Oncology Practice Questions

Q: A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?

Exophthalmos. ***Exophthalmos***- This finding, characterized by the **protrusion of the eyeball**, is typically associated with conditions like **Graves' disease** (hyperthyroidism) or orbital tumors.- It is *not* a component of **Horner's syndrome**, which is the classic neurological manifestation of a Pancoast tumor due to damage to the sympathetic chain.*Anhidrosis*- Pancoast tumors (superior sulcus tumors) often invade the **stellate ganglion** or other parts of the sympathetic chain.- Damage to sympathetic fibers causes reduced or absent sweating on the ipsilateral face and neck, manifesting as **anhidrosis**.*Miosis*- This refers to the **constriction of the pupil** and is a classic sign resulting from the loss of sympathetic input, which normally causes pupillary dilation.- The resulting unopposed action of the parasympathetic system leads to **miosis**.*Ptosis*- Ptosis, or the **drooping of the upper eyelid**, occurs due to paralysis of the **superior tarsal muscle** (Müller's muscle).- This small muscle is innervated by the sympathetic pathway, and its dysfunction results in mild **ptosis**, a core component of Horner's syndrome.

Q: Which of the following is the diagnostic test for carcinoid tumors?

Urinary 5-hydroxyindoleacetic acid. ***Urinary 5-hydroxyindoleacetic acid***- Carcinoid tumors actively produce **serotonin**, which is rapidly metabolized by **monoamine oxidase** into the inactive metabolite **5-hydroxyindoleacetic acid (5-HIAA)**.- A **24-hour urinary collection** for 5-HIAA is the most specific and confirms the functional diagnosis of **carcinoid syndrome** [1].*24-hour urinary catecholamines*- This test is primarily used for the diagnosis of **pheochromocytoma**, which secretes excess **norepinephrine** and **epinephrine**.- High levels of catecholamine metabolites, such as **metanephrines** and **vanillylmandelic acid (VMA)**, are diagnostic for pheochromocytoma, not carcinoid tumors, which primarily produce serotonin.*Serum calcitonin levels*- **Calcitonin** secretion is the key diagnostic and monitoring marker for **medullary thyroid carcinoma (MTC)**, a non-related neuroendocrine tumor originating from C-cells.- This marker is not specific or elevated in typical **carcinoid tumors** originating from the small bowel or lungs.*Serum chromogranin A*- **Chromogranin A (CgA)** is a general biomarker for **neuroendocrine tumors (NETs)** and is useful for screening and monitoring disease burden [2].- While sensitive for carcinoid tumors, it lacks the specificity of **5-HIAA** for diagnosing **carcinoid syndrome** and can be falsely elevated in conditions like PPI use or renal failure.

Q: Which of the following malignancies is unrelated to obesity?

Multiple myeloma. ***Multiple myeloma*** - While obesity is a risk factor for several cancers, there is limited or conflicting evidence directly linking **multiple myeloma** to high BMI, making it the most unrelated option among the choices provided. - The primary established risk factors for multiple myeloma include age (over 65), African descent, male sex, and a history of monoclonal gammopathy of undetermined significance (**MGUS**). [1] ***Stomach*** - Obesity, particularly abdominal obesity, increases the risk of developing **gastric cardia adenocarcinoma** due to increased prevalence of **gastroesophageal reflux disease (GERD)** and subsequent Barrett's esophagus. - Chronic inflammation and hormonal changes associated with high body fat contribute to the oncogenesis of stomach cancer. ***Pancreas*** - Obesity is a well-established risk factor for **pancreatic cancer**, increasing the risk by approximately 20-50% compared to healthy-weight individuals. [2] - The mechanism involves chronic low-grade inflammation, **insulin resistance**, and altered levels of adipokines (like leptin) and insulin-like growth factors. ***Meningioma*** - **Meningioma**, the most common primary central nervous system tumor, has a clear association with obesity. - High BMI contributes to increased risk, possibly mediated by elevated levels of **leptin** and **estrogen** (especially in postmenopausal women) which can act as growth factors.

Q: A 60 -year-old female presents with pain in her back of recent onset, which has become severe of late. During the course of investigations, she was found to have lytic lesions in the vertebrae and ribs. Which of the following organs should be carefully screened now for detecting the primary cause of these lesions?

Breast. **Breast** - **Breast cancer** is a common primary malignancy in women that frequently metastasizes to bone, causing **lytic lesions** in the vertebrae and ribs [4]. - The patient's age (60-year-old female) and the presence of severe, recent-onset back pain with multiple lytic lesions strongly suggest metastatic disease [2], with **breast cancer** being a top differential [4]. *Large intestine* - While **colorectal cancer** can metastasize to bone, it typically causes mixed lytic and blastic lesions or predominantly blastic lesions, rather than purely lytic lesions. - Furthermore, the frequency of bone metastases from colorectal cancer is generally lower compared to breast or lung primary tumors [1]. *Adrenal* - Primary **adrenal tumors** (e.g., adrenal cortical carcinoma, pheochromocytoma) rarely metastasize to bone and are not a common cause of diffuse lytic bone lesions. - Bone metastases from adrenal cancers are much less frequent and typically associated with advanced, aggressive disease [3]. *Small intestine* - **Small bowel malignancies** (e.g., adenocarcinomas, neuroendocrine tumors) rarely metastasize to bone. - When they do, the pattern of bone involvement is variable but less commonly presents as widespread lytic lesions in the spine and ribs without other systemic symptoms.

Q: A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is :

Speckled leucoplakia. ***Speckled leucoplakia*** - This patient, a **tobacco chewer** and **bidi smoker**, has risk factors and presents with a "white buccal mucosa with a bright red velvety plaque" (known as **speckled leukoplakia**), which is a highly suspicious lesion for **oral squamous cell carcinoma (OSCC)**, especially with symptoms like diminished mouth opening and occasional spitting of blood. - **Speckled leukoplakia** combines features of both leukoplakia (white areas) and erythroplakia (red velvety areas), and is considered the **highest risk precancerous lesion** for malignant transformation. *Erythroplakia* - Characterized by a **bright red velvety patch** that is flat or slightly depressed. - While highly suspicious for malignancy (with a 90% chance of being dysplastic or malignant), the description also includes a "white buccal mucosa," indicating a mixed white and red lesion. *Oral candidiasis* - Presents as **white, curdy patches** that can be scraped off, often revealing an erythematous base, and is typically associated with immunosuppression or antibiotic use. - It does not usually present with a persistent **red velvety component** or symptoms of diminished mouth opening indicative of malignancy. *Leukoplakia* - Defined as a **white plaque** that cannot be rubbed off and cannot be characterized as any other diagnosable disease. - Only describes the white component, while the patient's lesion also has a significant **red, velvety component**, classifying it more accurately as speckled leukoplakia.

Q: Which of the following are risk factors for the development of pancreatic cancer? 1. Cigarette smoking 2. Diabetes mellitus 3. Obesity 4. Caucasian ethnicity Select the correct answer using the code given below.

1, 2 and 3. ***1, 2 and 3*** - **Cigarette smoking** is a well-established and significant modifiable risk factor for pancreatic cancer, increasing the risk two to three-fold [1]. - **Long-standing diabetes mellitus**, particularly type 2, is both an independent risk factor and can be an early symptom of pancreatic cancer. **Obesity** is also clearly linked to an increased risk of pancreatic cancer, likely due to chronic inflammation and metabolic changes. *2, 3 and 4* - While diabetes mellitus and obesity are risk factors, **Caucasian ethnicity** is not considered a primary isolated risk factor for pancreatic cancer; rather, the incidence is slightly higher in certain other ethnic groups like African Americans. - This option incorrectly includes ethnicity as a primary risk factor while excluding **cigarette smoking**, which is a major contributor [1]. *1, 3 and 4* - This option correctly identifies **cigarette smoking** and **obesity** as risk factors. However, it incorrectly includes **Caucasian ethnicity** as a specific risk factor while omitting **diabetes mellitus**, which is a strong and well-documented risk factor. - **Diabetes mellitus** is a more significant risk factor than ethnicity. *1, 2 and 4* - This option correctly identifies **cigarette smoking** and **diabetes mellitus** as risk factors. However, it incorrectly includes **Caucasian ethnicity** and omits **obesity**, which is a well-established and significant risk factor. - **Obesity** has a stronger and more direct link to pancreatic cancer risk than ethnicity.

Q: Which of the following are correct with regard to lung cancer? 1. Surgical resection has a limited role in curative treatment of lung cancer. 2. Pattern of disease and prognosis of oat cell carcinoma are different to other varieties in the lungs. 3. Small cell lung cancer is a type of Neuroendocrine Tumour (NET). 4. Squamous cancer appears as a cavitating tumour in the lungs.

2, 3 and 4. ***2, 3 and 4*** - **Oat cell carcinoma** (small cell lung cancer) is known for its **aggressive behavior**, rapid growth, early metastasis, and distinct response to chemotherapy and radiation rather than surgery, making its pattern and prognosis different from **non-small cell lung cancer (NSCLC)** types [1]. - **Small cell lung cancer (SCLC)** originates from **neuroendocrine cells** in the lung, classifying it as a type of **Neuroendocrine Tumour (NET)**, which explains its unique biological and clinical characteristics [1]. - **Squamous cell carcinoma** is often centrally located and can undergo central necrosis, leading to **cavitation** which appears as a cavitating tumor on imaging [1]. *1, 3 and 4* - This option is incorrect because statement 1, which suggests surgical resection has a limited role in curative treatment, is generally **false for non-small cell lung cancer (NSCLC)**, where surgery is the primary curative modality in early stages [1]. - While statements 3 and 4 are correct, the inclusion of incorrect statement 1 makes this option invalid. *1, 2 and 3* - This option is incorrect as statement 1 claiming a limited role for surgical resection in curative treatment is generally **false for NSCLC**, where localized tumors are ideally treated with surgery [1]. - Statements 2 and 3 are correct, but the inaccuracy of statement 1 renders this option incorrect. *1, 2 and 4* - This option is incorrect because statement 1, which states that surgical resection has a limited role in curative treatment, is generally **incorrect for early-stage NSCLC** [1]. - Although statements 2 and 4 are accurate, the error in statement 1 makes this combination incorrect.

Q: The most common brain tumour in an adult is

cerebral metastasis. ***Cerebral metastasis*** - **Cerebral metastases** are the **most common brain tumours in adults**, originating from primary cancers elsewhere in the body (e.g., lung, breast, melanoma). - They often present as **multiple lesions** and can cause focal neurological deficits, seizures, and increased intracranial pressure. *Glioma* - While **gliomas** (including astrocytomas, glioblastoma multiforme) are the most common primary brain tumours, they are less common than metastatic lesions overall in adults. - They arise from **glial cells** within the brain and can be highly aggressive. *Pituitary tumour* - **Pituitary tumours** are benign adenomas originating from the pituitary gland. - They are common but constitute a smaller proportion of all adult brain tumours compared to metastases or gliomas, and often present with **endocrine disturbances** or **visual field defects**. *Vestibular schwannoma* - **Vestibular schwannomas** (acoustic neuromas) are benign tumours arising from the **vestibulocochlear nerve (cranial nerve VIII)**. - They are relatively rare and typically present with **hearing loss**, **tinnitus**, and **balance issues**.

Q: A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = 106/min, BP = 100/70 mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size 13 x 8 cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is

Gastrointestinal stromal tumor. ***Gastrointestinal stromal tumor*** - The rapid onset of symptoms like **upper abdominal pain**, **nausea**, **vomiting**, and **hematemesis**, along with signs of **hypovolemia** (tachycardia, hypotension, pallor), suggests acute gastrointestinal bleeding from a tumor [1]. - A **large exophytic tumor** in the stomach fundus with **intact overlying mucosa** on endoscopy points to a **submucosal lesion**, and **positive CD117 (c-Kit)** staining is a hallmark diagnostic feature of GISTs. *Carcinoid tumor* - While carcinoid tumors can occur in the gastrointestinal tract, they are typically **neuroendocrine tumors** and less commonly present as large, exophytic masses causing acute massive bleeding with the same frequency as GISTs. - Carcinoid tumors typically stain positive for **chromogranin A** and **synaptophysin**, not CD117. *Gastric lymphoma* - Gastric lymphoma commonly presents with **ulcerations** or infiltrative lesions of the gastric wall, which would typically cause mucosal disruption on endoscopy [2]. - Lymphomas are characterized by lymphoid markers like **CD20** or **CD3**, and not CD117 [2]. *Carcinoma stomach* - **Gastric carcinoma** often presents with **mucosal irregularities**, **ulcerations**, or **masses** that arise directly from the gastric epithelium, which would be visible on endoscopy as an invasive lesion [3]. - Gastric carcinomas are typically epithelial in origin and would not stain positive for **CD117**.

Question 1

A patient presents with breathlessness and is diagnosed with a Pancoast tumor. Which of the following findings is not typically associated with this condition?

Accepted Answer

Exophthalmos

Answer

Ptosis

Answer

Miosis

Answer

Anhidrosis

Question 2

Which of the following is the diagnostic test for carcinoid tumors?

Accepted Answer

Urinary 5-hydroxyindoleacetic acid

Answer

Serum chromogranin A

Answer

Serum calcitonin levels

Answer

24-hour urinary catecholamines

Question 3

Which of the following malignancies is unrelated to obesity?

Accepted Answer

Multiple myeloma

Answer

Pancreas

Answer

Stomach

Answer

Meningioma

Question 4

A 60 -year-old female presents with pain in her back of recent onset, which has become severe of late. During the course of investigations, she was found to have lytic lesions in the vertebrae and ribs. Which of the following organs should be carefully screened now for detecting the primary cause of these lesions?

Accepted Answer

Breast

Answer

Large intestine

Answer

Adrenal

Answer

Small intestine

Question 5

A 60-year-old tobacco chewer and heavy bidi smoker comes with diminished mouth opening and occasional spitting of blood mixed with saliva. Oral examination revealed a white buccal mucosa with a bright red velvety plaque. The most likely diagnosis is :

Accepted Answer

Speckled leucoplakia

Answer

Erythroplakia

Answer

Oral candidiasis

Answer

Leukoplakia

Question 6

Which of the following are risk factors for the development of pancreatic cancer?

1. Cigarette smoking
2. Diabetes mellitus
3. Obesity
4. Caucasian ethnicity

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 4

Question 7

Which of the following are correct with regard to lung cancer?

1. Surgical resection has a limited role in curative treatment of lung cancer.
2. Pattern of disease and prognosis of oat cell carcinoma are different to other varieties in the lungs.
3. Small cell lung cancer is a type of Neuroendocrine Tumour (NET).
4. Squamous cancer appears as a cavitating tumour in the lungs.

Accepted Answer

2, 3 and 4

Answer

1, 3 and 4

Answer

1, 2 and 3

Answer

1, 2 and 4

Question 8

The most common brain tumour in an adult is

Accepted Answer

cerebral metastasis

Answer

glioma

Answer

pituitary tumour

Answer

vestibular schwannoma

Question 9

Following the immunotherapy, in patients undergoing renal transplantation, the skin cancer most commonly seen is

Accepted Answer

Non-melanoma skin cancers (Squamous cell carcinoma and Basal cell carcinoma)

Answer

Hepatomas

Answer

Kaposi's sarcoma

Answer

Mycosis fungoides

Question 10

A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = 106/min, BP = 100/70 mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size 13 x 8 cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is

Accepted Answer

Gastrointestinal stromal tumor

Answer

Carcinoid tumor

Answer

Gastric lymphoma

Answer

Carcinoma stomach

Oncology — MCQs

Oncology — MCQs

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