Oncology Practice Questions

Q: All of the following are associated with increased risk of gastric adenocarcinoma except which of the following?

Celiac disease. ***Celiac disease*** - While celiac disease increases the risk of certain cancers like **T-cell lymphoma** (e.g., **enteropathy-associated T-cell lymphoma, EATL**) and **small intestinal adenocarcinoma**, it is not a significant risk factor for **gastric adenocarcinoma**. - The primary site of neoplastic transformation in celiac disease is the **small intestine**, not the stomach. *Smoking* - **Smoking** is a well-established risk factor for various cancers, including gastric adenocarcinoma, with a dose-dependent relationship. - It contributes to **chronic inflammation** and **mucosal damage** in the stomach, promoting oncogenesis. *H. pylori* - **_Helicobacter pylori_ infection** is a major causative agent for **gastric adenocarcinoma**, particularly the **intestinal type** [1]. - It induces chronic gastritis, leading to atrophy, intestinal metaplasia, and dysplasia, which are precursors to cancer [1], [2]. *Dietary nitrosamines* - **Dietary nitrosamines**, commonly found in highly processed and preserved foods (smoked meats, pickled vegetables), are potent **carcinogens** [1]. - They are directly linked to an increased risk of **gastric adenocarcinoma**, especially in populations with high consumption of such foods [1].

Q: A 55-year-old woman with non-small cell lung cancer is found to have an ALK gene rearrangement. How should this finding influence her treatment?

Switch to crizotinib, a targeted ALK inhibitor. ***Switch to crizotinib, a targeted ALK inhibitor*** - The presence of an **ALK gene rearrangement** in **non-small cell lung cancer (NSCLC)** is a strong indicator for **targeted therapy** with an **ALK inhibitor** like crizotinib. - These drugs specifically block the aberrant activity of the ALK fusion protein, leading to **superior response rates** and **progression-free survival** compared to standard chemotherapy in ALK-positive patients. *Refer for surgical resection, if appropriate* - **Surgical resection** is primarily considered for **early-stage NSCLC** without evidence of metastatic disease [1]. - While surgery can be curative, the presence of specific gene rearrangements like ALK typically prompts consideration of **neoadjuvant or adjuvant targeted therapy** or systemic therapy for advanced disease. *Consider radiation therapy, if indicated* - **Radiation therapy** for NSCLC is usually employed for **local control**, either in curative intent for early stages or for **palliative management** of symptoms in advanced disease [2]. - It does not directly address the underlying **genetic driver** (ALK rearrangement) and would not be the primary systemic treatment. *Continue standard chemotherapy, if appropriate for the patient's condition* - While **standard chemotherapy** is a treatment option for NSCLC, the identification of a **driver mutation** like an ALK rearrangement makes **targeted therapy** a significantly more effective and preferred first-line approach. - Continuing chemotherapy without considering targeted therapy would be **suboptimal** for a patient with an ALK rearrangement due to the availability of more effective treatments.

Q: Which of the following is not a risk factor for cholangiocarcinoma?

Hepatitis B. ***Hepatitis B*** - While **Hepatitis B** is a major risk factor for **hepatocellular carcinoma (HCC)**, its direct association with cholangiocarcinoma is less clear and not as established as other risk factors. - The primary connection between Hepatitis B and liver cancer is through chronic inflammation leading to **cirrhosis** and subsequent HCC. *Opisthorchis viverrini* - This **liver fluke** is a well-established and significant risk factor for cholangiocarcinoma, particularly in Southeast Asia, by inducing chronic inflammation and epithelial damage in bile ducts. - The parasite's presence leads to **biliary stasis**, chronic irritation, and genetic alterations that promote malignant transformation. *PCS* - **Primary Sclerosing Cholangitis (PSC)** is a strong risk factor for cholangiocarcinoma, with a lifetime risk of approximately 5-10% [1]. - The chronic inflammation and fibrosis of the bile ducts in PSC create an environment highly conducive to malignant transformation [1]. *Caroli's disease* - **Caroli's disease**, a congenital disorder characterized by multifocal segmental dilation of intrahepatic bile ducts, is strongly associated with an increased risk of cholangiocarcinoma [1]. - The **biliary stasis** and recurrent cholangitis caused by the dilations promote chronic inflammation, a key driver of malignancy [1].

Q: A 70-year-old smoker presents with hemoptysis, weight loss, and chest pain. Chest X-ray shows a mass in the right upper lobe. What is the most likely diagnosis?

Lung cancer. ***Lung cancer*** - The patient's age, history of **smoking**, and symptoms of **hemoptysis**, **weight loss**, and **chest pain** are highly suggestive of lung cancer. - A **mass in the right upper lobe** on Chest X-ray further supports this diagnosis, as lung cancer often presents as a solitary pulmonary nodule or mass. *Tuberculosis* - While tuberculosis can cause **hemoptysis** and **weight loss**, it is often associated with a history of exposure, night sweats, and typically infiltrates or cavitations rather than a discrete mass in an elderly smoker without other risk factors for TB. - While it can present with a solitary pulmonary nodule, the high-risk smoking history and specific symptom complex point away from TB as the most likely diagnosis. *Bronchiectasis* - Bronchiectasis is characterized by permanent **dilation of the bronchi**, leading to chronic cough with copious sputum production and recurrent infections. - It does not typically present with a discrete lung mass or significant weight loss without underlying chronic infection. *Pneumonia* - Pneumonia usually presents with acute onset of fever, cough with productive sputum, and shortness of breath. - A lung mass is not a typical presentation of acute pneumonia; rather, it manifests as infiltrates or consolidation on chest imaging.

Q: A 60-year-old man with advanced prostate cancer presents with severe, constant back pain. X-ray reveals vertebral metastases. What is the most appropriate management?

Radiation therapy. ***Radiation therapy*** - **Radiation therapy** is highly effective for localized pain control in **vertebral metastases** and can prevent further spinal cord compression [1]. - It works by shrinking the tumor, thereby alleviating pain and restoring neurological function in many cases. *Chemotherapy* - While chemotherapy is a systemic treatment for prostate cancer, its **pain-relieving effects are often slower** and less immediate compared to radiation for localized bone pain. - It may be used in conjunction with radiation, but it is typically not the **most appropriate initial management** for severe, constant pain due to vertebral metastases. *Surgical decompression* - **Surgical decompression** is primarily considered for patients with **spinal cord compression** leading to neurological deficits or intractable pain unresponsive to radiation [1]. - The patient's presentation of severe, constant back pain due to vertebral metastases, without mentioned neurological compromise, makes **radiation therapy a more appropriate first-line treatment** in this context [1]. *NSAIDs* - **NSAIDs** might provide some mild pain relief, but they are **insufficient for severe pain** caused by progressive vertebral metastases. - They also carry risks like **gastrointestinal complications** and **renal impairment**, especially in elderly patients with advanced cancer.

Q: A 45-year-old female with a history of breast cancer presents with new-onset shortness of breath. A chest X-ray reveals a pleural effusion. What is the most appropriate next step in management?

Thoracentesis. ***Thoracentesis*** - **Thoracentesis** is the most appropriate next step to both diagnose the cause of the pleural effusion and provide symptomatic relief from shortness of breath. - Analysis of the pleural fluid can differentiate between **transudative** and **exudative** effusions and identify malignant cells, which is crucial in a patient with a history of breast cancer. *Chest CT with contrast* - While a chest CT might provide more detailed imaging of the lungs and pleura, it does not directly address the need for fluid analysis or symptom relief. - It would be a useful *subsequent step* if the thoracentesis is inconclusive or to look for underlying masses, but not the immediate priority for a new, symptomatic effusion. *Repeat chest X-ray in one week* - Re-imaging in a week would delay diagnosis and treatment for a potentially serious condition, especially in a patient with a history of malignancy presenting with new symptoms. - It doesn't offer any diagnostic information about the nature of the fluid or immediate symptom relief. *Bronchoscopy* - **Bronchoscopy** is primarily used for evaluating intraluminal airway pathology or diffuse lung disease, such as tumors or infections within the bronchi. - It is not the initial procedure of choice for investigating a pleural effusion unless there is suspicion of an endobronchial lesion causing post-obstructive pneumonia and effusion, which is not indicated here.

Q: Which pancreatic tumor is associated with elevated CA 19-9 levels and jaundice?

Pancreatic adenocarcinoma. ***Pancreatic adenocarcinoma*** [1] - **Elevated CA 19-9 levels** are commonly associated with pancreatic adenocarcinoma, making it a key marker in diagnosis. - Jaundice often occurs due to **biliary obstruction** caused by the tumor, particularly when located in the head of the pancreas [1]. *Intraductal papillary mucinous neoplasm* [1] - While it can cause obstructive symptoms, it typically does not lead to **significantly elevated CA 19-9 levels** like pancreatic adenocarcinoma. - This tumor is often characterized by **mucin secretion** and can present with less severe jaundice. *Pancreatic neuroendocrine tumor* - These tumors usually do not elevate **CA 19-9** but instead can elevate other markers like **chromogranin A**. - Jaundice is less commonly associated as they tend to have different clinical behaviors compared to adenocarcinomas. *Solid pseudopapillary tumor* - This type of tumor is **rare** and typically not associated with elevated **CA 19-9 levels** like pancreatic adenocarcinoma is. - It usually presents in a younger demographic and does not typically cause jaundice unless obstructive. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, pp. 897, 899-900.

Q: A patient with metastatic prostate cancer has been found to have osteoblastic bone metastases. Which treatment approach would provide the best control of his disease?

Androgen deprivation therapy. ***Androgen deprivation therapy*** - Prostate cancer growth is primarily driven by **androgens**, making androgen deprivation therapy (ADT) the **first-line systemic treatment** for metastatic disease. - ADT aims to reduce androgen levels, thereby inhibiting the proliferation of prostate cancer cells, including those in **osteoblastic bone metastases** [1]. *Localized radiation therapy to bone metastases* - While **radiation therapy** can effectively manage localized pain from bone metastases, it does not address the underlying systemic progression of the cancer. - It is a **palliative measure** for symptomatic relief rather than a curative or comprehensive disease control strategy for widespread metastatic disease. *Bisphosphonate therapy to increase bone density* - **Bisphosphonates** are used to prevent skeletal-related events (SREs) like fractures and pain in patients with bone metastases, by inhibiting osteoclast activity and strengthening bone. - However, they do not treat the underlying cancer itself and are **not a primary treatment** for controlling disease progression. *Chemotherapy with a platinum-based regimen* - **Chemotherapy** is typically reserved for patients with more advanced prostate cancer that has become **castration-resistant** (i.e., no longer responds to ADT). - Platinum-based regimens are not typically the first choice for initial treatment of metastatic castration-sensitive prostate cancer, as ADT is more effective and less toxic in this setting.

Q: Management of acute lymphoblastic leukemia (ALL) in adults includes which of the following treatments?

High-dose chemotherapy. ***High-dose chemotherapy*** - **Adult ALL** requires intensive treatment due to its aggressive nature and propensity for relapse. [1] - **High-dose chemotherapy**, often involving **multi-agent regimens** and potentially followed by **hematopoietic stem cell transplantation**, is the cornerstone of inducing remission and preventing recurrence. [1] *Supportive care only* - **Supportive care** is crucial for managing complications and side effects but is insufficient as a standalone treatment for ALL, which is a rapidly progressive and life-threatening cancer. [1] - Delaying definitive treatment with chemotherapy would lead to **rapid disease progression** and poor outcomes. *Low-dose oral chemotherapy* - **Low-dose oral chemotherapy** is typically used for less aggressive malignancies or as maintenance therapy in certain contexts but is inadequate for the initial treatment of **acute lymphoblastic leukemia (ALL)** in adults. [1] - ALL requires an **intensive regimen** to achieve and maintain remission due to the rapid proliferation of leukemic cells. *Surgical removal of the lymph nodes* - **Surgical removal of lymph nodes** is not a primary treatment for **leukemia**, which is a cancer of the blood and bone marrow, not a localized solid tumor. - While ALL can involve lymph nodes, the disease is **systemic** and requires systemic therapy, such as chemotherapy, to target malignant cells throughout the body.

Q: A 50-year-old woman with chronic hepatitis B presents with an abdominal mass, and serum alpha-fetoprotein is elevated. What is the most likely diagnosis?

Hepatocellular carcinoma. ***Hepatocellular carcinoma*** - The **elevated alpha-fetoprotein (AFP)** level [1] and history of **chronic hepatitis B** strongly indicate hepatocellular carcinoma, as these factors are closely associated with this type of liver cancer [1]. - It commonly presents as an **abdominal mass** [1] in patients with underlying liver disease, particularly in those with chronic hepatitis or cirrhosis. *Metastatic colon cancer* - Typically presents with **elevated tumor markers** like CEA, not AFP, making it less likely in this case. - It often involves multiple liver lesions rather than a singular **abdominal mass** [1] due to liver metastases. *Cholangiocarcinoma* - While associated with liver lesions, it usually leads to **elevated CA 19-9 levels** rather than AFP. - Patients often present with **jaundice and bile duct obstruction**, which are not noted in this scenario. *Hepatic adenoma* - Generally seen in younger individuals, often associated with **oral contraceptive use**, and tends not to elevate AFP significantly. - Usually asymptomatic or may present with abdominal pain, unlike the strong association with chronic liver disease seen in this case.

Question 1

All of the following are associated with increased risk of gastric adenocarcinoma except which of the following?

Accepted Answer

Celiac disease

Answer

Smoking

Answer

H. pylori

Answer

Dietary nitrosamines

Question 2

A 55-year-old woman with non-small cell lung cancer is found to have an ALK gene rearrangement. How should this finding influence her treatment?

Accepted Answer

Switch to crizotinib, a targeted ALK inhibitor

Answer

Refer for surgical resection, if appropriate

Answer

Consider radiation therapy, if indicated

Answer

Continue standard chemotherapy, if appropriate for the patient's condition

Question 3

Which of the following is not a risk factor for cholangiocarcinoma?

Accepted Answer

Hepatitis B

Answer

Opisthorchis viverrini

Answer

PCS

Answer

Caroli's disease

Question 4

A 70-year-old smoker presents with hemoptysis, weight loss, and chest pain. Chest X-ray shows a mass in the right upper lobe. What is the most likely diagnosis?

Accepted Answer

Lung cancer

Answer

Tuberculosis

Answer

Bronchiectasis

Answer

Pneumonia

Question 5

A 60-year-old man with advanced prostate cancer presents with severe, constant back pain. X-ray reveals vertebral metastases. What is the most appropriate management?

Accepted Answer

Radiation therapy

Answer

Chemotherapy

Answer

Surgical decompression

Answer

NSAIDs

Question 6

A 45-year-old female with a history of breast cancer presents with new-onset shortness of breath. A chest X-ray reveals a pleural effusion. What is the most appropriate next step in management?

Accepted Answer

Thoracentesis

Answer

Chest CT with contrast

Answer

Repeat chest X-ray in one week

Answer

Bronchoscopy

Question 7

Which pancreatic tumor is associated with elevated CA 19-9 levels and jaundice?

Accepted Answer

Pancreatic adenocarcinoma

Answer

Pancreatic neuroendocrine tumor

Answer

Intraductal papillary mucinous neoplasm

Answer

Solid pseudopapillary tumor

Question 8

A patient with metastatic prostate cancer has been found to have osteoblastic bone metastases. Which treatment approach would provide the best control of his disease?

Accepted Answer

Androgen deprivation therapy

Answer

Localized radiation therapy to bone metastases

Answer

Bisphosphonate therapy to increase bone density

Answer

Chemotherapy with a platinum-based regimen

Question 9

Management of acute lymphoblastic leukemia (ALL) in adults includes which of the following treatments?

Accepted Answer

High-dose chemotherapy

Answer

Supportive care only

Answer

Low-dose oral chemotherapy

Answer

Surgical removal of the lymph nodes

Question 10

A 50-year-old woman with chronic hepatitis B presents with an abdominal mass, and serum alpha-fetoprotein is elevated. What is the most likely diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Cholangiocarcinoma

Answer

Hepatic adenoma

Answer

Metastatic colon cancer

Oncology — MCQs

Oncology — MCQs

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