Oncology Practice Questions

Q: What is the most common cause of brain metastasis?

Carcinoma lung. ***Carcinoma lung*** - Lung cancer is the most common source of **brain metastases**, accounting for a significant proportion of cases [1]. - Typically spreads via the **hematogenous route**, leading to multiple lesions in the brain [1]. *Prostate cancer* - While prostate cancer can metastasize to the brain, it is less common than lung cancer. - More frequently it spreads to **bone**, making it a relatively rare cause of brain metastases. *HCC* - Hepatocellular carcinoma (HCC) has a tendency to metastasize to the **lungs** and **bone**, but brain metastases are rare. - It typically performs worse in terms of brain involvement compared to lung carcinoma. *Seminoma* - Seminomas primarily spread to regional **lymph nodes** and can metastasize to other organs, but brain involvement is quite rare. - Common sites of metastasis include the **lungs** and **liver**, not the brain.

Q: Most common symptom of lung carcinoma is

Cough. ***Cough*** - **Chronic cough** is the most frequently reported symptom in patients with lung carcinoma, often progressing in severity or character. [1] - It results from irritation of the **bronchial tree** by the tumor or associated inflammation. [1] *Dyspnoea* - While common, **shortness of breath** typically occurs when the tumor significantly obstructs airways, causes pleural effusion, or spreads to lymphatics. [1] - It usually presents later in the disease progression compared to cough. *Weight loss* - **Unexplained weight loss** is a common systemic symptom of malignancy, including lung cancer, but is often a sign of advanced disease. [1] - This symptom is non-specific and can be associated with many chronic illnesses. *Chest pain* - **Chest pain** in lung carcinoma often indicates involvement of the pleura, chest wall, or mediastinum by the tumor. - It is a common symptom but is less frequent than cough as the initial presenting complaint.

Q: Which type of tumor is most amenable to chemotherapy?

Choriocarcinoma. ***Choriocarcinoma*** - **Choriocarcinoma** is highly sensitive to chemotherapy, often achieving **cure rates greater than 90%** even in metastatic settings, especially when treated with combination regimens such as EMA-CO. - Its rapid growth rate and high mitotic index make it particularly susceptible to **cytotoxic agents** that target rapidly dividing cells. *Embryonal rhabdomyosarcoma* - While treatable with chemotherapy, **rhabdomyosarcoma**, especially the embryonal subtype, typically requires a combination of **surgery, chemotherapy, and radiation**, and its response to chemotherapy alone is not as uniformly curative as choriocarcinoma. - The efficacy of chemotherapy is often dependent on the tumor's stage, location, and the completeness of surgical resection. *Hepatocellular carcinoma* - **Hepatocellular carcinoma (HCC)** is notoriously resistant to traditional systemic chemotherapy, with limited response rates and often requiring targeted therapies like sorafenib or lenvatinib. - Its management is primarily based on **surgical resection, liver transplantation**, or locoregional therapies such as **transarterial chemoembolization (TACE)** or radiofrequency ablation (RFA). *Thyroid carcinoma* - Most types of thyroid carcinoma, especially **differentiated thyroid cancers (papillary and follicular)**, are managed primarily with **surgery and radioactive iodine (RAI)** therapy, showing limited responsiveness to conventional chemotherapy. - Anaplastic thyroid carcinoma, while aggressive, also typically responds poorly to standard chemotherapy regimens, often requiring multimodal treatment.

Q: Which of the following is typically not elevated in multiple myeloma?

Increase in alkaline phosphatase. ***Increase in alkaline phosphatase*** - While multiple myeloma leads to **bone destruction**, it primarily involves **osteoclast activation** and bone resorption, rather than osteoblast activity. - Therefore, markers of osteoblast activity, like **alkaline phosphatase**, are typically not elevated and may even be normal or low, unless there's an associated complication like fracture healing or hepatobiliary disease. *Lytic lesions in bone* - Multiple myeloma cells produce factors that enhance **osteoclast activity** and inhibit osteoblast function, leading to the characteristic **punch-out lytic lesions** visible on imaging [1]. - These lesions are a hallmark of the disease and are caused by the destruction of bone tissue, not new bone formation [1]. *Hypercalcemia* - The extensive **bone destruction** caused by lytic lesions leads to the release of calcium into the bloodstream, resulting in **hypercalcemia**. - This is a common and serious complication of multiple myeloma, contributing to symptoms like fatigue, confusion, and kidney problems. *Hypercalciuria* - The increased serum calcium from **bone breakdown** often leads to an excessive excretion of calcium in the urine, known as **hypercalciuria**. - This can contribute to kidney stone formation and further worsen kidney function in patients with multiple myeloma.

Q: A 65-year-old white male in previously good health starts to notice blood in his urine, develops pain with urination, and experiences a weakened urinary stream. He seeks medical attention from his family doctor due to these symptoms. Laboratory findings reveal anemia, and urinalysis is positive for red cells, white cells, and gram-negative rods. A cystogram shows a tumor, and a transurethral biopsy confirms a malignant bladder tumor. Which of the following is true about this patient's tumor?

Is likely to recur after treatment. ***Is likely to recur after treatment*** - Bladder cancers, especially **urothelial carcinomas**, have a high rate of recurrence, often requiring ongoing surveillance after initial treatment [1]. - Recurrence can occur in the bladder or other parts of the **urothelial tract**, even after successful primary tumor resection [1]. *It is unlikely to be an adenocarcinoma* - This statement is actually **false** because the most common type of bladder cancer is **urothelial carcinoma** (transitional cell carcinoma), making adenocarcinoma less common but still a possibility [1]. - The symptoms described (hematuria, dysuria, weakened stream) are general for bladder cancer and do not specifically rule out adenocarcinoma. *Typically does not present with a palpable abdominal mass* - While bladder tumors *can* present with a palpable mass in advanced stages, the initial symptoms of **hematuria** and **dysuria** are more common. - A palpable mass in the abdomen would indicate a significantly large or invasive tumor, which is not suggested as the primary presentation here. *Does not typically cause an elevated serum acid phosphatase* - **Elevated serum acid phosphatase** is commonly associated with advanced **prostate cancer**, especially with bone metastases. - Bladder cancer does not typically cause an elevation in this specific marker.

Q: In which of the following conditions is emergency radiotherapy indicated?

Superior vena cava syndrome. ### Superior vena cava syndrome - **Emergency radiotherapy** is indicated in SVC syndrome, especially if caused by radiation-sensitive tumors, to rapidly reduce tumor burden and relieve **venous compression**. [3] - Rapid intervention is crucial due to the potential for **life-threatening compromise** of venous return from the head and upper extremities. [2] *Neoplastic cardiac tamponade* - The primary emergency treatment for **cardiac tamponade** is **pericardiocentesis** to urgently relieve fluid pressure around the heart. - Radiotherapy is not the immediate intervention for acute tamponade, though it may be used later to manage the underlying malignancy. *Acute epidural spinal cord compression* - **Acute spinal cord compression** requires immediate intervention, often with **high-dose corticosteroids** to reduce edema and emergent surgical decompression to prevent permanent neurological damage. [1] - Radiotherapy may be used as an adjunct or for less acute cases, but surgery is usually prioritized for acute compression. [1] *Tumor lysis syndrome* - **Tumor lysis syndrome** is a metabolic emergency managed with aggressive **hydration**, **allopurinol**, or **rasburicase** to prevent renal failure and electrolyte abnormalities. - Radiotherapy is not a treatment for the acute metabolic derangements of tumor lysis syndrome.

Q: PSA greater than 20 ng/mL is commonly seen in:

Prostate cancer. ***Prostate cancer*** - A **prostate-specific antigen (PSA)** level greater than **20 ng/mL** is highly suggestive of **prostate cancer**, especially advanced disease, and prompts further evaluation. - While other conditions can elevate PSA, such levels significantly increase the **positive predictive value** for malignancy. *BPH* - **Benign prostatic hyperplasia (BPH)** can elevate PSA, but levels typically remain below **10 ng/mL**, rarely exceeding **20 ng/mL**. - The PSA elevation in BPH is proportional to the **gland size**, which usually doesn't lead to such high values. *Prostatitis* - **Prostatitis** (inflammation of the prostate) can cause a transient, significant increase in PSA, sometimes above **20 ng/mL**. - However, the elevation typically **normalizes** after treatment of the infection or inflammation, unlike in prostate cancer. *Bladder cancer* - **Bladder cancer** does not typically cause an elevation in PSA unless there is concurrent **prostatic involvement** or other prostate pathology. - PSA is a **prostate-specific marker**, so its elevation is not directly indicative of bladder malignancy.

Q: Carcinoid tumor is diagnosed by what means?

Measurement of urinary 5-HIAA levels.. ***Measurement of urinary 5-HIAA levels.*** - Carcinoid tumors actively produce **serotonin (5-HT)**, which is metabolized into **5-hydroxyindoleacetic acid (5-HIAA)**. - Elevated levels of **5-HIAA** in a 24-hour urine collection are highly indicative of a carcinoid tumor [1]. *Serum Chromogranin A levels.* - **Chromogranin A** is a general marker for **neuroendocrine tumors**, including carcinoids, but is less specific than **5-HIAA** [1]. - Its levels can be elevated in other conditions like **renal insufficiency, atrophic gastritis**, and with **proton pump inhibitor (PPI)** use, leading to false positives. *Serum Neuron-Specific Enolase (NSE) levels.* - **NSE** is a marker primarily used for **small cell lung cancer** and some other neuroendocrine tumors, but it is not the primary diagnostic test for carcinoid. - While it can be elevated in some carcinoid cases, it lacks the specificity and diagnostic value of **urinary 5-HIAA** for classic carcinoid syndrome. *Measurement of urinary 5-HTP levels.* - **5-hydroxytryptophan (5-HTP)** is a precursor to serotonin, and its measurement is not a standard or primary diagnostic test for carcinoid tumors. - Carcinoid tumors typically directly produce **serotonin**, which is then metabolized to **5-HIAA**, making **5-HIAA** a more direct and reliable marker.

Q: What is the role of the HER2/neu receptor in breast cancer treatment?

Guiding treatment decisions. ***Predicting response to targeted therapies in breast cancer*** - The **HER2/neu receptor** is a key biomarker used to determine the effectiveness of targeted therapies, such as trastuzumab (Herceptin), in HER2-positive breast cancer [1]. - Presence of HER2 overexpression directly impacts treatment strategies and overall patient outcomes [1]. *Risk assessment for breast cancer screening* - While risk factors are essential for screening, **HER2/neu** is not utilized for general risk assessment. - Other factors like **family history** and **BRCA mutations** play a more significant role in this context. *Histological diagnosis of breast cancer* - Histological diagnosis primarily relies on **tissue biopsy** and specific grading systems, not HER2 status per se. - While HER2 can be evaluated histologically, it is not a key method for initial diagnosis [1]. *Prognosis and recurrence prediction in breast cancer* - HER2 positivity can indicate a worse prognosis, but it is more directly linked to **treatment response** than recurrence prediction [1]. - Other factors like **tumor size** and **lymph node status** are more traditionally used in prognosis.

Question 1

What is the most common cause of brain metastasis?

Accepted Answer

Carcinoma lung

Answer

Prostate cancer

Answer

HCC

Answer

Seminoma

Question 2

Most common symptom of lung carcinoma is

Accepted Answer

Cough

Answer

Dyspnoea

Answer

Weight loss

Answer

Chest pain

Question 3

Which type of tumor is most amenable to chemotherapy?

Accepted Answer

Choriocarcinoma

Answer

Embryonal rhabdomyosarcoma

Answer

Hepatocellular carcinoma

Answer

Thyroid carcinoma

Question 4

Which of the following is typically not elevated in multiple myeloma?

Accepted Answer

Increase in alkaline phosphatase

Answer

Hypercalcemia

Answer

Hypercalciuria

Answer

Lytic lesions in bone

Question 5

A 65-year-old white male in previously good health starts to notice blood in his urine, develops pain with urination, and experiences a weakened urinary stream. He seeks medical attention from his family doctor due to these symptoms. Laboratory findings reveal anemia, and urinalysis is positive for red cells, white cells, and gram-negative rods. A cystogram shows a tumor, and a transurethral biopsy confirms a malignant bladder tumor. Which of the following is true about this patient's tumor?

Accepted Answer

Is likely to recur after treatment

Answer

It is unlikely to be an adenocarcinoma

Answer

Typically does not present with a palpable abdominal mass

Answer

Does not typically cause an elevated serum acid phosphatase

Question 6

In which of the following conditions is emergency radiotherapy indicated?

Accepted Answer

Superior vena cava syndrome

Answer

Neoplastic cardiac tamponade

Answer

Acute epidural spinal cord compression

Answer

Tumor lysis syndrome

Question 7

What is the best method for screening prostate cancer?

Accepted Answer

PSA test

Answer

DRE and PSA together

Answer

PET scan

Answer

DRE

Question 8

PSA greater than 20 ng/mL is commonly seen in:

Accepted Answer

Prostate cancer

Answer

BPH

Answer

Prostatitis

Answer

Bladder cancer

Question 9

Carcinoid tumor is diagnosed by what means?

Accepted Answer

Measurement of urinary 5-HIAA levels.

Answer

Serum Chromogranin A levels.

Answer

Serum Neuron-Specific Enolase (NSE) levels.

Answer

Measurement of urinary 5-HTP levels.

Question 10

What is the role of the HER2/neu receptor in breast cancer treatment?

Accepted Answer

Guiding treatment decisions

Answer

Screening for breast cancer risk

Answer

Assessing tumor recurrence risk

Answer

Diagnosis of breast cancer based on HER2 status

Oncology — MCQs

Oncology — MCQs

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