Quiz: Malignant Ovarian Tumors — 11 questions

1. What is the epidemiologic relationship between malignant ovarian tumors and other gynecologic malignancies?

A. They are the most common and the least lethal gynecologic malignancies

B. They are the second most common but the deadliest gynecologic malignancies

C. They are the third most common and have intermediate mortality

D. They are less common and less lethal than cervical malignancies

Answer: (B)

Explanation

Malignant ovarian tumors rank second in frequency after endometrial cancer but are the deadliest gynecologic malignancies. The most common gynecologic malignancy is not ovarian cancer, which addresses the common misconception.

2. What is the primary origin of approximately 90% of ovarian malignancies?

A. Surface epithelium of the ovary

B. Germ cells within the ovary

C. Stromal cells of the ovary

D. Metastatic tumors from other sites

Answer: (A)

Explanation

Most ovarian malignancies originate from the surface epithelium, accounting for about 90% of cases. Germ-cell and stromal tumors are less common, and metastatic tumors originate elsewhere.

3. Why are ovarian cancers frequently diagnosed at stages III–IV?

A. Metastatic deposits form only after the primary tumor becomes symptomatic

B. The ovary lacks blood vessels that could produce early warning signs

C. Hormonal changes conceal the tumor until ovarian function declines

D. Tumor cells spread through the peritoneal cavity before clear symptoms develop

Answer: (D)

Explanation

Ovarian tumor cells can disseminate through the peritoneal cavity before clear symptoms appear, leading to advanced-stage diagnosis. The delay is related to early peritoneal spread rather than hormonal concealment or a lack of ovarian blood vessels.

4. What is the approximate lifetime risk of developing ovarian cancer in women?

A. 1 in 50 women

B. 1 in 100 women

C. 1 in 200 women

D. 1 in 70 women

Answer: (D)

Explanation

The lifetime risk of ovarian cancer is about 1 in 70 women. The other options are either overestimations or underestimations of this risk.

5. Which group correctly lists the principal epithelial ovarian tumor types?

A. Metastatic, dysgerminoma, yolk-sac, granulosa-cell, and mucinous tumors

B. Dysgerminoma, yolk-sac, serous, mucinous, and Brenner tumors

C. Serous, mucinous, endometrioid, clear-cell, and Brenner tumors

D. Granulosa-cell, Sertoli–Leydig, endometrioid, clear-cell, and serous tumors

Answer: (C)

Explanation

Epithelial ovarian tumors include serous, mucinous, endometrioid, clear-cell, and Brenner tumors. Dysgerminoma and yolk-sac tumor belong to the germ-cell group, while granulosa-cell and Sertoli–Leydig tumors are sex-cord stromal tumors.

6. What is the main purpose of the WHO histological classification of ovarian tumors?

A. To assess the prognosis and survival rates of different ovarian tumors.

B. To identify genetic mutations associated with ovarian tumors.

C. To categorize ovarian tumors based on their tissue origin and cellular characteristics.

D. To determine the stage of ovarian cancer for treatment planning.

Answer: (C)

Explanation

The WHO classification aims to categorize ovarian tumors based on their tissue origin and cellular features, which guides diagnosis and management. It is not primarily used for staging, genetic identification, or prognosis assessment.

7. Which pairing correctly distinguishes granulosa-cell tumors from Sertoli–Leydig tumors?

A. Both tumor types secrete estrogen and commonly produce endometrial hyperplasia

B. Granulosa-cell tumors secrete estrogen, whereas Sertoli–Leydig tumors secrete androgens

C. Both tumor types secrete androgens and commonly produce virilization

D. Granulosa-cell tumors secrete androgens, whereas Sertoli–Leydig tumors secrete estrogen

Answer: (B)

Explanation

Granulosa-cell tumors produce estrogen and may cause endometrial hyperplasia, whereas Sertoli–Leydig tumors produce androgens and may cause virilization. Their hormonal effects differ because they arise from distinct sex-cord stromal cell types.

8. When is ovarian cancer most commonly diagnosed, reflecting its progression through the stages?

A. At stage II when pelvic organs are involved

B. At stage V when distant metastases are evident

C. At stages III–IV due to early spread before symptoms appear

D. At stage I during routine screening

Answer: (C)

Explanation

Ovarian cancer is often diagnosed at stages III–IV because tumor cells spread through the peritoneal cavity before clear symptoms develop. Early stages are usually asymptomatic, making detection difficult.

9. How does the clinical presentation of early ovarian cancer differ from that of advanced stages?

A. Early ovarian cancer typically presents with vague symptoms like abdominal discomfort and bloating, whereas advanced stages often show signs such as abdominal distension, ascites, and systemic symptoms.

B. Early ovarian cancer usually causes severe pain and bleeding, while advanced stages are asymptomatic.

C. Early stages are characterized by palpable pelvic masses with no other symptoms, whereas late stages always present with jaundice and liver enlargement.

D. Early ovarian cancer is often diagnosed through routine screening, while advanced stages are only found incidentally during surgery.

Answer: (A)

Explanation

Early ovarian cancer generally presents with nonspecific symptoms like discomfort and bloating, making early detection difficult. In contrast, advanced stages often manifest with more pronounced signs such as abdominal distension and ascites due to tumor spread.

10. Who proposed the FIGO 2021 staging system for ovarian cancer?

A. The World Health Organization (WHO)

B. The European Society of Gynaecological Oncology (ESGO)

C. The International Federation of Gynecology and Obstetrics (FIGO)

D. The American Society of Clinical Oncology (ASCO)

Answer: (C)

Explanation

The FIGO 2021 staging system for ovarian cancer was proposed by the International Federation of Gynecology and Obstetrics (FIGO). The WHO primarily classifies tumors histologically, not staging systems.

11. What is a common cause of high-grade serous ovarian carcinoma according to molecular pathogenesis?

A. It often arises from the fimbrial end of the fallopian tube due to STIC lesions.

B. It develops mainly from stromal cell proliferation within the ovary.

C. It results from metastatic spread from the gastrointestinal tract.

D. It is primarily caused by germ-cell mutations such as in dysgerminomas.

Answer: (A)

Explanation

High-grade serous ovarian carcinoma is frequently associated with serous tubal intraepithelial carcinoma (STIC) lesions at the fimbrial end of the fallopian tube, which are considered precursor lesions. This differs from germ-cell or stromal origins, which are less common causes of this aggressive subtype.