic and para-aortic lymph node dissection was not performed. According to current guidelines, what is the most appropriate postoperative management regarding adjuvant therapy?

   1. A.External beam radiotherapy (EBRT)
   2. B.Vaginal brachytherapy (VBT)
   3. C.Combination chemotherapy with carboplatin and paclitaxel
   4. D.Observation only
   See the answer and solution
3. Question 3Q-84EB56

   A 35-year-old woman presents with persistent foul-smelling vaginal discharge and post-coital bleeding. Examination reveals an exophytic growth on the cervix measuring 3 cm in greatest dimension, involving the cervix without extension to the lower third of the vagina or pelvic sidewall. There is no hydronephrosis on imaging. What is the correct FIGO stage for this cervical cancer?

   1. A.Stage IB1
   2. B.Stage IB2
   3. C.Stage IB3
   4. D.Stage IIA1
   See the answer and solution
4. Question 4Q-F061A9

   A 62-year-old postmenopausal woman presents with a complex pelvic mass, ascites, and an elevated CA-125 level. She undergoes an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and optimal debulking. Histopathology confirms high-grade serous carcinoma of the ovary, staged as IIIC. What is the standard first-line adjuvant systemic therapy?

   1. A.Bleomycin, Etoposide, and Cisplatin (BEP)
   2. B.Paclitaxel and Carboplatin
   3. C.Tamoxifen and Megestrol acetate
   4. D.Methotrexate and Leucovorin rescue
   See the answer and solution
5. Question 5Q-2B9219

   A 22-year-old nulliparous female presents with a rapidly growing, painful solid-cystic right ovarian mass. Serum tumor markers show elevated alpha-fetoprotein (AFP) and normal beta-hCG and CA-125. She undergoes a fertility-sparing right salpingo-oophorectomy and surgical staging. Histology reveals a malignant germ cell tumor. Which of the following is the most likely diagnosis?

   1. A.Dysgerminoma
   2. B.Immature teratoma
   3. C.Yolk sac tumor (Endodermal sinus tumor)
   4. D.Granulosa cell tumor
   See the answer and solution