Gynaecological oncology: HE4: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Gynaecological oncology: HE4

Sample item

A premenopausal woman has a pelvic mass with CA-125 of 120 U/mL. Which additional marker helps to distinguish a malignant epithelial tumour from endometriosis, as it is less often raised in benign gynaecological conditions?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Human epididymis protein 4 (HE4)

CA-125 is raised in endometriosis, PID, menstruation and pregnancy as well as in cancer, so it lacks specificity in premenopausal women. HE4 is overexpressed in serous and endometrioid ovarian cancers but rarely in endometriosis, and the combination forms the ROMA index. AFP, hCG and LDH are germ cell tumour markers.

Option by option

  • A. Serum beta-hCG

    hCG is a marker of choriocarcinoma and pregnancy.

  • B. Lactate dehydrogenase

    LDH is raised in dysgerminoma.

  • C. Alpha-fetoprotein

    AFP is a marker of yolk sac tumours.

  • D. Human epididymis protein 4 (HE4) (correct)

    Correct. HE4 is more specific for epithelial ovarian cancer than CA-125 alone.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Human epididymis protein 4 (HE4). CA-125 is raised in endometriosis, PID, menstruation and pregnancy as well as in cancer, so it lacks specificity in premenopausal women.

Why is "Serum beta-hCG" not the answer?

hCG is a marker of choriocarcinoma and pregnancy.

Why is "Lactate dehydrogenase" not the answer?

LDH is raised in dysgerminoma.

Why is "Alpha-fetoprotein" not the answer?

AFP is a marker of yolk sac tumours.

What concept does this question test?

It tests Gynaecological oncology: HE4 in OBG. HE4 is overexpressed in serous and endometrioid ovarian cancers but rarely in endometriosis, and the combination forms the ROMA index. AFP, hCG and LDH are germ cell tumour markers.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological oncology: HE4?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.