Gynaecological oncology: fertility-sparing treatment in endometrial cancer: 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: fertility-sparing treatment in endometrial cancer

Sample item

A 30-year-old nulliparous woman with PCOS has grade 1 endometrioid adenocarcinoma on biopsy. MRI shows no myometrial invasion and no extrauterine disease, and she strongly wishes to conceive. Which approach is appropriate?

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

The answer and the reasoning

B. Progestin therapy (oral or levonorgestrel IUS) with close endometrial surveillance

In carefully selected young women with grade 1 endometrioid cancer confined to the endometrium, fertility-sparing treatment with high-dose progestins or the levonorgestrel IUS is accepted after counselling. Repeat biopsies are needed every few months, and hysterectomy follows childbearing or failure to respond. Radiotherapy and chemotherapy are used for advanced or high-risk disease.

Option by option

  • A. Combination chemotherapy with carboplatin and paclitaxel

    Chemotherapy is for advanced or high-risk disease and does not preserve the endometrium.

  • B. Progestin therapy (oral or levonorgestrel IUS) with close endometrial surveillance (correct)

    Correct. Progestin therapy with surveillance is the fertility-sparing option for early low-grade disease.

  • C. Adjuvant pelvic radiotherapy alone

    Radiotherapy alone does not treat the disease and would ruin fertility.

  • D. Immediate radical hysterectomy with pelvic lymphadenectomy

    Radical hysterectomy is not needed for early low-grade disease and removes fertility.

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.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Progestin therapy (oral or levonorgestrel IUS) with close endometrial surveillance. In carefully selected young women with grade 1 endometrioid cancer confined to the endometrium, fertility-sparing treatment with high-dose progestins or the levonorgestrel IUS is accepted after counselling.

Why is "Combination chemotherapy with carboplatin and paclitaxel" not the answer?

Chemotherapy is for advanced or high-risk disease and does not preserve the endometrium.

Why is "Adjuvant pelvic radiotherapy alone" not the answer?

Radiotherapy alone does not treat the disease and would ruin fertility.

Why is "Immediate radical hysterectomy with pelvic lymphadenectomy" not the answer?

Radical hysterectomy is not needed for early low-grade disease and removes fertility.

What concept does this question test?

It tests Gynaecological oncology: fertility-sparing treatment in endometrial cancer in OBG. Repeat biopsies are needed every few months, and hysterectomy follows childbearing or failure to respond. Radiotherapy and chemotherapy are used for advanced or high-risk disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: fertility-sparing treatment in endometrial cancer?

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.