MCQs on Gynecological Oncology

MCQ Bank Gynaecology Module

Written by Dr. Priya Menon (MBBS, FRANZCOG) – Obstetrician and Gynaecologist

Question 1

Miranda is a 33-year-old patient of yours, who has presented for cervical screening test today. Her previous tests were all normal. She is married, has never been pregnant, and started her sexual relationships from the age of 17 years. She has been using oral contraceptive pills (OCPs) for the past 8 years as the means of contraception. She does not smoke but drinks alcohol on social occasions. She is obese with a BMI of 31 kg/m². In consulting her, which one of the following will you mention as the most significant risk factor for development of cervical cancer in the future?

A) Sexual relationship.
B) Alcohol.
C) Obesity.
D) Prolonged use of OCPs.
E) Nulliparity.

Correct Answer: D) Prolonged use of OCPs.

Explanation:
The most important risk factor for cervical cancer is persistent infection with high-risk human papillomavirus (HPV) types, especially HPV 16 and 18. Virtually all cervical cancer cases are caused by HPV, and other risk factors contribute only in the presence of HPV infection.

Prolonged use of oral contraceptive pills (OCPs)—particularly use for more than 5 years—has been consistently shown to increase the risk of cervical cancer. Studies have demonstrated a 60% increased risk with 5–9 years of use, and up to a twofold increase with ≥10 years of use. The mechanism may involve increased susceptibility to persistent HPV infection or changes in cervical epithelial cells.

Other options:

  • Sexual activity alone is not a risk factor unless it results in HPV infection.
  • Alcohol has no known direct link to cervical cancer.
  • Obesity is weakly associated and not a major independent risk factor.
  • Nulliparity may even have a protective effect, whereas multiparity (≥5 births) slightly increases risk in HPV-infected women.

Thus, for Miranda, the most significant modifiable risk factor among the given options is her prolonged use of OCPs.

Question 2

Hanna is a 32-year-old patient of yours, who has decided to start combined oral contraceptive pills (COCs) for contraception, but she is worried about the risk of cancer because she has heard from her friends and read on different websites that COCs increase the risk of some cancers. In consulting her regarding long-term use of COCs, which one of the cancers will you mention to be of highest risk for her if she takes COCs in the long run?

A) Endometrial cancer.
B) Colon cancer.
C) Breast cancer.
D) Cervical cancer.
E) Ovarian cancer.

Correct Answer: D) Cervical cancer.

Explanation:
Combined oral contraceptives (COCs) have variable effects on cancer risk. While they are protective against some cancers, they are associated with increased risk of others.

COCs significantly reduce the risk of:

  • Ovarian cancer (up to 50% lower risk with long-term use)
  • Endometrial cancer (at least 30% risk reduction)
  • Colorectal cancer (15–20% lower risk)

However, long-term use of COCs (especially ≥5 years) is associated with a notable increase in the risk of cervical cancer.

  • Risk increases by about 60% with 5–9 years of use, and doubles after 10 years.
  • This is thought to be due to enhanced susceptibility of cervical cells to persistent infection with high-risk HPV types, the necessary cause of cervical cancer.

There is also a slight increase in breast cancer risk, but this returns to baseline within about 10 years after stopping COCs.

Thus, for Hanna, the most significant cancer risk associated with long-term COC use is cervical cancer, and this should be clearly explained during counseling.

Question 3

In which one of the following women groups, endometrial hyperplasia is most likely to be found?

A) An ovulating woman.
B) An obese diabetic woman.
C) A woman on cyclic combined oral contraceptive pills.
D) A woman on Depo-Provera® for treatment of endometriosis.
E) A woman with an intrauterine device.

Correct Answer: B) An obese diabetic woman.

Explanation:
Endometrial hyperplasia is characterized by excessive proliferation of the endometrium, which can progress to or coexist with endometrial carcinoma. It is primarily caused by excess unopposed estrogen exposure.

Among the options, obesity and diabetes are associated with an increased risk of endometrial hyperplasia. Diabetes mellitus type 2 increases levels of insulin-like growth factor (IGF), which promotes endometrial proliferation. Obesity causes peripheral conversion of androgens to estrogen in adipose tissue, leading to excess estrogen exposure.

Other risk factors for endometrial hyperplasia and cancer include chronic anovulation (e.g., PCOS), nulliparity, late menopause, and unopposed estrogen therapy.

  • Ovulating women (A) have cyclical progesterone exposure, which protects against hyperplasia.
  • Women on cyclic combined oral contraceptive pills (C) receive progesterone, which counteracts estrogen’s effect.
  • Women on Depo-Provera® (D) receive progesterone, which is protective.
  • Intrauterine devices (E) have not been linked to increased risk.

Thus, the obese diabetic woman is the most likely group to develop endometrial hyperplasia.

Previous Next

14. Gynecology Module

14.1 Abnormal Uterine Bleeding

14.2 Amenorrhea

14.3 Subfertility

14.4 Contraception

14.5 Menopause

14.6 Gynecological Oncology

14.7 Other Gynecological Disorders

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