Oncology Practice Questions

Q: Which cancer most commonly metastasizes to the brain?

Lung cancer. ***Lung cancer*** - Lung cancer is the most common source of **brain metastases**, accounting for approximately **40%** of cases. - It often leads to **multiple metastases** due to hematogenous spread to the brain, especially affecting the **cerebral hemispheres**. - The brain is a favored site of metastases for lung carcinomas, with approximately **20%** of cases involving brain metastases. *Prostate cancer* - While prostate cancer can metastasize to the brain, it is much less common than lung cancer, primarily spreading to **bones** and **lymph nodes**. - When it does metastasize, it usually manifests later in the disease course compared to lung cancer. *Breast cancer* - Although breast cancer is also a known cancer that can metastasize to the brain, it ranks below lung cancer in incidence of brain metastasis, typically seen in advanced cases. - It often leads to single or few lesions in the brain as compared to the **multiplicity** seen with lung cancer. *Head and neck cancer* - Head and neck cancers metastasize predominantly to regional lymph nodes more than the brain. - They are less associated with brain metastases compared to **lung**, **breast**, or **melanoma** cancers.

Q: A 57-year-old man presents with hemoptysis and generalized weakness. His symptoms began with small-volume hemoptysis 4 weeks ago, followed by progressive weakness, fatigue, and weight loss over the past 2 weeks. He has a 45-pack-year history of cigarette smoking. Physical examination is unremarkable, and laboratory studies reveal mild anemia and hyponatremia. Chest x-ray shows a 5-cm left, mid-lung field mass with mediastinal lymphadenopathy. MR scan of the brain is normal. What is the most likely cause of his symptoms?

Small cell lung carcinoma. ***Small cell lung carcinoma*** - This presentation, including **hemoptysis** [1], **progressive weakness**, **fatigue**, **weight loss** [2], and a **large lung mass with mediastinal lymphadenopathy** in a heavy smoker [3], is highly characteristic of **small cell lung carcinoma (SCLC)**. - The presence of **hyponatremia** suggests **syndrome of inappropriate antidiuretic hormone (SIADH)**, a common paraneoplastic syndrome associated with SCLC due to ectopic ADH production [2]. *Bronchial carcinoid tumor* - While carcinoid tumors can cause hemoptysis, they typically grow slowly and are characterized by **neuroendocrine symptoms** (e.g., flushing, diarrhea, wheezing) that are not mentioned here. - Malignant carcinoid tumors are less common and rarely present with such rapid progressive systemic symptoms and extensive lymphadenopathy. *Lung adenocarcinoma* - Adenocarcinoma often presents with a mass and can cause hemoptysis and systemic symptoms, but it is **less strongly associated with SIADH** and mediastinal lymphadenopathy in the initial presentation compared to SCLC. - While adenocarcinoma is common in smokers, the rapid progression and specific paraneoplastic finding point more towards SCLC. *Lung abscess* - A lung abscess typically presents with **fever**, **productive cough of purulent sputum**, and often pleuritic chest pain, which are absent in this case [4]. - While an abscess can cause hemoptysis and general malaise, the presence of **lymphadenopathy** and the rapid progression with hyponatremia are not typical features [4].

Q: A patient with Hodgkin's lymphoma presents with isolated cervical lymphadenopathy, and biopsy from the lesion shows characteristic lacunar cells. The treatment of choice for this patient is:

Chemotherapy with Radiotherapy. ### Chemotherapy with Radiotherapy - This combination is the standard of care for most stages of **Hodgkin's lymphoma**, including early-stage disease with localized **lymphadenopathy**. [1] - **Chemotherapy** targets systemic disease while **radiotherapy** delivers localized high-dose treatment to affected lymph nodes, improving local control and preventing recurrence. ### Chemotherapy alone - While chemotherapy is crucial for **systemic disease control** in Hodgkin's lymphoma, using it alone for localized disease might lead to a higher risk of local recurrence compared to combined modality therapy. - In certain very early stages or specific patient populations, this might be considered, but generally, local control with **radiotherapy** is preferred for isolated disease. ### Radiotherapy alone - **Radiotherapy alone** was historically used for early-stage Hodgkin's lymphoma but has been largely replaced by combined modality therapy due to better **overall survival** and disease control with the addition of chemotherapy. [1] - It might be considered in very specific, highly localized, and favorable presentations, but in the presence of **lacunar cells** and the aim for optimal outcome, combined modality therapy is preferred. ### No treatment needed - **Hodgkin's lymphoma** is a malignant neoplastic disease that requires active treatment to achieve remission and cure. - Untreated **Hodgkin's lymphoma** is a progressive and fatal disease, making "no treatment" an inappropriate option.

Q: Birt-Hogg-Dubé syndrome is associated with:

Renal cell carcinoma (RCC). ***Renal cell carcinoma (RCC)*** - Birt-Hogg-Dubé syndrome is an **autosomal dominant disorder** characterized by an increased risk of developing **renal cell carcinoma**, particularly **chromophobe** and **oncocytic hybrid tumors**. - It results from mutations in the **FLCN gene**, which encodes the protein folliculin. *Lung cancer* - While Birt-Hogg-Dubé syndrome is associated with **pulmonary cysts** and an increased risk of **spontaneous pneumothorax**, it is not directly linked to an increased risk of **primary lung cancer**. - The cystic lung changes are distinct from cancerous lesions. *Stomach cancer* - There is **no established association** between Birt-Hogg-Dubé syndrome and an increased risk of developing **stomach cancer**. - The syndrome primarily affects the skin, lungs, and kidneys. *Ovarian cancer* - Birt-Hogg-Dubé syndrome has **no known association** with an increased incidence of **ovarian cancer**. - The clinical manifestations are generally limited to specific organs mentioned earlier.

Q: Which of the following is NOT typically associated with carcinoma of the pancreas?

Hypoglycemia. ***Hypoglycemia*** - **Hypoglycemia** is generally not a direct paraneoplastic syndrome or common complication of typical pancreatic adenocarcinoma. - While **insulinomas** (a rare type of pancreatic neuroendocrine tumor) cause hypoglycemia, they are distinct from pancreatic adenocarcinoma [1]. *Syndrome of inappropriate secretion of ADH* - **SIADH** can be a paraneoplastic syndrome, causing **hyponatremia** due to excessive ADH secretion. - Although less common than in small cell lung cancer, some pancreatic cancers can produce **ectopic ADH**. *Erythrocytosis* - Some tumors, including certain pancreatic cancers, can produce **erythropoietin** leading to **erythrocytosis** (an increase in red blood cell mass). - This is a paraneoplastic syndrome reflecting excessive red blood cell production. *Hypercalcemia* - **Hypercalcemia of malignancy** is a well-recognized paraneoplastic syndrome that can occur with various cancers, including pancreatic cancer. - It can result from **parathyroid hormone-related peptide (PTHrP) production** by the tumor or extensive bony metastases.

Q: For which malignancy is intensity-modulated radiotherapy (IMRT) the most suitable?

Prostate. ***Prostate*** - **IMRT** is highly suitable for prostate cancer due to the prostate's proximity to critical organs like the **rectum and bladder**. - Its ability to conform the **radiation dose tightly** to the tumor while sparing adjacent healthy tissue significantly reduces side effects like **rectal bleeding** or **urinary dysfunction** [1]. *Lung* - While IMRT is used in lung cancer, especially for complex tumors near vital structures, **stereotactic body radiation therapy (SBRT)** is often preferred for early-stage lung cancer due to its high dose delivery over fewer fractions. - The **motion of the lung** during respiration can make precise IMRT delivery challenging without specialized techniques like **gating or tracking**. *Leukemias* - **Leukemias** are systemic diseases involving blood and bone marrow, making localized radiation therapies like IMRT generally unsuitable as a primary treatment. - Treatment for leukemias primarily involves **chemotherapy, targeted therapy, or stem cell transplant**. *Stomach* - **Stomach cancer** often requires larger radiation fields due to tumor spread and nodal involvement, making the precise dose sculpting of IMRT less advantageous compared to its benefits in smaller, well-defined tumors. - The **mobility of the stomach** and surrounding organs can also present challenges for highly conformal radiation delivery.

Q: Which is the most active single chemotherapeutic agent in the treatment of leiomyosarcoma?

Adriamycin. ***Adriamycin*** - **Adriamycin** (doxorubicin) is an **anthracycline antibiotic** and is recognized as the most effective single agent for treating **leiomyosarcoma**. - It works by intercalating DNA and inhibiting macromolecular biosynthesis, leading to cell death in rapidly dividing cancer cells. *Daunorubicin* - While also an **anthracycline antibiotic**, **daunorubicin** is primarily used in the treatment of **leukemias**, such as acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL), rather than soft tissue sarcomas. - Its efficacy against solid tumors like leiomyosarcoma is significantly lower compared to doxorubicin. *Methotrexate* - **Methotrexate** is an **antifolate agent** commonly used in various cancers like **leukemia**, **lymphoma**, and **osteosarcoma**, as well as autoimmune diseases. - It is not considered a primary or highly active agent in the treatment of leiomyosarcoma. *Cisplatin* - **Cisplatin** is a **platinum-based chemotherapy drug** primarily used for **epithelial cancers** such as ovarian, testicular, bladder, and lung cancers. - It has limited activity as a single agent in the treatment of leiomyosarcoma.

Q: Which of the following statements about hepatocellular carcinoma (HCC) is true?

All of the options.. ***All of the options.*** - This option is correct because HCC is indeed resectable in early stages under specific conditions, AFP levels are elevated in a significant portion of cases, and it is the most common primary liver tumor. [1] - Each individual statement provides an accurate insight into the characteristics and clinical aspects of hepatocellular carcinoma. [2] *It is resectable in early stages, depending on size, location, and liver function.* - **Early-stage HCC** can be potentially cured with **surgical resection** or liver transplantation, provided the tumor is small, solitary, and the patient has good liver function. [2] - The decision for resectability is complex and depends on factors such as **tumor size, location**, and the patient's **Child-Pugh score** or MELD score for liver function. *More than 70% of cases show increased AFP levels.* - **Alpha-fetoprotein (AFP)** is a widely used **tumor marker** for HCC, and elevated levels are observed in 60-80% of patients, particularly those with larger tumors. [1] - While helpful for screening and monitoring, AFP is not specific enough for diagnosis on its own, as it can also be elevated in other liver conditions and germ cell tumors. *It is the most common primary liver tumor, though metastatic tumors are more common overall.* - **Hepatocellular carcinoma (HCC)** accounts for about 80-90% of **primary liver cancers**, making it the most prevalent type originating in the liver. - However, **metastatic liver cancer**, meaning cancer that has spread to the liver from another primary site (e.g., colon, lung, breast), is significantly more common in the general population than primary liver cancers.

Q: Age for regular mammography screening in average-risk women is

40. ***40*** - Current guidelines from organizations like the **American Cancer Society (ACS)** recommend that women at **average risk** begin regular annual mammography screening at **age 40**. - While other organizations have slightly different recommendations, **age 40** is a commonly cited starting point to maximize benefits for average-risk women. *55* - **Age 55** is typically when some guidelines suggest transitioning to **biennial** (every other year) mammography screening, rather than initiating it. - Delaying initial screening until 55 would miss potential early detection opportunities for many women. *25* - **Age 25** is generally considered too young for routine mammography screening in **average-risk women**, as breast tissue is denser and cancer incidence is very low. - Screening this early is reserved for high-risk individuals with specific genetic mutations or strong family histories. *35* - While **age 35** is closer to the recommended starting age, it is generally earlier than the standard guidelines for **average-risk women**. - Some high-risk individuals might begin screening around this age, but it's not the universal recommendation for the general population.

Q: Which of the following statements about esophageal cancer is true?

Esophageal cancer is more lethal than colorectal cancer.. Esophageal cancer is more lethal than colorectal cancer. - Esophageal cancer generally has a poorer prognosis and a lower 5-year survival rate compared to colorectal cancer, making it more lethal. - This is often due to its aggressive nature and tendency to be diagnosed at advanced stages. Small lesions generally have a better prognosis. - While true for some cancers, this statement is misleading in the context of esophageal cancer because even small esophageal lesions can be highly aggressive and already involve deeper layers or lymph nodes. - Early detection of seemingly "small" lesions does improve outcomes, but the overall prognosis remains challenging due to the disease's inherent aggressiveness, even at early stages. Asymptomatic benign esophageal lesions are usually monitored. - The question is about esophageal cancer, not benign lesions. Asymptomatic benign lesions are typically managed based on their specific type and risk of progression, but this statement does not address esophageal cancer. [1] - This option introduces a different diagnostic and management consideration, shifting focus from the malignancy. Squamous cell carcinoma is declining globally and is now less common than adenocarcinoma worldwide. - While the incidence of adenocarcinoma has been rising in Western countries, squamous cell carcinoma (SCC) still accounts for the majority of esophageal cancers worldwide, especially in undeveloped nations. - The global shift where adenocarcinoma supersedes SCC is not universally true, especially when considering the global burden of the disease. [2]

Question 1

Which cancer most commonly metastasizes to the brain?

Accepted Answer

Lung cancer

Answer

Head and neck cancer

Answer

Prostate cancer

Answer

Breast cancer

Question 2

A 57-year-old man presents with hemoptysis and generalized weakness. His symptoms began with small-volume hemoptysis 4 weeks ago, followed by progressive weakness, fatigue, and weight loss over the past 2 weeks. He has a 45-pack-year history of cigarette smoking. Physical examination is unremarkable, and laboratory studies reveal mild anemia and hyponatremia. Chest x-ray shows a 5-cm left, mid-lung field mass with mediastinal lymphadenopathy. MR scan of the brain is normal. What is the most likely cause of his symptoms?

Accepted Answer

Small cell lung carcinoma

Answer

Bronchial carcinoid tumor

Answer

Lung adenocarcinoma

Answer

Lung abscess

Question 3

A patient with Hodgkin's lymphoma presents with isolated cervical lymphadenopathy, and biopsy from the lesion shows characteristic lacunar cells. The treatment of choice for this patient is:

Accepted Answer

Chemotherapy with Radiotherapy

Answer

Chemotherapy alone

Answer

Radiotherapy alone

Answer

No treatment needed

Question 4

Birt-Hogg-Dubé syndrome is associated with:

Accepted Answer

Renal cell carcinoma (RCC)

Answer

Lung cancer

Answer

Stomach cancer

Answer

Ovarian cancer

Question 5

Which of the following is NOT typically associated with carcinoma of the pancreas?

Accepted Answer

Hypoglycemia

Answer

Hypercalcemia

Answer

Erythrocytosis

Answer

Syndrome of inappropriate secretion of ADH

Question 6

For which malignancy is intensity-modulated radiotherapy (IMRT) the most suitable?

Accepted Answer

Prostate

Answer

Lung

Answer

Leukemias

Answer

Stomach

Question 7

Which is the most active single chemotherapeutic agent in the treatment of leiomyosarcoma?

Accepted Answer

Adriamycin

Answer

Methotrexate

Answer

Cisplatin

Answer

Daunorubicin

Question 8

Which of the following statements about hepatocellular carcinoma (HCC) is true?

Accepted Answer

All of the options.

Answer

It is resectable in early stages, depending on size, location, and liver function.

Answer

More than 70% of cases show increased AFP levels.

Answer

It is the most common primary liver tumor, though metastatic tumors are more common overall.

Question 9

Age for regular mammography screening in average-risk women is

Accepted Answer

40

Answer

55

Answer

25

Answer

35

Question 10

Which of the following statements about esophageal cancer is true?

Accepted Answer

Esophageal cancer is more lethal than colorectal cancer.

Answer

Small lesions generally have a better prognosis.

Answer

Asymptomatic benign esophageal lesions are usually monitored.

Answer

Squamous cell carcinoma is declining globally and is now less common than adenocarcinoma worldwide.

Oncology — MCQs

Oncology — MCQs

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