Oncology Practice Questions

Q: Serum thyroglobulin level is an important tumor marker for

Papillary carcinoma thyroid. ***Papillary carcinoma thyroid*** - **Serum thyroglobulin** is produced by follicular cells of the thyroid and serves as an excellent tumor marker for **differentiated thyroid cancers**, including papillary carcinoma, particularly after thyroidectomy [1]. - Elevated thyroglobulin levels in a patient with a history of papillary thyroid cancer, especially after removal of the thyroid gland, suggest **recurrence or persistent disease**. *Thyroid lymphoma* - **Thyroid lymphoma** is a lymphoid malignancy, and its primary tumor marker is typically associated with lymphocytic origin, such as **beta-2 microglobulin** or **LDH**, not thyroglobulin. - Thyroglobulin is a product of thyroid follicular cells, which are not the cell of origin for lymphoma. *Medullary carcinoma thyroid* - **Medullary thyroid carcinoma** originates from the parafollicular C cells, which produce **calcitonin**. - **Calcitonin** is the primary tumor marker for medullary thyroid carcinoma, not thyroglobulin. *Anaplastic carcinoma thyroid* - **Anaplastic thyroid carcinoma** is an undifferentiated tumor with very aggressive behavior and often does not produce significant amounts of thyroglobulin. - While some anaplastic carcinomas may have elevated thyroglobulin, it's not a reliable or specific marker due to the **dedifferentiated nature** of the cells.

Q: Consider the following statements: Poor prognostic indicators in advanced germ cell tumours show 1. primary sites in mediastinum 2. non-pulmonary metastasis 3. lactate dehydrogenase more than 10 times of normal value Which of the statements given above are correct?

1, 2 and 3. ***1, 2 and 3*** - **All three statements** represent poor prognostic indicators in advanced germ cell tumors, as defined by the **International Germ Cell Cancer Collaborative Group (IGCCCG)** classification. - A primary site in the **mediastinum**, the presence of **non-pulmonary visceral metastases**, and **LDH levels >10 times the upper limit of normal** are all independent factors associated with a worse prognosis. *1 and 2 only* - This option is incorrect because it excludes a critically important poor prognostic indicator: **markedly elevated lactate dehydrogenase (LDH)**. - While mediastinal primary and non-pulmonary metastases are poor prognostic factors, high LDH further defines the **poor risk group**. [1] *2 and 3 only* - This option is incorrect as it omits the significance of a **mediastinal primary site** as a poor prognostic factor in advanced germ cell tumors. - **Mediastinal germ cell tumors** are known to have a worse prognosis compared to testicular primaries, even in the absence of other poor risk factors. *1 and 3 only* - This option is incorrect because it fails to include **non-pulmonary metastases** as a distinct poor prognostic factor for advanced germ cell tumors. - The presence of metastases to sites like the **liver, brain, or bone** significantly worsens the prognosis compared to lung-only metastases.

Q: First line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:

Anastrazole. ***Anastrazole*** - **Aromatase inhibitors** like anastrozole are the preferred first-line hormone therapy for **post-menopausal women** with **hormone-receptor-positive metastatic breast cancer**. - They work by **blocking the aromatase enzyme**, which is responsible for estrogen production in peripheral tissues in post-menopausal women. *Ovarian suppression by surgery* - Ovarian suppression is primarily used in **pre-menopausal women** to reduce estrogen production by the ovaries. - Since the patient is **post-menopausal**, her ovaries are no longer the primary source of estrogen production. *Antiprogestins* - **Antiprogestins** are not standard first-line hormone therapy for metastatic breast cancer. - While some progestational agents have been used in breast cancer treatment, **antiprogestins** are not established as a primary treatment. *Tamoxifen* - **Tamoxifen** is a **selective estrogen receptor modulator (SERM)** that has been widely used in breast cancer treatment. - While effective, **aromatase inhibitors** are generally preferred over tamoxifen as first-line therapy for **post-menopausal metastatic breast cancer** due to superior efficacy and tolerability profiles in this demographic.

Q: A 60-year-old male patient has an antral carcinoma spreading to the head of the pancreas with multiple small metastases to the right lobe of the liver. What is the best treatment approach?

Palliative chemotherapy. Palliative chemotherapy - The presence of **multiple small metastases** in the liver indicates **metastatic disease**, which is generally considered incurable with surgery [2]. - **Palliative chemotherapy** aims to control disease progression, alleviate symptoms, and improve quality of life in patients with advanced metastatic cancer. Surgical resection with adjuvant chemotherapy - **Surgical resection** is not indicated due to the presence of **distant metastases** (to the liver), classifying the disease as Stage IV [1]. - **Adjuvant chemotherapy** is given after curative surgery to reduce recurrence risk, which is not the goal here as the disease is already metastatic. Radiation therapy alone - **Radiation therapy alone** is typically reserved for localized disease or for palliative symptom management (e.g., pain from bone metastases), not for widespread metastatic disease. - It would not adequately address the systemic nature of **multiple liver metastases** from a pancreatic primary. Supportive care only - While supportive care is crucial, **palliative chemotherapy** offers a chance to prolong survival and manage symptoms more effectively than supportive care alone in suitable patients with advanced pancreatic cancer. - Skipping chemotherapy entirely would mean foregoing potential benefits in terms of disease control and quality of life, especially for patients with a good performance status.

Q: A patient presents with a mediastinal mass and is diagnosed with pure red cell aplasia. What is the most probable underlying cause?

Thymic neoplasia. ***Thymic neoplasia*** - **Thymoma** is strongly associated with **pure red cell aplasia (PRCA)**, where the body's immune system, influenced by the abnormal thymus, attacks and destroys red blood cell precursors in the bone marrow. - A mediastinal mass, particularly in an adult presenting with PRCA, should raise strong suspicion for a **thymic tumor**. *Bronchogenic carcinoma* - While bronchogenic carcinoma can present as a **mediastinal mass**, it is not typically associated with **pure red cell aplasia**. - Its paraneoplastic syndromes usually involve endocrine or neurological manifestations rather than direct hematopoietic suppression of red cell precursors. *T-cell Acute Lymphoblastic Leukemia* - **T-cell ALL** can present with a **mediastinal mass** due to thymic involvement, but it causes **pancytopenia** or **anemia** due to bone marrow infiltration by leukemic cells, not a selective aplasia of red cell precursors. - In T-cell ALL, there would be a proliferation of immature lymphoid cells, differentiating it from PRCA. *Non-Hodgkin Lymphoma* - Certain types of **non-Hodgkin lymphoma** (e.g., lymphoblastic lymphoma) can present with a **mediastinal mass**. - However, lymphoma would typically cause **bone marrow infiltration** leading to cytopenias, not specifically **pure red cell aplasia**, where only erythroid precursors are targeted.

Q: KEYNOTE-189 trial for pembrolizumab is done for?

Pembrolizumab with chemo given for NSCLC. ***Pembrolizumab with chemo given for NSCLC*** - The **KEYNOTE-189 trial** investigated the efficacy of **pembrolizumab** in combination with chemotherapy as first-line treatment for **metastatic nonsquamous non-small cell lung cancer (NSCLC)**. - This trial demonstrated significant improvements in overall survival and progression-free survival, leading to the approval of pembrolizumab in this setting. *Nivolumab with chemo given for NSCLC* - **Nivolumab** is another PD-1 inhibitor, but studies specifically combining nivolumab with chemotherapy for NSCLC (e.g., CheckMate 227) are distinct from KEYNOTE-189. - While both drugs are used in NSCLC, their pivotal trials and specific combination regimens differ. *Only Pembrolizumab for NSCLC* - Although pembrolizumab monotherapy is approved for certain NSCLC patients with high PD-L1 expression, the **KEYNOTE-189 trial specifically focused on a combination approach** with chemotherapy. - Other KEYNOTE trials, like KEYNOTE-024, evaluated pembrolizumab monotherapy in NSCLC. *Only nivolumab for NSCLC* - **Nivolumab monotherapy** has been studied and approved for NSCLC, particularly in the second-line setting or for patients with high PD-L1 expression, but this was not the focus of the KEYNOTE-189 trial. - Trials like CheckMate 017 and 057 investigated nivolumab as a single agent in NSCLC.

Q: A 62-year-old man presents with “yellowing” of the skin. He says he has been having intermittent upper abdominal pain, which is relieved by Tylenol. He also recalls that he has lost some weight over the past several months but can not quantify the amount. His past medical history is significant for type 2 diabetes mellitus. He reports a 40-pack-year smoking history. The patient is afebrile and vital signs are within normal limits. Physical examination reveals mild jaundice and a palpable gallbladder. Laboratory findings are significant for the following: Total bilirubin 13 mg/dL Direct bilirubin: 10 mg/dL Alkaline phosphatase (ALP): 560 IU/L An ultrasound of the abdomen reveals a hypoechoic mass in the epigastric region. The patient is scheduled for a CT abdomen and pelvis with specific organ protocol for further evaluation. Which of the following best describes this patient’s most likely diagnosis?

CA 19-9 is a marker for this condition.. ***CA 19-9 is a marker for this condition.*** - The patient's presentation with **painless jaundice**, **weight loss**, **palpable gallbladder (Courvoisier's sign)**, and markedly elevated **direct bilirubin** and **ALP** strongly suggests **pancreatic head adenocarcinoma**, which obstructs the common bile duct [1]. - **CA 19-9** is a widely used and clinically relevant tumor marker for **pancreatic cancer**, though its utility is primarily for monitoring treatment response and recurrence rather than initial diagnosis. *Caffeine consumption is an established risk factor for this condition.* - **Smoking**, not caffeine consumption, is a significant and well-established **risk factor for pancreatic cancer**, aligning with the patient's 40-pack-year history. - Other risk factors include **chronic pancreatitis**, **obesity**, **diabetes**, and certain **hereditary syndromes** [1]. *Patients with this condition often rapidly develop glucose intolerance and severe diabetes.* - While pancreatic cancer can cause **new-onset diabetes** or worsen pre-existing diabetes, this is typically a **consequence of the tumor** affecting pancreatic islet cells, not a characteristic of its development [1]. - The patient already has a history of **type 2 diabetes mellitus**, which is a *risk factor* for pancreatic cancer. *This condition is most common in Caucasians.* - **Pancreatic cancer** shows a slightly higher incidence in **African Americans** compared to Caucasians. - The incidence generally **increases with age** and is more common in males. *The majority of cases occur in the body of the pancreas.* - Approximately **60-70% of pancreatic adenocarcinomas** occur in the **head of the pancreas**, consistent with the patient's presentation of obstructive jaundice and a palpable gallbladder [1]. - Tumors in the body or tail are less likely to present with jaundice early as they do not obstruct the bile duct.

Q: All are risk factors of esophageal squamous cell carcinoma except:

GERD. ***GERD*** - **Gastroesophageal reflux disease (GERD)** is strongly associated with **esophageal adenocarcinoma**, not esophageal squamous cell carcinoma. - Chronic acid reflux can lead to **Barrett's esophagus**, which is a precursor to adenocarcinoma [1]. *Smoking* - **Smoking** is a significant and well-documented risk factor for **esophageal squamous cell carcinoma**, increasing the risk in a dose-dependent manner. - Carcinogens in tobacco smoke directly damage esophageal epithelial cells, promoting malignant transformation. *Achalasia cardia* - **Achalasia cardia** involves impaired relaxation of the lower esophageal sphincter and loss of peristalsis, leading to food stasis and chronic inflammation [2]. - This chronic irritation and inflammation significantly increase the risk of developing **esophageal squamous cell carcinoma**. *Alcohol* - **Alcohol consumption**, especially heavy drinking, is a major risk factor for **esophageal squamous cell carcinoma**. - Alcohol metabolizes into acetaldehyde, a known carcinogen, which directly damages DNA in esophageal cells.

Q: Which is not seen in Tumour lysis Syndrome?

Hypophosphatemia. ***Hypophosphatemia*** - **Tumor lysis syndrome (TLS)** is characterized by the rapid breakdown of tumor cells, leading to the release of intracellular components into the bloodstream. - This process typically results in **acute hyperphosphatemia**, not hypophosphatemia, due to the high phosphate content within tumor cells. *Hyperkalemia* - **Hyperkalemia** is a hallmark of TLS because potassium, a major intracellular cation, is released in large quantities as tumor cells lyse. - Excess potassium can lead to potentially life-threatening cardiac arrhythmias. *Hyperuricemia* - **Hyperuricemia** occurs in TLS because nucleic acids (DNA and RNA) released from dying tumor cells are metabolized into purines, which are then converted to uric acid [1]. - High uric acid levels can precipitate in the renal tubules, leading to **acute kidney injury** [1]. *Hypocalcemia* - **Hypocalcemia** develops in TLS secondary to the acute hyperphosphatemia. - The excess phosphate binds with serum calcium to form **calcium-phosphate precipitates**, effectively lowering the concentration of free ionized calcium.

Question 1

Serum thyroglobulin level is an important tumor marker for

Accepted Answer

Papillary carcinoma thyroid

Answer

Thyroid lymphoma

Answer

Medullary carcinoma thyroid

Answer

Anaplastic carcinoma thyroid

Question 2

Consider the following statements: Poor prognostic indicators in advanced germ cell tumours show

1. primary sites in mediastinum 
2. non-pulmonary metastasis 
3. lactate dehydrogenase more than 10 times of normal value Which of the statements given above are correct?

Accepted Answer

1, 2 and 3

Answer

1 and 2 only

Answer

2 and 3 only

Answer

1 and 3 only

Question 3

First line hormone therapy for post-menopausal woman with metastatic carcinoma breast is:

Accepted Answer

Anastrazole

Answer

Ovarian suppression by surgery

Answer

Antiprogestins

Answer

Tamoxifen

Question 4

A 60-year-old male patient has an antral carcinoma spreading to the head of the pancreas with multiple small metastases to the right lobe of the liver. What is the best treatment approach?

Accepted Answer

Palliative chemotherapy

Answer

Surgical resection with adjuvant chemotherapy

Answer

Radiation therapy alone

Answer

Supportive care only

Question 5

A patient presents with a mediastinal mass and is diagnosed with pure red cell aplasia. What is the most probable underlying cause?

Accepted Answer

Thymic neoplasia

Answer

Bronchogenic carcinoma

Answer

T-cell Acute Lymphoblastic Leukemia

Answer

Non-Hodgkin Lymphoma

Question 6

KEYNOTE-189 trial for pembrolizumab is done for?

Accepted Answer

Pembrolizumab with chemo given for NSCLC

Answer

Nivolumab with chemo given for NSCLC

Answer

Only Pembrolizumab for NSCLC

Answer

Only nivolumab for NSCLC

Question 7

A 62-year-old man presents with “yellowing” of the skin. He says he has been having intermittent upper abdominal pain, which is relieved by Tylenol. He also recalls that he has lost some weight over the past several months but can not quantify the amount. His past medical history is significant for type 2 diabetes mellitus. He reports a 40-pack-year smoking history. The patient is afebrile and vital signs are within normal limits. Physical examination reveals mild jaundice and a palpable gallbladder. Laboratory findings are significant for the following:
Total bilirubin 13 mg/dL
Direct bilirubin: 10 mg/dL
Alkaline phosphatase (ALP): 560 IU/L
An ultrasound of the abdomen reveals a hypoechoic mass in the epigastric region. The patient is scheduled for a CT abdomen and pelvis with specific organ protocol for further evaluation. Which of the following best describes this patient’s most likely diagnosis?

Accepted Answer

CA 19-9 is a marker for this condition.

Answer

Caffeine consumption is an established risk factor for this condition.

Answer

Patients with this condition often rapidly develop glucose intolerance and severe diabetes.

Answer

This condition is most common in Caucasians.

Answer

The majority of cases occur in the body of the pancreas.

Question 8

A 63-year-old man comes to the physician because of a 3-month history of fatigue and constipation. He reports having dull pain in the left portion of the midback for 2 weeks that has persisted despite taking ibuprofen. His father died of prostate cancer at 70 years of age. The patient has smoked one pack of cigarettes daily for 45 years. Vital signs are within normal limits. Physical examination shows a left-sided varicocele both in supine and in standing position. Rectal examination shows a symmetrically enlarged prostate with no masses. Laboratory studies show:
Hemoglobin 11.2 g/dL
Serum
Creatinine 1.0 mg/dL
Calcium 11.8 mg/dL
Urine
Protein 1+
Blood 2+
Which of the following is the most appropriate next step in management?

Accepted Answer

CT scan of the abdomen

Answer

Urine cytology

Answer

Chest x-ray

Answer

Serum protein electrophoresis

Answer

Prostate biopsy

Question 9

All are risk factors of esophageal squamous cell carcinoma except:

Accepted Answer

GERD

Answer

Smoking

Answer

Achalasia cardia

Answer

Alcohol

Question 10

Which is not seen in Tumour lysis Syndrome?

Accepted Answer

Hypophosphatemia

Answer

Hyperkalemia

Answer

Hyperuricemia

Answer

Hypocalcemia

Oncology — MCQs

Oncology — MCQs

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