A 38-year-old woman attends a cervical screening camp at a Primary Health Centre. Visual inspection with acetic acid shows a dense, well-defined acetowhite area touching the squamocolumnar junction and covering about a quarter of the cervix; the whole lesion and the junction are visible, with no growth or contact bleeding. The centre follows the single-visit screen-and-treat approach. What is the most appropriate step?

Ablation of the lesion at the same visit

Referral for radical hysterectomy

Cold knife conization the next week

Repeat VIA screening after five years

A 35-year-old woman's routine Pap smear is reported as atypical squamous cells of undetermined significance (ASC-US), with no symptoms and a healthy-looking cervix. What is the preferred next step?

Repeat cytology after 5 years as routine

Gynaecological cancers and cervical screening

41 NEET-PG practice questions on Gynaecological cancers and cervical screening, part of Obstetrics & Gynaecology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 38-year-old woman attends a cervical screening camp at a Primary Health Centre. Visual inspection with acetic acid shows a dense, well-defined acetowhite area touching the squamocolumnar junction and covering about a quarter of the cervix; the whole lesion and the junction are visible, with no growth or contact bleeding. The centre follows the single-visit screen-and-treat approach. What is the most appropriate step?
1. AAblation of the lesion at the same visit
2. BReferral for radical hysterectomy
3. CCold knife conization the next week
4. DRepeat VIA screening after five years
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Answer: A · Ablation of the lesion at the same visit
A dense acetowhite area touching the squamocolumnar junction is a positive VIA test. In screen-and-treat, a VIA-positive woman is treated at once by ablation (cryotherapy or thermal ablation) if the whole lesion and junction are visible, the lesion covers less than three-quarters of the cervix and there is no suspicion of invasive cancer, as here. Treating in the same visit avoids losing women to follow-up, the main weakness of multi-visit programmes. India screens women aged 30-65 years with VIA every 5 years; lesions that are too large, enter the canal or look suspicious are referred for colposcopy, biopsy or LEEP.
- B: Radical hysterectomy treats invasive cancer, which there is no sign of here.
- C: Conization is for lesions unsuitable for ablation or suspected microinvasion.
- D: A positive VIA needs treatment now, not routine rescreening.
Question 2 · Medium
A 64-year-old undergoes surgical staging for endometrioid adenocarcinoma of the endometrium. Histology shows tumour invading through the full thickness of the myometrium to the uterine serosa; the cervix, adnexa, peritoneal washings and lymph nodes are free of tumour. Using FIGO 2009 staging, what is the stage?
1. AStage II
2. BStage IIIA
3. CStage IB
4. DStage IIIB
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Answer: B · Stage IIIA
In FIGO 2009, invasion of the uterine serosa or the adnexa is stage IIIA. Stage IA is invasion of less than half the myometrium, IB half or more, II cervical stromal invasion, IIIB vaginal or parametrial involvement, IIIC nodal spread and IV bladder or bowel mucosa or distant spread. Peritoneal cytology no longer changes the stage. FIGO 2023 has since added histological type, lymphovascular invasion and molecular class, so the system used must always be stated.
- A: Stage II needs cervical stromal invasion.
- C: IB is invasion of half or more of the myometrium without reaching the serosa.
- D: IIIB is vaginal or parametrial involvement.
Question 3 · Easy
A 45-year-old woman with weight loss and epigastric discomfort for 4 months has bilateral solid ovarian masses. An ovarian biopsy shows mucin-filled signet ring cells infiltrating a cellular stroma. Where is the primary tumour most likely to be?
1. ABreast
2. BEndometrium
3. CPancreas
4. DStomach
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Answer: D · Stomach
Krukenberg tumours are bilateral ovarian metastases made of mucin-secreting signet ring cells in a cellular stroma, most often from a diffuse-type gastric carcinoma and less often from the colon, breast or biliary tract. Spread may be lymphatic, haematogenous or transcoelomic. Upper GI endoscopy is needed in any woman with bilateral solid ovarian masses and signet ring cells. The prognosis is poor because it reflects advanced primary disease.
- A: Breast cancer can spread to the ovary but is a less common source of this pattern.
- B: Endometrial cancer spreads to the ovary as endometrioid, not signet ring, carcinoma.
- C: The pancreas is a rare source of Krukenberg tumours.
Question 4 · Easy
While taking a Pap smear from a 34-year-old in the gynae OPD, the doctor rotates an Ayre's spatula through 360 degrees around the external os and adds an endocervical brush. Which area must the sample include because most cervical precancers arise there?
1. ATransformation zone
2. BUpper endocervical canal
3. CEctocervix away from the os
4. DPosterior vaginal fornix
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Answer: A · Transformation zone
The transformation zone lies between the original and the current squamocolumnar junction, where columnar epithelium is replaced by squamous epithelium through metaplasia. Immature metaplastic cells are most vulnerable to HPV, so almost all CIN and cervical cancers start here. The sample must include the junction, so the spatula is rotated around the os, and a brush samples the canal when the junction has moved inside it, as after menopause. Smears are not taken during menstruation.
- B: The upper canal lies above the junction in most women of this age.
- C: The outer ectocervix away from the junction is rarely where precancer starts.
- D: A fornix sample collects shed cells and misses the transformation zone.
Question 5 · Medium
A 35-year-old woman's routine Pap smear is reported as atypical squamous cells of undetermined significance (ASC-US), with no symptoms and a healthy-looking cervix. What is the preferred next step?
1. AReflex high-risk HPV testing
2. BImmediate loop excision
3. CTotal hysterectomy
4. DRepeat cytology after 5 years as routine
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Answer: A · Reflex high-risk HPV testing
ASC-US is the commonest abnormal cytology result, and most women with it have no significant lesion. Testing the same sample for high-risk HPV (reflex testing) sorts them: HPV-positive women go on to colposcopy, while HPV-negative women have a very low risk and continue surveillance at a longer interval. Immediate excision ('see and treat') is considered for HSIL cytology, not for ASC-US. Hysterectomy is never a response to abnormal cytology alone.
- B: Immediate excision is considered for HSIL cytology, not ASC-US.
- C: Hysterectomy is never a response to an abnormal smear alone.
- D: Five years is too long to leave an abnormal result without triage.
Question 6 · Hard
A 38-year-old woman in a district HPV-based screening programme that follows the WHO (2021) screen, triage and treat approach has a positive high-risk HPV DNA test. Triage by VIA at the same visit is negative, and she is not living with HIV. What should be done next?
1. ACold knife conization within 4 weeks
2. BAblative treatment at the same visit
3. CReturn to routine screening after 10 years
4. DRepeat HPV DNA testing after 24 months
Answer and explanation in LearnFree account
Question 7 · Medium
A 38-year-old mother of two, whose mother died of ovarian cancer, tests positive for a pathogenic BRCA1 mutation. She is counselled using four statements: 1. Risk-reducing salpingo-oophorectomy after childbearing lowers her risk of ovarian cancer. 2. Yearly CA-125 and transvaginal ultrasound have been shown to reduce ovarian cancer deaths. 3. Most BRCA-related ovarian cancers are high-grade serous carcinomas. 4. Her sisters and children can be offered testing for the mutation. Which statements are correct?
1. A1, 2, 3 and 4
2. B3 and 4 only
3. C1, 2 and 3 only
4. D1, 3 and 4 only
Answer and explanation in LearnFree account
Question 8 · Medium
A 38-year-old para 2 has a 1.8 cm squamous cell carcinoma confined to the cervix with 6 mm stromal invasion (FIGO 2018 stage IB1). MRI shows no parametrial or nodal disease. She is fit and has completed her family. What is the most appropriate treatment?
1. ABrachytherapy alone
2. BRadical hysterectomy with pelvic lymphadenectomy
3. CCold knife conization alone
4. DSimple extrafascial hysterectomy
Answer and explanation in LearnFree account
Question 9 · Medium
A 62-year-old woman, 11 years after menopause and not on hormone therapy, has had two episodes of vaginal spotting. The cervix looks healthy, and transvaginal ultrasound shows an endometrial thickness of 9 mm (this unit investigates further when it is more than 4 mm). What is the next step?
1. AReassurance and review if bleeding recurs
2. BRepeat ultrasound after 6 months
3. CEndometrial sampling for histology
4. DStart oral progestogen therapy
Answer and explanation in LearnFree account
Question 10 · Medium
A 54-year-old woman who has taken tamoxifen for 3 years after surgery for oestrogen receptor-positive breast cancer has postmenopausal bleeding, and her endometrium is thickened. Why does tamoxifen raise her risk of endometrial disease?
1. AIt acts as a partial oestrogen agonist on the endometrium
2. BIt blocks progesterone receptors in endometrial glands and stroma
3. CIt inhibits aromatase and lowers oestrogen levels
4. DIt inactivates the mismatch repair enzymes
Answer and explanation in LearnFree account
Question 11 · Easy
A 23-year-old woman has a 6 cm right ovarian cyst on a routine scan. It contains an echogenic nodule casting an acoustic shadow, a fat-fluid level and fine echogenic lines in a 'dot-dash' pattern. What is the most likely diagnosis?
1. AMature cystic teratoma
2. BMucinous cystadenoma
3. CEndometrioma
4. DFollicular cyst
Answer and explanation in LearnFree account
Question 12 · Medium
A 55-year-old woman with untreated advanced cervical cancer is admitted with vomiting, drowsiness and very little urine output. Serum creatinine is 7.8 mg/dL and potassium 6.4 mmol/L, and ultrasound shows bilateral hydronephrosis. What is the mechanism of her renal failure?
1. ABilateral ureteric obstruction by tumour
2. BPrerenal kidney injury from vomiting alone
3. CCisplatin-induced tubular necrosis
4. DImmune-complex glomerulonephritis
Answer and explanation in LearnFree account
Question 13 · Medium
At colposcopy of a 31-year-old with HSIL cytology, Lugol's iodine is applied. The normal squamous epithelium stains mahogany brown, but a sharply outlined area near the os stays mustard yellow. Why does the abnormal area fail to stain?
1. AIts cells contain little or no glycogen
2. BIts cells are covered by excess keratin
3. CIts cells have lost their nuclear DNA
4. DIt has an increased surface blood supply
Answer and explanation in LearnFree account
Question 14 · Hard
A 67-year-old widow's endometrial biopsy shows serous carcinoma. Before the results are discussed, her son meets the gynaecologist alone and asks that his mother not be told she has cancer because 'she will lose hope'. The patient is mentally competent and has been asking about her results. What is the most appropriate response?
1. AAsk the son to sign consent for her treatment instead
2. BDisclose the full diagnosis to her at once with the son present
3. CAgree to withhold the diagnosis and tell only the son
4. DAcknowledge his concern, then ask the patient how much she wants to know
Answer and explanation in LearnFree account
Question 15 · Medium
A 59-year-old woman, 9 years after menopause, has vaginal bleeding and breast tenderness. Ultrasound shows a 10 cm solid-cystic right ovarian mass and a 14 mm endometrium, and endometrial biopsy shows hyperplasia without atypia. Serum inhibin is raised. Ovarian histology shows small cells with grooved 'coffee-bean' nuclei arranged around small spaces containing eosinophilic material. What is the most likely tumour?
1. ADysgerminoma
2. BAdult granulosa cell tumour
3. CSertoli-Leydig cell tumour
4. DBrenner tumour
Answer and explanation in LearnFree account
Question 16 · Medium
A 46-year-old para 4 has a 4 cm cervical growth. Examination under anaesthesia shows the upper vagina is free and the right parametrium is thickened, but the thickening does not reach the pelvic wall. Cystoscopy and proctoscopy are normal, and CT shows no hydronephrosis and no enlarged lymph nodes. What is the FIGO (2018) stage?
1. AStage IIA2
2. BStage IIIB
3. CStage IB3
4. DStage IIB
Answer and explanation in LearnFree account
Question 17 · Easy
A 52-year-old para 5 with postcoital bleeding has a friable, exophytic growth on the cervix, and a punch biopsy is taken in the gynae OPD. Which histological type is most likely?
1. ASquamous cell carcinoma
2. BSmall cell neuroendocrine carcinoma
3. CAdenosquamous carcinoma
4. DAdenocarcinoma
Answer and explanation in LearnFree account
Question 18 · Hard
A 34-year-old woman has palpitations, weight loss and tremor. Free T4 is raised and TSH suppressed, but technetium uptake in the thyroid is low and serum thyroglobulin is raised. She has no neck pain or tenderness and takes no thyroid medicines. A pelvic scan shows a 6 cm left ovarian mass containing fat and solid areas. What is the most likely source of her thyroid hormone?
1. AToxic multinodular goitre
2. BSubacute granulomatous (de Quervain) thyroiditis
3. CStruma ovarii in an ovarian teratoma
4. DFactitious thyroxine intake
Answer and explanation in LearnFree account
Question 19 · Medium
A 29-year-old at 20 weeks of pregnancy has an HSIL Pap smear. Colposcopy by an experienced colposcopist shows changes consistent with CIN 3 and no features of invasion, and a directed biopsy confirms CIN 3 without invasion. What is the most appropriate plan?
1. ACaesarean section with hysterectomy at term
2. BColposcopic follow-up; treat after delivery
3. CLoop excision now to remove the lesion
4. DCold knife conization in the second trimester
Answer and explanation in LearnFree account
Question 20 · Medium
A 48-year-old woman with squamous cell carcinoma of the cervix, FIGO stage IIB, has normal renal function and a good performance status. What is the standard treatment?
1. APalliative chemotherapy alone
2. BNeoadjuvant chemotherapy followed by surgery
3. CRadical hysterectomy with pelvic lymphadenectomy
4. DConcurrent cisplatin chemoradiation with brachytherapy
Answer and explanation in LearnFree account
Question 21 · Medium
At laparotomy for a large multiloculated ovarian mass, a 50-year-old woman's abdomen is found to be filled with gelatinous mucin. Peritoneal deposits show scanty mucinous epithelium floating in pools of mucin. Which organ should also be examined because it is the usual primary source of this condition?
1. AGallbladder
2. BFallopian tube
3. CStomach
4. DAppendix
Answer and explanation in LearnFree account
Question 22 · Hard
A 57-year-old woman has had a hysterectomy for grade 3 endometrioid carcinoma of the endometrium confined to the uterus. Molecular classification of the tumour is requested to guide adjuvant treatment. Which molecular group would carry the best prognosis?
1. ANo specific molecular profile
2. Bp53-abnormal (copy-number high)
3. CPOLE-ultramutated
4. DMismatch repair-deficient
Answer and explanation in LearnFree account
Question 23 · Easy
A 55-year-old woman has breathlessness and abdominal distension. She has a right pleural effusion, ascites and a 9 cm solid, firm left ovarian mass. After the mass is removed, histology shows benign spindle cells producing collagen, and the effusion and ascites resolve completely. What is this condition?
1. APseudomyxoma peritonei
2. BPseudo-Meigs syndrome
3. CKrukenberg tumour
4. DMeigs syndrome
Answer and explanation in LearnFree account
Question 24 · Easy
A 35-year-old woman whose screening test is positive for high-risk HPV asks which types cause most cervical cancers. Which two HPV types together cause about 70% of cervical cancers worldwide?
1. ATypes 1 and 2
2. BTypes 6 and 11
3. CTypes 16 and 18
4. DTypes 31 and 33
Answer and explanation in LearnFree account
Question 25 · Medium
A 52-year-old woman with stage III high-grade serous ovarian carcinoma and a germline BRCA1 mutation has a complete response to surgery and carboplatin-paclitaxel. She is started on olaparib as maintenance. Why does this drug selectively kill her tumour cells?
1. AIt inhibits VEGF-driven new blood vessel formation in the tumour
2. BIt blocks single-strand break repair in cells lacking homologous recombination
3. CIt stabilises microtubules and arrests dividing cells in mitosis
4. DIt forms DNA cross-links that the tumour cells cannot excise
Answer and explanation in LearnFree account

16 more Gynaecological cancers and cervical screening questions

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Gynaecological cancers and cervical screening

A 45-year-old woman with weight loss and epigastric discomfort for 4 months has bilateral solid ovarian masses. An ovarian biopsy shows mucin-filled signet ring cells infiltrating a cellular stroma. Where is the primary tumour most likely to be?

While taking a Pap smear from a 34-year-old in the gynae OPD, the doctor rotates an Ayre's spatula through 360 degrees around the external os and adds an endocervical brush. Which area must the sample include because most cervical precancers arise there?

A 35-year-old woman's routine Pap smear is reported as atypical squamous cells of undetermined significance (ASC-US), with no symptoms and a healthy-looking cervix. What is the preferred next step?

A 38-year-old woman in a district HPV-based screening programme that follows the WHO (2021) screen, triage and treat approach has a positive high-risk HPV DNA test. Triage by VIA at the same visit is negative, and she is not living with HIV. What should be done next?

A 38-year-old para 2 has a 1.8 cm squamous cell carcinoma confined to the cervix with 6 mm stromal invasion (FIGO 2018 stage IB1). MRI shows no parametrial or nodal disease. She is fit and has completed her family. What is the most appropriate treatment?

A 62-year-old woman, 11 years after menopause and not on hormone therapy, has had two episodes of vaginal spotting. The cervix looks healthy, and transvaginal ultrasound shows an endometrial thickness of 9 mm (this unit investigates further when it is more than 4 mm). What is the next step?

A 54-year-old woman who has taken tamoxifen for 3 years after surgery for oestrogen receptor-positive breast cancer has postmenopausal bleeding, and her endometrium is thickened. Why does tamoxifen raise her risk of endometrial disease?

A 23-year-old woman has a 6 cm right ovarian cyst on a routine scan. It contains an echogenic nodule casting an acoustic shadow, a fat-fluid level and fine echogenic lines in a 'dot-dash' pattern. What is the most likely diagnosis?

A 55-year-old woman with untreated advanced cervical cancer is admitted with vomiting, drowsiness and very little urine output. Serum creatinine is 7.8 mg/dL and potassium 6.4 mmol/L, and ultrasound shows bilateral hydronephrosis. What is the mechanism of her renal failure?

At colposcopy of a 31-year-old with HSIL cytology, Lugol's iodine is applied. The normal squamous epithelium stains mahogany brown, but a sharply outlined area near the os stays mustard yellow. Why does the abnormal area fail to stain?

A 52-year-old para 5 with postcoital bleeding has a friable, exophytic growth on the cervix, and a punch biopsy is taken in the gynae OPD. Which histological type is most likely?

A 29-year-old at 20 weeks of pregnancy has an HSIL Pap smear. Colposcopy by an experienced colposcopist shows changes consistent with CIN 3 and no features of invasion, and a directed biopsy confirms CIN 3 without invasion. What is the most appropriate plan?

A 48-year-old woman with squamous cell carcinoma of the cervix, FIGO stage IIB, has normal renal function and a good performance status. What is the standard treatment?

A 57-year-old woman has had a hysterectomy for grade 3 endometrioid carcinoma of the endometrium confined to the uterus. Molecular classification of the tumour is requested to guide adjuvant treatment. Which molecular group would carry the best prognosis?

A 35-year-old woman whose screening test is positive for high-risk HPV asks which types cause most cervical cancers. Which two HPV types together cause about 70% of cervical cancers worldwide?

A 52-year-old woman with stage III high-grade serous ovarian carcinoma and a germline BRCA1 mutation has a complete response to surgery and carboplatin-paclitaxel. She is started on olaparib as maintenance. Why does this drug selectively kill her tumour cells?