Ovarian Cancer Post-Test: 20 items multiple choice and 5 items as modified true or false

Multiple Choice
1) JF, a 60-year-old female, was diagnosed to have recurrent ovarian cancer. The ff
molecular tests can be considered for this patient, EXCEPT:
a. BRCA 1/2
b. TMB
c. MMR
d. MSI
e. PDL-1
f. HRD
g. NTRK

2) After completion of primary chemotherapy with Bevacizumab, patients with Stage III
BRCA-Mutated Ovarian Cancer may be started on maintenance Olaparib and
Bevacizumab, according to PAOLA1. What are the appropriate dosages?
a. Olaparib 300mg PO BID + Bevacizumab 5mg/kg IV q21 days
b. Olaparib 200mg PO OD + Bevacizumab 5mg/kg IV q21 days
c. Olaparib 300mg PO BID + Bevacizumab 15mg/kg IV q21 days
d. Olaparib 200mg PO BID + Bevacizumab 15mg/kg IV q21 days

3) Which one among the following is INCORRECT?

a. Platinum refractory – progressed while receiving primary platinum-based therapy
b. Platinum resistant – relapse within 6 months of receiving primary platinum-based
therapy
c. Partially platinum sensitive – recurrence between 6 and 12 months after primary
platinum-based therapy
d. Platinum sensitive – relapse >12 months after primary platinum-based therapy
e. All of the above
f. None of the above
 4) For patients with platinum-sensitive recurrent ovarian cancer with high grade serous
histology, we can offer retreatment with the ff:
a. Carboplatin + Liposomal Doxorubicin
b. Carboplatin + Paclitaxel + Epirubicin
c. FOLFOX
e. All of the above

5) KU, 55/F, presented with persistent bloating. TVS showed a right ovarian mass. She
underwent optimal cytoreduction, achieving R0. Histopathology revealed Stage I disease
and clear cell histology. What is the next best step in managing this patient?
a. IV Carboplatin + Paclitaxel
b. HIPEC
c. Surveillance
d. Check for BRCA mutation

Patients with stage IA or IB, grade 1 or 2 cancers have 5-year DFS rates greater than 90% with surgery
alone and are not offered adjuvant treatment. For patients with stage IA or IB, grade 3 tumors, all with
stage IC disease, and those with clear cell carcinoma, adjuvant chemotherapy is recommended. (ASCO)

6) Surveillance in Ovarian Cancer consists of the following, EXCEPT:

a. Clinic visits every 4 months on the 3rd year
b. CA-125 if initially elevated
c. Chest and Whole Abdomen MRI with Contrast if with new symptoms
d. Pelvic exam at least every 3 months
7) __________ may be considered for as primary systemic therapy for an epithelial ovarian
CA patient with ECOG 3.
a. Intraperitoneal paclitaxel/cisplatin
b. Weekly paclitaxel/carboplatin
c. Liposomal doxorubicin/carboplatin q3 weeks
d. Single agent bevacizumab
8) Which of the following support the use of HIPEC in Ovarian CA?
a. The chemotherapy agents used in HIPEC must be cell-cycle specific
b. Hyperthermia allows for enhanced tissue penetration of the chemotherapy agent
c. Chemotherapy drugs must have a heat-synergistic cytotoxic effect
d. A and B
e. B and C
f. A, B, and C
9) Which of the ff is TRUE regarding diagnosing Ovarian Cancer?
a. Fine-needle aspiration is done in patients who are not candidates for primary
debulking surgery
b. Diagnosis is through excision biopsy of the suspicious ovarian new growth
c. There is no need for para-arotic lymph node dissection in early stage ovarian cancer
 d. Omentectomy must be avoided, unless with note of omental implant
intraoperatively.
10) LM, a 61/F, was diagnosed as relapsed ovarian cancer after completing chemotherapy 3
months ago. What would be the best approach for this patient?
a. Clinical trial
b. Systemic chemotherapy for recurrence
c. Best supportive care
d. All of the above
11) A 64/F patient was referred post-operatively with a histopath showing mucinous ovarian
CA. This organ should be checked in the pathology review or must have been evaluated
intraoperatively:
a. Ileum
b. Appendix
c. Gall Bladder
d. Rectum
12) Which patient will benefit most from single agent Bevacizumab as maintenance
therapy?
a. BRCA1 wild type with partial response to primary platinum-based chemotherapy
b. BRCA2 mutated with stable disease after primary platinum-based chemotherapy
c. Unknown BRCA and HRD status with partial response after primary platinum-
based chemotherapy with Bevacizumab
d. BRCA2 mutated with complete response after primary platinum-based
chemotherapy with Bevacizumab

13) Which of the following is involved in interval debulking surgery after neoadjuvant
chemotherapy for invasive epithelial ovarian cancer?
a. Possible HIPEC with Cisplatin 100mg/m2
 b. Stripping of peritoneal surfaces
c. Resection of enlarged lymph nodes
d. A and B
e. B and C
f. A and C
14) Which of the ff would need adjuvant therapy after cytoreductive surgery in ovarian
cancer?
a. Tumor involving both ovaries
b. Tumor involving one ovary
c. Tumor involving one fallopian tube
d. None of the above
15) You note that JC, a 59/F patient on surveillance, has rising CA-125 levels. Two years ago,
she was previously treated with chemotherapy for advanced stage ovarian cancer. Which
of the following would be the least appropriate for this patient?
a. PET CT with Contrast
b. MMR/MSI and BRCA testing
c. Delay treatment until with clinical relapse
d. Immediate treatment for disease recurrence
16) Which of the following regarding Niraparib in Ovarian Cancer is FALSE?
a. Thrombocytopenia is the most common adverse effect
b. Exclusively for patients with BRCA mutation
c. Given after 2 or more lines of systemic therapy
d. For patients with partial response to platinum chemotherapy
17) MM, a 63/F, recently diagnosed with advanced ovarian cancer, is deemed a poor surgical
candidate for cytoreduction. What will be our approach for this patient?
a. Refer to Rad Onco for possible chemoRT with weekly Carboplatin
b. Give Carboplatin + Paclitaxel for 3 cycles
c. Test for BRCA mutation and consider starting on a PARP inhibitor prior to surgery
d. Do peritoneal sampling via aspiration to determine staging
18) After giving the appropriate therapy for patient MM (from Question #17), imaging
showed progressive disease. What would be the next best step in managing the patient?
a. Topotecan
b. Check for hormone receptor status and consider starting Tamoxifen
c. Test for BRCA mutation and consider starting on a PARP inhibitor
d. Gemcitabine + Cisplatin
19) Which among the following statements regarding FIGO staging in Ovarian CA is TRUE?
a. Malignant cells on ascitic fluid cytology would classify patient as Stage IIIC
b. A 2 cm para-aortic metastatic LN would indicate Stage IVA
c. Surgical spill is classified as Stage II
d. Malignant pleural effusion is staged differently from other distant metastasis
20) The strongest risk factor for the development of ovarian cancer:
a. Use of hormonal therapy
b. Age
c. Family history
 d. Nulliparity
e. Lynch syndrome
True or False
1) Prophylactic bilateral salpingo-oophorectomy nullifies the chance of developing ovarian
cancer in patients with high risk.
2) According to GOG 218, the addition of Bevacizumab to Paclitaxel/Carboplatin showed a
significant increase in both PFS and OS, compared to the control group.
3) Bilateral salpingo-oophorectomy with uterine preservation is not considered a fertility-
sparing surgery.
4) There is a difference in PFS between giving carboplatin and paclitaxel every 3 weeks vs
dose dense carboplatin and paclitaxel.
5) Patients who had partial response to maintenance Olaparib after 2 years were permitted
to continue receiving Olaparib beyond 2 years.

ANSWER KEY
1) E
2) C
3) F
4) A
5) A
6) D
7) B
8) E
9) A
10) D
11) B
12) C
13) F
14) C
15) D
16) B
17) B
18) A
19) D
20) B

True or False
1) False
2) False
3) False
4) False
5) True