Oncology Practice Questions

Q: Carcinoembryonic antigen (CEA) is raised in which of the following conditions?

Inflammatory bowel disease. Carcinoembryonic antigen (CEA) is raised in which of the following conditions? ***Inflammatory bowel disease*** - **Carcinoembryonic antigen (CEA)** levels can be elevated in various inflammatory conditions, including **inflammatory bowel disease (IBD)** [1], due to tissue inflammation and turnover, even in the absence of malignancy. - While primarily associated with malignancy, CEA is not specific and can be a non-specific marker of inflammation. *Sickle cell anemia* - **Sickle cell anemia** is a genetic **hemoglobinopathy** characterized by abnormal hemoglobin, leading to red blood cell sickling and hemolysis. - It does not typically cause an elevation in **CEA levels**, as it is not a direct inflammatory or cancerous condition linked to CEA production. *Colorectal cancer* - Although **colorectal cancer** [2] is the most well-known condition associated with significantly elevated **CEA levels**, particularly for monitoring recurrence, the question asks where CEA is "raised," implying conditions beyond just malignancy. - High CEA in colorectal cancer reflects the production of this **onco-fetal glycoprotein** [2] by cancerous cells. *Hepatitis* - **Hepatitis**, an inflammation of the liver, can cause a rise in liver enzymes and other inflammatory markers. - However, **CEA levels** are not typically elevated in hepatitis unless there is an underlying malignancy or severe liver cirrhosis, which is not directly implied by the term "hepatitis" alone.

Q: Screening is not useful in which carcinoma

Testicular carcinoma. Testicular carcinoma - **Testicular cancer** typically presents as a painless mass, and **self-examination** is often emphasized for early detection rather than formal screening programs due to low incidence and variable benefits. - While early detection is important, population-wide screening for testicular cancer is **not recommended** due to its rarity and lack of evidence for improved outcomes compared to opportunistic detection. *Carcinoma prostate* - **Prostate cancer screening** using **PSA (prostate-specific antigen)** testing and digital rectal examinations is routinely performed, though its benefits and risks are debated [1]. - Early detection aims to identify potentially aggressive cancers, but also leads to **overdiagnosis and overtreatment** of indolent lesions [1]. *Carcinoma colon* - **Colorectal cancer screening** is highly effective and widely recommended through methods like **colonoscopy**, fecal occult blood testing, and sigmoisingoscopy. - Screening aims to detect **polyps** before they become cancerous or find cancer at an early, treatable stage, significantly reducing mortality. *Carcinoma breast* - **Breast cancer screening** using **mammography** is a well-established and highly effective method for early detection in women. - Early detection allows for timely treatment, significantly improving prognosis and reducing breast cancer mortality.

Q: What is the most common cause of death in patients with advanced cancer?

Infection. ***Infection*** - **Immunosuppression** from cancer itself and its treatments (e.g., chemotherapy, radiation) significantly increases susceptibility to infections. - Many patients with advanced cancer die from **sepsis** or opportunistic infections due to their weakened immune systems [1]. *Bleeding* - While bleeding can be a significant complication in advanced cancer (e.g., from tumor erosion, thrombocytopenia), it is less common as a direct cause of death compared to infection. - Life-threatening hemorrhages are typically managed, and other factors often contribute to mortality. *Respiratory failure* - **Respiratory failure** can occur due to **lung metastases**, direct tumor invasion, or complications like pneumonia in advanced cancer patients. - However, the underlying cause of such pneumonia or decline is often infectious or a result of systemic weakness. *Renal failure* - **Renal failure** can be caused by tumor obstruction of the urinary tract, **nephrotoxic chemotherapy**, or paraneoplastic syndromes. - Although serious, it is not the most frequent immediate cause of death in the broad population of advanced cancer patients.

Q: All of the following are paraneoplastic syndromes for renal cell carcinoma except which of the following?

Acanthosis Nigricans. Acanthosis Nigricans - Acanthosis nigricans is primarily associated with **insulin resistance** and is not a known paraneoplastic syndrome related to renal cell carcinoma. - Paraneoplastic syndromes typically involve **systemic effects** of tumors rather than dermatological manifestations like acanthosis nigricans. *Fever* - Fever can occur as a result of the body's response to tumors, including renal cell carcinoma, and is classified as a **paraneoplastic syndrome**. - It reflects the **systemic inflammatory response** often seen with malignancies. *Anaemia* - Anaemia is a common paraneoplastic syndrome associated with renal cell carcinoma due to the production of **erythropoietin** or as a result of **chronic disease** [1]. - It can lead to **fatigue** and pallor in affected individuals, making it relevant to renal cancers [1]. *Amyloidosis* - Amyloidosis can occur as a paraneoplastic syndrome in various malignancies, including renal cell carcinoma, due to **protein misfolding** states. - It can lead to complications affecting **kidney function** and other organs, aligning it with renal cell carcinoma, though kidney tumors also frequently present with hypercalcemia [1].

Q: Major contribution to cachexia with advanced cancer?

Tumor-necrosis-factor (TNF). ***Tumor-necrosis-factor (TNF)*** - **Tumor necrosis factor (TNF-α)** is a prominent cytokine involved in the pathogenesis of cancer cachexia, leading to muscle wasting and weight loss [1]. - It induces inflammation, increases **catabolism**, and reduces anabolism, contributing significantly to the metabolic dysfunction seen in cancer patients [1]. *Histamine* - **Histamine** is primarily known for its role in allergic reactions and inflammatory responses, but it is not a major direct driver of cachexia. - While it can be released in various inflammatory conditions, its direct contribution to the severe muscle wasting and metabolic changes of cachexia is limited compared to other cytokines. *Interferon* - **Interferons (IFNs)** are cytokines typically associated with antiviral responses and immune modulation, which can have diverse effects on metabolism. - While some interferons can indirectly contribute to systemic inflammation and fatigue, they are not considered a primary or major direct mediator of muscle catabolism and fat loss characteristic of cancer cachexia. *Clathrin* - **Clathrin** is a protein involved in the formation of clathrin-coated vesicles, essential for **endocytosis** and intracellular trafficking. - It has no direct role in the systemic metabolic dysregulation or muscle wasting associated with cancer cachexia.

Q: Which of the following is true regarding carcinoid tumor?

Neuroendocrine tumor. ### Most common site is lung - Carcinoid tumors are more commonly found in the **gastrointestinal tract**, specifically the appendix and ileum, rather than the lungs [1]. - This statement is false as they can occur in the lungs but are not the most common site overall. ### Potentially malignant tumor - Carcinoid tumors can be classified as **malignant,** especially if they show aggressive behavior or metastasis. - Many carcinoid tumors, particularly those in the gastrointestinal tract, can be **non-functional** and less aggressive [1]. ### Neuroendocrine tumor - Carcinoid tumors are indeed a type of **neuroendocrine tumor**, arising from **neuroendocrine cells**. - This classification emphasizes their origin and potential for secretion of hormones like **serotonin**. ### Associated with serotonin production - Many carcinoid tumors produce **serotonin**, leading to symptoms like **carcinoid syndrome** when they metastasize, particularly to the liver [1]. - This statement is true, indicating their involvement in neuroendocrine secretions.

Q: All are common sites of primary cancer for bone metastasis except:

Brain. ***Brain*** - The **brain** is not a common site for primary bone metastasis, as bone metastases typically originate from organs like the **breast**, **lung**, and **prostate**. - While brain tumors can metastasize to bone, the reverse (primary bone cancer) occurring here is rare. *Breast* - Breast cancer is one of the **most prevalent sources** of bone metastases, commonly affecting the spine and pelvis. - Symptoms often include **bone pain** and potential fractures due to metastasis. *Brain* - Similar to , while brain tumors can metastasize, **primary cancers** do not commonly originate in the bone. - The **metastatic spread** to the brain from other primary sites is common, but not the other way around. *Breast* - Again, breast cancer commonly leads to **bone metastasis**, accounting for a significant percentage of these cases. - It is important to identify busy metastasis to **manage** symptoms and improve patient outcomes.

Q: Which of the following is a feature of tumor lysis syndrome?

Hypocalcemia (a decrease in blood calcium levels). ***Hypocalcemia (a decrease in blood calcium levels)*** - **Hypocalcemia** in tumor lysis syndrome results from the precipitation of calcium with excessive phosphate released from lysed tumor cells. - The elevated phosphate levels bind to calcium, forming **calcium phosphate crystals** that can deposit in tissues, further lowering serum calcium. *Metabolic alkalosis (a rise in blood pH)* - Tumor lysis syndrome typically leads to **metabolic acidosis**, not alkalosis, due to the release of acidic intracellular metabolites like uric acid and phosphate. - The accumulation of these acidic compounds overwhelms the body's buffering systems, decreasing blood pH. *Hypokalemia (a decrease in blood potassium levels)* - Tumor lysis syndrome is characterized by **hyperkalemia**, an increase in blood potassium, as potassium is a major intracellular cation released during cell lysis. - The rapid breakdown of numerous tumor cells dumps vast amounts of intracellular potassium into the bloodstream. *Hypophosphatemia (a decrease in blood phosphate levels)* - Tumor lysis syndrome causes **hyperphosphatemia**, an elevation in blood phosphate levels, because phosphate is abundantly present within tumor cells and is released upon their destruction. - This excessive release of intracellular phosphate is a hallmark biochemical feature of the syndrome.

Q: Chemotherapeutic Agent of Choice for the treatment of CML?

Imatinib. ***Imatinib*** - **Imatinib** is a **tyrosine kinase inhibitor** specifically targeting the **BCR-ABL fusion protein**, which is the hallmark of CML [1][2]. - It dramatically improved the prognosis of CML patients, making it the **first-line therapy** and agent of choice due to its high efficacy and relatively low toxicity compared to conventional chemotherapy [2]. *Vincristine* - **Vincristine** is a **vinca alkaloid** that inhibits microtubule formation, primarily used in acute leukemias and lymphomas. - It is not the agent of choice for CML due to its different mechanism of action and the availability of more targeted therapies for CML. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, used in various cancers and autoimmune diseases. - While it can be used in some hematologic malignancies, it is not the preferred or most effective treatment for CML, especially given the success of targeted therapies. *Methotrexate* - **Methotrexate** is an **antimetabolite** that interferes with DNA synthesis, commonly used in acute leukemias, lymphomas, and autoimmune conditions. - It is not considered the chemotherapeutic agent of choice for CML, as its mechanism of action is not specific to the BCR-ABL anomaly characteristic of CML.

Q: What is true about HER2/neu overexpression in cancer?

Responds well to monoclonal antibodies. ***Responds well to monoclonal antibodies*** - HER2/neu overexpression is targeted by **monoclonal antibodies** like trastuzumab (Herceptin), improving treatment outcomes [1]. - These therapies are specifically designed to **inhibit HER2-positive** tumors, leading to better overall prognosis compared to those without such therapies [1]. *Good prognosis* - HER2/neu overexpression is generally associated with a **poor prognosis** due to increased aggressiveness of the cancer. - It correlates with **higher rates of recurrence** and metastasis compared to HER2-negative breast cancers. *Responds well to taxanes* - While taxanes are commonly used in breast cancer treatment, HER2/neu positivity does not specifically imply a good response. - Response rates may not significantly differ based on HER2 status for taxane-based therapies alone. *Seen only in breast cancer* - HER2/neu overexpression can also occur in other cancers, such as **gastric and gastroesophageal junction cancers**. - It is not exclusive to breast cancer, though it is most commonly studied in this context [1].

Question 1

Carcinoembryonic antigen (CEA) is raised in which of the following conditions?

Accepted Answer

Inflammatory bowel disease

Answer

Sickle cell anemia

Answer

Colorectal cancer

Answer

Hepatitis

Question 2

Screening is not useful in which carcinoma

Accepted Answer

Testicular carcinoma

Answer

Carcinoma prostate

Answer

Carcinoma colon

Answer

Carcinoma breast

Question 3

What is the most common cause of death in patients with advanced cancer?

Accepted Answer

Infection

Answer

Bleeding

Answer

Respiratory failure

Answer

Renal failure

Question 4

All of the following are paraneoplastic syndromes for renal cell carcinoma except which of the following?

Accepted Answer

Acanthosis Nigricans

Answer

Fever

Answer

Amyloidosis

Answer

Anaemia

Question 5

Major contribution to cachexia with advanced cancer?

Accepted Answer

Tumor-necrosis-factor (TNF)

Answer

Histamine

Answer

Interferon

Answer

Clathrin

Question 6

Which of the following is true regarding carcinoid tumor?

Accepted Answer

Neuroendocrine tumor

Answer

Associated with serotonin production

Answer

Potentially malignant tumor

Answer

Most common site is lung

Question 7

All are common sites of primary cancer for bone metastasis except:

Accepted Answer

Brain

Answer

Prostate

Answer

Lung

Answer

Thyroid

Question 8

Which of the following is a feature of tumor lysis syndrome?

Accepted Answer

Hypocalcemia (a decrease in blood calcium levels)

Answer

Metabolic alkalosis (a rise in blood pH)

Answer

Hypokalemia (a decrease in blood potassium levels)

Answer

Hypophosphatemia (a decrease in blood phosphate levels)

Question 9

Chemotherapeutic Agent of Choice for the treatment of CML?

Accepted Answer

Imatinib

Answer

Vincristine

Answer

Cyclophosphamide

Answer

Methotrexate

Question 10

What is true about HER2/neu overexpression in cancer?

Accepted Answer

Responds well to monoclonal antibodies

Answer

Good prognosis

Answer

Responds well to taxanes

Answer

Seen in various cancers, including breast cancer

Oncology — MCQs

Oncology — MCQs

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