Endometrial Carcinoma MCQs

Obstetrics & Gynaecology · 97 free questions with answers & explanations.

  1. A 58-year-old postmenopausal woman presents with postmenopausal bleeding. Transvaginal ultrasound shows endometrial thickness of 12 mm. Endometrial biopsy is performed and reveals endometrioid adenocarcinoma. MRI shows tumor confined to the inner half of the myometrium with no cervical extension. Lymph nodes appear normal. What is the FIGO 2023 stage?
  2. A 55-year-old obese woman with a history of polycystic ovary syndrome and unopposed estrogen use for 5 years is diagnosed with well-differentiated endometrioid endometrial carcinoma. Which molecular feature is MOST commonly associated with this hormone-driven (Type 1) endometrial carcinoma?
  3. A 68-year-old obese, nulliparous, hypertensive woman is diagnosed with FIGO Stage IA (myometrial invasion <50%) Grade 1 endometrioid endometrial carcinoma. Adjuvant therapy recommended per current ESGO/ESTRO guidelines is:
  4. A 52-year-old woman with Lynch syndrome is counselled about risk-reducing surgery. Her endometrial biopsy is benign. Which statement about endometrial cancer risk in Lynch syndrome is CORRECT?
  5. A 58-year-old postmenopausal obese woman with Type 2 diabetes undergoes endometrial biopsy for postmenopausal bleeding. Histology shows grade 1 endometrioid adenocarcinoma. MRI pelvis shows tumor confined to the endometrium with no myometrial invasion. What is her FIGO stage?
  6. Which molecular subtype of endometrial carcinoma has the BEST prognosis and what is its key genetic feature?
  7. The PORTEC-3 trial compared pelvic radiotherapy alone versus chemoradiation in high-risk endometrial cancer. Which molecular subtype of endometrial cancer identified by TCGA (The Cancer Genome Atlas) classification has the BEST prognosis and does NOT benefit from adjuvant chemotherapy?
  8. A 52-year-old post-menopausal woman presents with stage IA grade 2 endometrioid endometrial carcinoma (FIGO 2009), <50% myometrial invasion. Sentinel lymph node biopsy is negative. Which is the CURRENT evidence-based management according to ESGO/ESTRO/ESP 2020 guidelines?
  9. A 62-year-old postmenopausal woman has endometrial carcinoma. Hysterectomy specimen shows endometrioid adenocarcinoma grade 2 with myometrial invasion to 60% depth, lymphovascular space invasion (LVSI), and no lymph node metastasis. According to FIGO 2023 revised staging for endometrial carcinoma, what stage does extensive LVSI specifically confer?
  10. According to the ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) molecular classification adopted in WHO 2020 and FIGO 2023, which molecular subtype of endometrial carcinoma carries the worst prognosis?
  11. The ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) molecular classification introduced by TCGA uses 4 subtypes. Which molecular subtype carries the BEST prognosis despite being classified as high histological grade?
  12. A 45-year-old woman with endometrial intraepithelial neoplasia (EIN/atypical endometrial hyperplasia) desires fertility preservation. The MOST appropriate progestin treatment and response monitoring approach is:
  13. TCGA (The Cancer Genome Atlas) molecular classification of endometrial carcinoma identifies four subtypes. A 52-year-old woman's endometrial carcinoma shows MSI-High status on immunohistochemistry (loss of MLH1 and PMS2 expression). Which molecular subtype does this represent, and what is the therapeutic implication?
  14. A 48-year-old woman with Stage IA grade 1 endometrioid endometrial carcinoma (invades <50% myometrium, no LVSI) is treated with hysterectomy and bilateral salpingo-oophorectomy. She is nulliparous and has been in remission for 2 years. Lynch syndrome testing reveals MLH1 germline mutation. What surveillance/management recommendation applies specifically to her Lynch syndrome status?
  15. The TCGA (The Cancer Genome Atlas) 2013 molecular classification of endometrial carcinoma identified four molecular subgroups. Which subgroup has the BEST prognosis despite being predominantly high-grade tumors?
  16. A 42-year-old woman with Stage IA grade 1 endometrioid endometrial carcinoma (confined to endometrium, no myometrial invasion) desires future fertility. Endocrine therapy with high-dose progestins is planned. Which treatment regimen and response assessment interval is currently recommended?
  17. The ProMisE molecular classification (2014) for endometrial carcinoma identifies 4 molecular subgroups with prognostic and treatment implications. The group with the best prognosis, characterized by POLE (polymerase epsilon) ultramutated genotype, shows which feature on immunohistochemistry?
  18. In the management of advanced or recurrent endometrial carcinoma with dMMR/MSI-H status, the landmark GARNET trial demonstrated activity of which agent as a single agent?
  19. The 2023 FIGO staging of endometrial carcinoma introduced molecular classification. A patient with endometroid endometrial carcinoma and POLE (polymerase epsilon) ultramutated genotype has which prognosis compared to other molecular subtypes?
  20. Conservative (fertility-sparing) management of well-differentiated endometrial carcinoma (Grade 1, Stage IA, no myometrial invasion) with progestogens is appropriate. The recommended progesterone therapy and response evaluation interval is:
  21. Lynch syndrome (hereditary non-polyposis colorectal cancer, HNPCC) is associated with endometrial carcinoma. The gene most frequently mutated in Lynch syndrome-associated endometrial cancer is:
  22. The TCGA (The Cancer Genome Atlas) molecular classification of endometrial carcinoma identifies four subgroups. Which molecular subgroup has the BEST prognosis, characterized by ultramutated status due to DNA polymerase epsilon (POLE) exonuclease domain mutations?
  23. A 52-year-old woman with Type II endometrial carcinoma (uterine serous carcinoma, FIGO Stage III) is completing surgical staging. Optimal surgical staging for uterine serous carcinoma requires which additional step beyond standard staging for Type I endometrial carcinoma?
  24. The TCGA (The Cancer Genome Atlas) 2013 molecular classification of endometrial carcinoma identified 4 prognostic groups. The ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) algorithm classifies endometrial cancer into these groups using practical immunohistochemistry and molecular markers. Which of the following correctly matches the molecular subtype with its key defining feature and prognosis?
  25. A 45-year-old premenopausal woman with Stage IA Grade 1 endometrial carcinoma (endometrioid type, myometrial invasion <50%) wants to preserve her uterus and fertility. Which of the following regimens is currently recommended for fertility-sparing treatment of Grade 1 endometrioid endometrial cancer Stage IA?
  26. The PORTEC-3 trial (2018) compared concurrent chemoradiotherapy (CCRT) versus pelvic radiotherapy alone in high-risk endometrial cancer. For which specific FIGO Stage subgroup did CCRT show a significant improvement in overall survival compared to radiotherapy alone?
  27. TCGA (The Cancer Genome Atlas, 2013) classified endometrial carcinoma into four molecular subgroups. A 58-year-old is found to have a POLEmut (POLE-ultramutated) endometrial carcinoma of grade 3 endometrioid histology. What is the clinical implication of this molecular classification regarding adjuvant treatment?
  28. Lynch syndrome accounts for approximately 3% of endometrial carcinomas. The Amsterdam II criteria and Revised Bethesda guidelines identify risk. In Lynch syndrome, which MMR gene mutation is most specifically associated with endometrial carcinoma predominance over colorectal carcinoma?
  29. The WHO 2020 classification of endometrial carcinoma introduced a molecularly-driven classification system. A 65-year-old woman with endometrial carcinoma shows POLE (exonuclease domain) mutation on next-generation sequencing. According to the ProMisE/TCGA molecular subgrouping, what is her prognosis and how does it affect adjuvant therapy decisions?
  30. A 55-year-old woman with endometrial carcinoma FIGO Stage IIIC1 (positive pelvic lymph nodes, no para-aortic involvement) is planned for adjuvant therapy. The PORTEC-3 trial results recommend which treatment?
  31. The ProMisE molecular classification system for endometrial carcinoma (based on TCGA) identifies four molecular subgroups. Which subgroup has the BEST prognosis?
  32. A 52-year-old woman with stage IA grade 1 endometrioid endometrial carcinoma (FIGO 2023) undergoes surgical staging with no lymphovascular space invasion (LVSI). According to ESGO/ESTRO/ESP 2020 risk stratification, she falls in which risk group, and what adjuvant treatment is recommended?
  33. The TCGA molecular classification of endometrial carcinoma identifies four subgroups. Which molecular subgroup carries the BEST prognosis and is characterised by ultra-high somatic mutation burden?
  34. A 55-year-old postmenopausal woman on tamoxifen for breast cancer for 5 years presents with postmenopausal bleeding. Transvaginal ultrasound shows endometrial thickness of 9 mm (the endometrial echo is heterogeneous). What is the appropriate investigation?
  35. The TCGA (The Cancer Genome Atlas) molecular classification of endometrial carcinoma identifies four prognostic subgroups. Which subgroup, characterised by POLE exonuclease domain mutations with an ultramutated phenotype, carries the most favourable prognosis despite high tumour grade?
  36. Lynch syndrome (HNPCC) is associated with endometrial carcinoma. Which MMR gene mutation has the highest penetrance for endometrial carcinoma (highest lifetime risk ~60%) compared to colorectal cancer risk?
  37. The ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) molecular classification divides endometrial carcinoma into 4 subgroups. Which subgroup has the BEST prognosis and is associated with POLE (proofreading exonuclease domain) mutations?
  38. A woman with FIGO stage IC (deep myometrial invasion >50%) grade 3 endometrioid endometrial carcinoma, no cervical or adnexal involvement, negative lymph nodes on staging, no LVSI: what does ESMO/ESGO 2020 recommend for adjuvant therapy?
  39. The 2020 WHO/ESGO molecular classification of endometrial carcinoma divides tumors into four prognostic groups. A 55-year-old woman has endometrioid grade 1 endometrial cancer with POLE exonuclease domain mutation on next-generation sequencing. Which statement BEST describes the prognostic significance and clinical implication?
  40. A 48-year-old woman with Stage IVB endometrial carcinoma (metastatic to lung and liver) has tumor tissue showing mismatch repair deficiency (dMMR) on immunohistochemistry. She progresses after first-line carboplatin-paclitaxel. What is the MOST appropriate second-line therapy with BEST evidence?
  41. A 64-year-old postmenopausal woman with a BMI of 38, type 2 diabetes, and hypertension presents with postmenopausal bleeding. Transvaginal ultrasound shows endometrial thickness of 14 mm. Endometrial biopsy confirms endometrioid adenocarcinoma. MRI shows tumour confined to the uterus with >50% myometrial invasion but no cervical involvement. The FIGO 2023 stage is:
  42. A 45-year-old with Grade 1 endometrioid endometrial carcinoma Stage IA who wishes to preserve fertility is considered for conservative management. The required minimum endometrial thickness confirming response to progestogen therapy on repeat biopsy is:
  43. The Lynch syndrome (hereditary non-polyposis colorectal cancer, HNPCC) associated endometrial cancer is characterised by which of the following features?
  44. A 62-year-old post-menopausal woman undergoes hysterectomy for endometrial cancer. Histology shows grade 2 endometrioid adenocarcinoma with 60% myometrial invasion, no lymphovascular space invasion (LVSI), cervical stroma involvement present, and negative lymph nodes. According to FIGO 2023 endometrial cancer staging, this is:
  45. The PORTEC-3 trial compared chemotherapy-radiotherapy vs radiotherapy alone in high-risk endometrial cancer. The molecular subgroup that derived the greatest benefit from combined treatment (chemoradiation) in terms of overall survival was:
  46. A 38-year-old nulliparous woman with Stage IA grade 1 endometrioid endometrial carcinoma confined to the endometrium (no myometrial invasion) strongly desires to preserve fertility. Hormonal conservative management is offered. The MOST appropriate regimen and monitoring interval is:
  47. According to FIGO 2023 staging of endometrial carcinoma, which NEW molecular subtype-based change was incorporated that was NOT present in FIGO 2009?
  48. A 72-year-old woman presents with postmenopausal bleeding. Endometrial biopsy shows Grade 2 endometrioid adenocarcinoma. MRI staging shows invasion into the outer half of the myometrium without cervical involvement. There is no lymphadenopathy. FIGO stage is IB. What is the RECOMMENDED adjuvant treatment?
  49. Lynch syndrome (HNPCC) is associated with lifetime risk of endometrial cancer of approximately:
  50. A 68-year-old postmenopausal obese (BMI 34) woman presents with postmenopausal bleeding. Endometrial biopsy shows endometrioid adenocarcinoma, Grade 2. MRI pelvis shows tumour invading >50% of myometrial thickness with no cervical extension or parametrial invasion. CT shows no distant metastasis. Retroperitoneal lymph nodes are negative on imaging. FIGO 2023 stage is:
  51. A 45-year-old woman with Grade 1 endometrioid endometrial carcinoma Stage IA (confined to endometrium, no myometrial invasion) desires future fertility. She has no other medical contraindications. After thorough counselling, which is the most appropriate fertility-sparing approach?
  52. The ProMisE molecular classification of endometrial cancer identifies 4 prognostic groups. A tumour with mutated p53 (p53abn) by immunohistochemistry belongs to which molecular subgroup and what is its prognosis?
  53. According to FIGO 2023 endometrial cancer staging, which molecular classifier defines the MOST FAVOURABLE prognostic group?
  54. A 62-year-old obese woman with grade 2 endometrioid endometrial carcinoma invades 60% of the myometrium. There is no cervical stromal invasion and no lymph node involvement. Peritoneal washings are negative. According to FIGO 2009 staging, she is:
  55. According to the revised FIGO 2023 endometrial cancer staging, a patient with endometrioid endometrial carcinoma invading <50% myometrium, no cervical glandular involvement, and a positive pelvic lymph node 0.4 cm is staged as:
  56. The PORTEC-3 trial established the benefit of chemotherapy added to radiotherapy in high-risk endometrial cancer. Which molecular subgroup showed the GREATEST benefit from adjuvant chemotherapy + radiotherapy over radiotherapy alone?
  57. Lynch syndrome (HNPCC) is associated with an increased lifetime risk of endometrial carcinoma. Which mismatch repair gene mutation carries the HIGHEST lifetime risk of endometrial cancer in Lynch syndrome?
  58. A 62-year-old post-menopausal woman on long-term tamoxifen for breast cancer presents with per-vaginal bleeding. Pelvic ultrasound shows endometrial thickness of 10 mm. What is the next most appropriate investigation?
  59. A 58-year-old woman is diagnosed with endometrial carcinoma: endometrioid grade 2, invasion to outer half of myometrium, extensive lymphovascular space invasion (LVSI), pelvic lymph nodes negative on sentinel lymph node biopsy. Under FIGO 2023 staging, the presence of extensive LVSI in this scenario upgrades the stage to:
  60. The ProMisE molecular classifier for endometrial cancer identifies four groups. Which molecular group carries the BEST prognosis and may not require adjuvant therapy after complete staging surgery for stage I–II disease?
  61. A 62-year-old postmenopausal woman has endometrial carcinoma (endometrioid grade 2). FIGO 2023 staging: tumour invades outer half of myometrium, cervical stromal invasion present, no adnexal or parametrial involvement, no lymphovascular space invasion (LVSI), sentinel lymph nodes negative, no distant metastases. What is her FIGO 2023 stage?
  62. Which molecular subtype of endometrial carcinoma defined by TCGA (The Cancer Genome Atlas) classification carries the BEST prognosis, characterised by markedly elevated somatic mutation burden?
  63. A 52-year-old woman with endometrial cancer, Grade 1 endometrioid, Stage IA (no myometrial invasion, FIGO 2009), is treated with total hysterectomy and bilateral salpingo-oophorectomy. She asks about adjuvant treatment. According to PORTEC-1 trial findings, which adjuvant treatment is recommended?
  64. A 62-year-old post-menopausal woman with stage IA endometrioid endometrial carcinoma (Grade 1, invasion <50% myometrium, no LVSI) undergoes total hysterectomy and bilateral salpingo-oophorectomy. According to ESMO-ESGO-ESTRO 2021 risk classification, she is in which risk group and what adjuvant treatment is recommended?
  65. The TCGA (The Cancer Genome Atlas) molecular classification of endometrial cancer identifies four prognostic groups. Which molecular subgroup carries the BEST prognosis and is characterised by very high tumour mutational burden?
  66. A 52-year-old obese woman on tamoxifen for breast cancer for 5 years develops postmenopausal bleeding. Pelvic ultrasound shows endometrial thickness of 10 mm. What is the MOST appropriate next step?
  67. According to FIGO 2023 endometrial cancer staging, a tumour that invades the outer half of the myometrium with positive cervical stroma involvement is now staged as:
  68. The ProMisE molecular classifier categorises endometrial cancers into four prognostic groups. Which molecular group carries the BEST prognosis with near-universal cure?
  69. A 38-year-old nulliparous woman with Grade 1 endometrial adenocarcinoma confined to the endometrium without myometrial invasion or cervical involvement requests fertility-sparing treatment. The most appropriate management is:
  70. Endometrial cancer with invasion confined to the inner half of the myometrium, no cervical stromal involvement, and no nodal or distant metastasis is classified as FIGO stage:
  71. Lynch syndrome (hereditary non-polyposis colorectal cancer) is associated with endometrial cancer. Which mismatch repair gene mutation most commonly predisposes to Lynch syndrome-associated endometrial carcinoma?
  72. A 52-year-old woman with endometrial carcinoma has a FIGO 2023 molecular classification showing microsatellite instability-high (MSI-H) status. This molecular subgroup is associated with which prognosis and treatment implication?
  73. Under FIGO 2023 staging of endometrial carcinoma, which new molecular subtype has been incorporated that determines stage assignment?
  74. The PORTEC-2 trial compared pelvic external beam radiotherapy (EBRT) to vaginal brachytherapy (VBT) in intermediate-risk endometrial carcinoma. What was the primary finding?
  75. In endometrial carcinoma, Lynch syndrome (hereditary non-polyposis colorectal cancer) is caused by defects in which genes?
  76. A 55-year-old woman with FIGO Stage IA Grade 1 endometrioid endometrial carcinoma (superficial myometrial invasion <50%, no LVSI) undergoes TAH-BSO. According to ESMO/ESGO/ESTRO 2021 risk stratification, she is in which risk group and what adjuvant treatment is recommended?
  77. Lynch syndrome (Hereditary Non-Polyposis Colorectal Cancer — HNPCC) is the most common hereditary cause of endometrial cancer. Which mismatch repair gene mutation is associated with the highest risk of endometrial cancer in Lynch syndrome?
  78. FIGO 2023 staging of endometrial carcinoma introduced a significant change. Which histological feature now upstages a previously Stage I endometrial carcinoma to Stage II?
  79. Progestin therapy (medroxyprogesterone acetate or LNG-IUD) for Grade 1 endometrial carcinoma confined to the endometrium (Stage IA) in a young woman desiring fertility works by which molecular mechanism?
  80. According to FIGO 2023 staging of endometrial carcinoma, which new molecular subtype has been incorporated that changes staging independent of histological grade?
  81. A 65-year-old obese postmenopausal woman with type 2 diabetes presents with postmenopausal bleeding. Endometrial biopsy shows grade 1 endometrioid adenocarcinoma. Imaging confirms disease confined to the endometrium. For a medically operable patient, the standard surgical approach is:
  82. A 35-year-old nulliparous woman with grade 1 endometrioid adenocarcinoma limited to the endometrium (no myometrial invasion on MRI) wishes to preserve her fertility. The fertility-sparing treatment of choice is:
  83. The 2023 ESGO/ESTRO/ESP molecular classification of endometrial carcinoma identifies four molecular subgroups with distinct prognoses. The subgroup with the BEST prognosis regardless of histological grade or stage is:
  84. A 45-year-old woman is diagnosed with Lynch syndrome (MSH2 mutation) during colorectal cancer screening. She has not yet developed endometrial cancer. She asks about prophylactic measures. The most effective option to reduce her lifetime endometrial cancer risk is:
  85. A 60-year-old postmenopausal woman with postmenopausal bleeding has endometrial biopsy showing grade 1 endometrioid adenocarcinoma. Imaging shows no myometrial invasion and no lymph node involvement. This is FIGO stage:
  86. The PORTEC-3 trial evaluated the role of adjuvant chemotherapy in high-risk endometrial carcinoma. Its key finding was:
  87. In the molecular classification of endometrial carcinoma, which subtype carries the BEST prognosis and is defined by pathogenic mutations in the exonuclease domain of POLE?
  88. A 65-year-old obese woman undergoes hysterectomy and bilateral salpingo-oophorectomy for endometrial carcinoma. Histology shows endometrioid adenocarcinoma, FIGO grade 2, myometrial invasion of 55% (outer half), no cervical stromal involvement, no lymphovascular space invasion (LVSI). What is the FIGO 2023 stage?
  89. Molecular classification of endometrial carcinoma per ProMisE/TCGA identifies four groups. Which molecular subgroup has the BEST prognosis?
  90. A 38-year-old nulliparous woman with grade 1 endometrial carcinoma limited to the endometrium (FIGO Stage IA) desires fertility preservation. Which treatment is appropriate?
  91. Lynch syndrome (hereditary non-polyposis colorectal cancer, HNPCC) is associated with a significantly elevated lifetime risk of which gynaecological malignancy?
  92. According to FIGO 2023 revised staging of endometrial cancer, which of the following is correctly classified as Stage IIIC2?
  93. The ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) system identifies 4 molecular sub-types. Which sub-type carries the BEST prognosis with the highest 5-year survival?
  94. A 52-year-old woman with type 2 diabetes and BMI 38 kg/m² is found to have endometrial hyperplasia with atypia (EIN) on biopsy. She desires fertility preservation. The MOST appropriate medical management is:
  95. Which molecular subtype of endometrial cancer according to the TCGA/ProMisE classification has the BEST prognosis regardless of histological grade or stage?
  96. In Lynch syndrome (Hereditary Nonpolyposis Colorectal Cancer — HNPCC), which is the most common gynaecological cancer, and what is the lifetime risk in MMR gene mutation carriers?
  97. A 38-year-old nulliparous woman with well-differentiated endometrioid adenocarcinoma confined to the endometrium (Stage IA, Grade 1, POLE wild-type, no LVSI, no myometrial invasion) wishes to preserve fertility. What is the standard fertility-sparing treatment?
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