Quiz: Malignant Ovarian Tumors — 11 questions

1. Which statement best describes the epidemiologic significance of malignant ovarian tumors among gynecologic cancers?

A. They are equally common and equally lethal as endometrial malignancies

B. They are the second most common and the most lethal gynecologic malignancies

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

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

Answer: (B)

Explanation

Malignant ovarian tumors rank second in frequency after endometrial cancer but cause the highest mortality among gynecologic malignancies. The most plausible misconception is that ovarian cancer is the most common gynecologic malignancy, whereas endometrial cancer is more common.

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

A. The ovarian surface epithelium

B. Stromal cells of the ovary

C. Germ cells within the ovary

D. Metastatic tumors from other sites

Answer: (A)

Explanation

Most ovarian malignancies originate from the ovarian surface epithelium, accounting for about 90% of cases. The other options represent less common origins, with germ cells and stromal cells being less frequently involved in malignant transformations.

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

A. Malignant cells spread through the peritoneal cavity before clear symptoms develop

B. Most tumors originate in stromal cells that conceal symptoms during early growth

C. Tumors usually remain confined to the ovary until late hormonal changes occur

D. The ovary has limited blood flow, delaying detection on standard imaging studies

Answer: (A)

Explanation

Ovarian cancer often disseminates through the peritoneal cavity before symptoms become obvious, so many patients present with advanced-stage disease. A tumor remaining confined to the ovary would tend to support earlier rather than later diagnosis.

4. What is the approximate proportion of ovarian malignancies that originate from the ovarian surface epithelium?

A. Approximately 50%

B. Approximately 30%

C. Approximately 90%

D. Approximately 70%

Answer: (C)

Explanation

Most ovarian malignancies, about 90%, arise from the ovarian surface epithelium. This distinguishes them from germ-cell and stromal tumors, which originate from different cell types within the ovary.

5. How does the WHO 2020 classification distribute the major categories of malignant ovarian tumors?

A. Sex-cord stromal tumors account for 90%, while epithelial and germ-cell tumors each account for 5%

B. Metastatic tumors account for 90%, while epithelial and germ-cell tumors each account for 5%

C. Epithelial tumors account for 90%, while germ-cell and sex-cord stromal tumors each account for 5%

D. Germ-cell tumors account for 90%, while epithelial and stromal tumors each account for 5%

Answer: (C)

Explanation

The WHO 2020 classification identifies epithelial tumors as approximately 90% of malignant ovarian tumors, with germ-cell and sex-cord stromal tumors each contributing about 5%, alongside metastatic tumors as a separate category. The main confusion is assigning the 90% proportion to germ-cell or stromal tumors, which are each associated with 5%.

6. What is the primary purpose of the CA-125 marker in the management of ovarian cancer?

A. To screen asymptomatic women for early ovarian cancer detection

B. To distinguish between benign and malignant ovarian cysts

C. To monitor disease progression and recurrence in epithelial ovarian cancer

D. To diagnose ovarian cancer in the general population

Answer: (C)

Explanation

CA-125 is mainly used to monitor disease progression and detect recurrence in patients with epithelial ovarian cancer, not for initial diagnosis or screening in asymptomatic women. Its levels can be elevated in benign conditions, limiting its use as a screening tool.

7. Which pairing correctly contrasts high-grade and low-grade serous ovarian carcinomas?

A. High-grade tumors are usually unilateral and multilocular, whereas low-grade tumors are typically bilateral metastases from the stomach

B. High-grade tumors grow slowly and link to KRAS or BRAF, whereas low-grade tumors are aggressive and linked to TP53 or BRCA1/2

C. High-grade tumors are aggressive and linked to TP53 or BRCA1/2, whereas low-grade tumors grow slowly and link to KRAS or BRAF

D. High-grade tumors are associated with endometriosis, whereas low-grade tumors commonly contain signet-ring cells

Answer: (C)

Explanation

High-grade serous carcinoma is aggressive and associated with TP53 and BRCA1/2 mutations, while low-grade serous carcinoma generally grows slowly and is associated with KRAS and BRAF mutations. The reversed mutation and behavior pattern is the key misconception because it swaps the characteristic profiles of the two tumor types.

8. When was the FIGO 2021 staging system for ovarian cancer officially published?

A. 2018

B. 2010

C. 2015

D. 2021

Answer: (D)

Explanation

The FIGO 2021 staging system for ovarian cancer was officially published in 2021, providing updated criteria for staging the disease. The previous versions were published in earlier years, such as 2014 and 2018, but the latest revision is from 2021.

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

A. Early-stage ovarian cancer typically presents with vague symptoms like abdominal discomfort and bloating, whereas advanced-stage disease often shows signs such as abdominal distension from ascites, pelvic mass, and weight loss.

B. Early-stage ovarian cancer usually causes severe pain and bleeding, while advanced-stage disease is asymptomatic and discovered incidentally.

C. Early-stage ovarian cancer is characterized by rapid growth and metastasis, while advanced-stage disease remains localized with minimal symptoms.

D. Early-stage ovarian cancer presents with specific symptoms like vaginal bleeding and pelvic pain, whereas advanced-stage disease only causes systemic symptoms like fever and malaise.

Answer: (A)

Explanation

Early ovarian cancer often presents with vague, non-specific symptoms such as abdominal discomfort and bloating, making early detection difficult. In contrast, advanced disease typically causes more noticeable symptoms like abdominal distension due to ascites and a palpable pelvic mass.

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

A. The World Health Organization (WHO)

B. The American Cancer Society (ACS)

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

D. The European Society of Gynecological Oncology (ESGO)

Answer: (C)

Explanation

The FIGO 2021 staging system for ovarian cancer was proposed by the International Federation of Gynecology and Obstetrics (FIGO). The WHO provides histological classifications, but the staging system was developed by FIGO.

11. What is the main cause of the high mortality rate associated with ovarian cancer?

A. High effectiveness of early screening methods

B. Overuse of diagnostic imaging causing unnecessary interventions

C. Late diagnosis due to vague early symptoms leading to advanced-stage detection

D. Genetic mutations that make the cancer resistant to treatment

Answer: (C)

Explanation

The high mortality rate is primarily due to ovarian cancer being diagnosed at stages III–IV because early symptoms are vague and nonspecific. This delays detection and treatment, allowing the disease to progress.