Oncology Practice Questions

Q: Most common site of intracranial metastasis is from primary carcinoma of

Lungs. ***Lungs*** - **Lung cancer** is the most common primary tumor to metastasize to the brain, accounting for approximately **40-50% of all intracranial metastases**. - This high incidence is due to the advanced stage at diagnosis for many lung cancers and the rich vascular supply of the brain. [1] *Testes* - While germ cell tumors of the testes can metastasize to the brain, it is a relatively rare event compared to lung cancer. - Brain metastases from testicular cancer are more common with **choriocarcinoma** histology. *Stomach* - **Gastric cancer** can metastasize to the brain, but it is uncommon, occurring in less than 1% of cases. - When it does occur, it generally indicates widespread disease and a poor prognosis. *Breast* - **Breast cancer** is another common source of brain metastases, but it ranks **second to lung cancer** as a primary source. - The incidence of brain metastases from breast cancer is increasing, partly due to improved systemic treatments extending patient survival.

Q: A 65-year-old woman presents with a 5-week history of yellow skin and sclera, anorexia, and epigastric pain. Her past medical history is significant for insulin-dependent diabetes mellitus. She smoked one pack of cigarettes a day for the past 20 years. Physical examination reveals jaundice and a palpable gallbladder. Laboratory studies show a serum bilirubin level of 10 mg/dL, mostly in the conjugated form, and an elevated alkaline phosphatase (260 U/L). A CT scan of the abdomen discloses a mass in the head of the pancreas and multiple nodules in the liver measuring up to 3 cm. Which of the following is the most important risk factor for the neoplasm arising in the patient?

Cigarette smoking. ***Cigarette smoking*** - **Smoking** is a well-established and significant risk factor for adenocarcinoma of the **pancreas**, which aligns with the patient's presentation of a pancreatic head mass, obstructive jaundice (yellow skin/sclera, high conjugated bilirubin, elevated alkaline phosphatase), and palpable gallbladder [3]. - The 20-year history of smoking significantly increases her individual risk for this particular type of cancer. *Cholelithiasis* - While **gallstones** can cause obstructive jaundice (e.g., choledocholithiasis), they are not a primary risk factor for **pancreatic adenocarcinoma**. - The patient's CT scan indicates a **pancreatic head mass** and liver nodules, pointing away from primary gallstone disease as the etiology of the neoplasm. *Alcohol abuse* - Chronic **alcohol abuse** is a major risk factor for chronic pancreatitis, which can, in turn, increase the risk of pancreatic cancer [1]. - However, direct causation between alcohol abuse and pancreatic cancer is less strong than with smoking, and there is no mention of alcohol abuse in the patient's history [2]. *Diabetes mellitus type 1* - While a proportion of patients with newly diagnosed **pancreatic cancer** may develop diabetes (often type 2 or an unusual type of diabetes), **insulin-dependent diabetes mellitus type 1** itself is considered a minor or even non-existent risk factor for pancreatic cancer. - The presence of diabetes in this patient is more likely a concurrent condition or a consequence of the pancreatic tumor rather than a primary risk factor for its development.

Q: Which one of the following is not sensitive to chemotherapy in advanced stage?

Pancreatic carcinoma. ***Pancreatic carcinoma*** - **Pancreatic carcinoma** is notoriously difficult to treat with chemotherapy, especially in advanced stages, due to its **aggressive biology**, inherent resistance mechanisms, and late presentation [1]. - The disease often presents with **metastatic spread** before diagnosis, and the response rates to even combination chemotherapy regimens are typically poor, highlighting its poor sensitivity [1]. *Wilm's tumor* - **Wilm's tumor (nephroblastoma)** is a pediatric kidney cancer that is highly sensitive to chemotherapy, even in advanced stages. - Combination chemotherapy regimens are a cornerstone of treatment, often leading to **excellent prognosis** and cure rates. *Ovarian carcinoma* - **Ovarian carcinoma**, particularly epithelial ovarian cancer, is often initially sensitive to **platinum-based chemotherapy**. - While it frequently recurs, the initial response to chemotherapy, even in advanced stages, can be significant, leading to periods of **remission**. *Ewing's sarcoma* - **Ewing's sarcoma** is a highly aggressive bone and soft tissue tumor that is very sensitive to chemotherapy, which is a critical component of its multidisciplinary treatment. - Modern multidisciplinary approaches, including intensive chemotherapy, have significantly improved survival rates for patients with both localized and **metastatic disease**.

Q: A 44 year old man goes to his physician for an employment physical examination. The clinician notices that the patient's fingers are clubbed. He also demonstrates tenderness over the distal ends of the radius, ulna, and fibula. This patient should be explicitly evaluated to exclude which of the following?

Lung cancer. ***Lung cancer*** - The combination of **clubbing** (hypertrophic osteoarthropathy) and **periosteal tenderness** (typically of the long bones) is highly suggestive of paraneoplastic syndrome associated with **bronchogenic carcinoma**, particularly **non-small cell lung cancer** [1]. - **Hypertrophic osteoarthropathy** is characterized by proliferation of skin and bone at distal extremities, often leading to clubbing and pain in the long bones [1], which is a classic presentation with lung malignancies. *Renal cancer* - While renal cell carcinoma can present with various paraneoplastic syndromes, **hypertrophic osteoarthropathy** and clubbing are not typical or primary associations [2]. - Common paraneoplastic syndromes with renal cancer include **polycythemia** (due to erythropoietin production) [3] and **hypercalcemia** [2], [3]. *Liver cancer* - **Hepatocellular carcinoma** can be associated with paraneoplastic syndromes, but **clubbing** and **hypertrophic osteoarthropathy** are not among the classic presentations. - Paraneoplastic syndromes in liver cancer often involve **hypoglycemia** or **erythrocytosis** [3]. *Gastrointestinal cancer* - Although **gastrointestinal malignancies** can cause various systemic symptoms, **hypertrophic osteoarthropathy** with prominent clubbing is not a primary or common paraneoplastic manifestation [2]. - GI cancers might indirectly cause clubbing in settings of chronic malabsorption, but not typically as a direct paraneoplastic effect like lung cancer.

Q: Which isotope is used for treating bone cancer?

Sr. Phosphorus-32 is a radioisotope commonly used in the treatment of bone cancer and related conditions due to its ability to target bone tissues. Other isotopes used in the treatment of bone metastases include Strontium-89 and Samarium-153.

Q: Stauffer syndrome is related to

Renal cell carcinoma. ***Renal cell carcinoma*** - **Stauffer syndrome** is a paraneoplastic syndrome predominantly associated with **renal cell carcinoma** (RCC) [1]. - It is characterized by **non-metastatic hepatic dysfunction** (elevated transaminases, alkaline phosphatase, bilirubin) that resolves upon tumor resection. *Carcinoma colon* - Colorectal carcinoma can be associated with various paraneoplastic syndromes, such as **acanthosis nigricans**, but typically **not Stauffer syndrome**. - Liver dysfunction in colorectal carcinoma is usually due to **metastatic disease**, not a paraneoplastic effect. *Carcinoma breast* - Breast cancer is linked to paraneoplastic syndromes like **Lambert-Eaton myasthenic syndrome** [2] or **hypercalcemia of malignancy**, but not Stauffer syndrome. - Liver involvement in breast cancer is commonly due to **metastasis**. *Hepatocellular carcinoma* - Hepatocellular carcinoma itself is a primary liver malignancy and can cause various forms of **liver dysfunction**. - However, Stauffer syndrome refers to **non-metastatic liver dysfunction** as a paraneoplastic effect of an **extrahepatic tumor**, most notably RCC [1].

Q: Commonest cause of skeletal metastasis is

Breast. ***Breast*** - **Breast cancer** is the most common cause of **skeletal metastasis** overall, especially in women, due to its high incidence and propensity to spread to bone. - Metastases often present as **osteolytic lesions**, sometimes mixed with osteoblastic features. *Prostate* - **Prostate cancer** is the most common cause of skeletal metastasis in **men**, frequently leading to **osteoblastic lesions**. - While very common in men, overall incidence is lower than breast cancer. *Thyroid* - **Thyroid cancer** can metastasize to bone, often presenting as **osteolytic lesions**, but it is less common than breast and prostate cancer. - Its overall contribution to skeletal metastases is significantly smaller. *Kidney* - **Renal cell carcinoma (RCC)** also metastasizes to bone, typically causing **osteolytic lesions** that can be highly vascular. - Similar to thyroid cancer, its incidence of bone metastasis is lower than that of breast and prostate cancer.

Q: A patient developed paraplegia. On routine examination and X-ray it was found that there are osteoblastic lesions in his spine. What is the MOST probable diagnosis?

Ca. Prostate. ***Ca. Prostate*** - **Prostate cancer** has a strong predilection for metastasizing to bone and typically produces **osteoblastic lesions** (new bone formation) in the spine [2]. - The presence of **paraplegia** suggests spinal cord compression due to these metastatic lesions [1]. *Breast Ca.* - While **breast cancer** frequently metastasizes to bone (commonly spine, pelvis, ribs, skull), it typically causes **osteolytic lesions** (bone destruction), though mixed lesions can occur. - Paraplegia can result from breast cancer metastases but the primary lesion type is usually osteolytic. *Carcinoma thyroid* - **Thyroid cancer** metastases to bone are rare and generally lead to **osteolytic lesions**, not osteoblastic. - Although it can cause spinal cord compression, the characteristic osteoblastic appearance is not typical for thyroid cancer. *Pancreatic Ca.* - **Pancreatic cancer** rarely metastasizes to bone, and when it does, the lesions are almost exclusively **osteolytic**. - Therefore, it is highly unlikely to be the cause of osteoblastic spinal lesions and subsequent paraplegia.

Q: The MOST important risk factor for pancreatic cancer among the following is:

Cigarette smoking. Cigarette smoking - Cigarette smoking is the leading modifiable risk factor for pancreatic cancer, accounting for approximately 25% of cases [1]. - The risk increases with the number of cigarettes smoked and the duration of smoking, with a higher risk for heavy smokers. *Alcohol* - While heavy alcohol consumption can lead to chronic pancreatitis, it is not considered a direct and independent risk factor for pancreatic cancer to the same extent as smoking. - The association is often indirect, mediated through its role in developing chronic pancreatitis. *Chronic pancreatitis* - Chronic pancreatitis significantly increases the risk of pancreatic cancer, but it is often a consequence of other underlying factors like alcohol abuse or genetic predispositions. - Although it's a strong risk factor, its prevalence as a primary cause is less than that of smoking directly. *Diabetes* - Diabetes, particularly new-onset diabetes in older adults, can be an early symptom of pancreatic cancer rather than solely a risk factor. - While it is associated with an increased risk, it is not as strong a modifiable risk factor as smoking.

Q: Which of the following most commonly produces osteoblastic secondaries?

Carcinoma prostate. ***Carcinoma prostate*** - **Prostate cancer** has a strong predilection for metastasizing to bone and typically results in **osteoblastic (bone-forming) lesions** [1]. - Tumors from the prostate release factors, such as **prostate-specific antigen (PSA)** and factors that stimulate osteoblasts, leading to new bone formation. *Carcinoma urinary bladder* - **Urinary bladder carcinoma** can metastasize to bone, but it usually produces **osteolytic (bone-destroying) lesions**, rather than osteoblastic ones. - Bone metastases from bladder cancer are less common than from prostate or breast cancer, and often indicate advanced disease. *Carcinoma breast* - **Breast cancer** is a very common cause of bone metastases, which can be **osteolytic, osteoblastic, or mixed** . - However, purely osteoblastic lesions are less common in breast cancer compared to prostate cancer, and osteolytic lesions are more frequently observed, especially in certain subtypes. *Carcinoma lung* - **Lung cancer** commonly metastasizes to bone, with **osteolytic lesions** being the predominant type. - While some subtypes can rarely cause osteoblastic changes, the vast majority of bone metastases from lung cancer involve bone destruction rather than bone formation.

Question 1

Most common site of intracranial metastasis is from primary carcinoma of

Accepted Answer

Lungs

Answer

Testes

Answer

Stomach

Answer

Breast

Question 2

A 65-year-old woman presents with a 5-week history of yellow skin and sclera, anorexia, and epigastric pain. Her past medical history is significant for insulin-dependent diabetes mellitus. She smoked one pack of cigarettes a day for the past 20 years. Physical examination reveals jaundice and a palpable gallbladder. Laboratory studies show a serum bilirubin level of 10 mg/dL, mostly in the conjugated form, and an elevated alkaline phosphatase (260 U/L). A CT scan of the abdomen discloses a mass in the head of the pancreas and multiple nodules in the liver measuring up to 3 cm. Which of the following is the most important risk factor for the neoplasm arising in the patient?

Accepted Answer

Cigarette smoking

Answer

Cholelithiasis

Answer

Alcohol abuse

Answer

Diabetes mellitus type 1

Question 3

Which one of the following is not sensitive to chemotherapy in advanced stage?

Accepted Answer

Pancreatic carcinoma

Answer

Wilm's tumor

Answer

Ovarian carcinoma

Answer

Ewing's carcinoma

Question 4

A 44 year old man goes to his physician for an employment physical examination. The clinician notices that the patient's fingers are clubbed. He also demonstrates tenderness over the distal ends of the radius, ulna, and fibula. This patient should be explicitly evaluated to exclude which of the following?

Accepted Answer

Lung cancer

Answer

Renal cancer

Answer

Liver cancer

Answer

Gastrointestinal cancer

Question 5

Which isotope is used for treating bone cancer?

Accepted Answer

Sr

Answer

I-131

Answer

Tc

Answer

Ga

Question 6

Stauffer syndrome is related to

Accepted Answer

Renal cell carcinoma

Answer

Carcinoma colon

Answer

Carcinoma breast

Answer

Hepatocellular carcinoma

Question 7

Commonest cause of skeletal metastasis is

Accepted Answer

Breast

Answer

Prostate

Answer

Thyroid

Answer

Kidney

Question 8

A patient developed paraplegia. On routine examination and X-ray it was found that there are osteoblastic lesions in his spine. What is the MOST probable diagnosis?

Accepted Answer

Ca. Prostate

Answer

Breast Ca.

Answer

Carcinoma thyroid

Answer

Pancreatic Ca.

Question 9

The MOST important risk factor for pancreatic cancer among the following is:

Accepted Answer

Cigarette smoking

Answer

Alcohol

Answer

Chronic pancreatitis

Answer

Diabetes

Question 10

Which of the following most commonly produces osteoblastic secondaries?

Accepted Answer

Carcinoma prostate

Answer

Carcinoma urinary bladder

Answer

Carcinoma breast

Answer

Carcinoma lung

Oncology — MCQs

Oncology — MCQs

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