Oncology Practice Questions

Q: A 45-year-old man presents with splenomegaly and weight loss. Peripheral smear shows leukocytosis with a left shift. Bone marrow is hypercellular. Cytogenetic analysis reveals t(9;22). What is the treatment of choice?

Imatinib. ***Imatinib*** - This drug acts as a **tyrosine kinase inhibitor** that specifically targets the **BCR-ABL fusion protein** created by the **t(9;22)** chromosomal translocation. - It is the **first-line therapy** for chronic phase Chronic Myeloid Leukemia (CML) due to its high efficacy and minimal side-effect profile compared to older treatments. *Rituximab* - A monoclonal antibody directed against **CD20**, used primarily in the treatment of **B-cell non-Hodgkin lymphomas** and certain autoimmune conditions. - It is not indicated for CML treatment because the malignant cells in CML do not typically express the CD20 surface antigen. *IFN alpha* - Historically used as the treatment of choice for CML before the development of targeted therapies like tyrosine kinase inhibitors. - It is now mostly relegated to a second-line role or used when target-specific therapy is contraindicated, as it is associated with significant **flu-like side effects**. *Hydroxyurea* - A non-specific **myelosuppressive agent** used to provide temporary control of leukocyte counts in CML. - While it helps in reducing cytoreduction, it does not induce **molecular remission** or address the underlying BCR-ABL molecular driver, so it is not the curative treatment of choice.

Q: Which of the following hormones is elevated in small cell carcinoma of the lung?

Atrial natriuretic factor (ANF). Small cell lung carcinoma (SCLC) is a neuroendocrine tumor known for its strong association with paraneoplastic syndromes due to the ectopic secretion of hormones [1]. **Why Option B is Correct:** SCLC is the most common cause of the **Syndrome of Inappropriate Antidiuretic Hormone (SIADH)** [1], [2]. While SIADH is primarily caused by ectopic ADH (vasopressin) production, studies have shown that SCLC cells can also secrete **Atrial Natriuretic Factor (ANF)** or Brain Natriuretic Peptide (BNP). Both ADH and ANF contribute to the characteristic hyponatremia seen in these patients—ADH by increasing water reabsorption and ANF by promoting natriuresis (sodium excretion). **Analysis of Incorrect Options:** * **Option A (PTH):** Ectopic production of **PTHrP** (Parathyroid Hormone-related Protein) is classically associated with **Squamous Cell Carcinoma** of the lung, leading to hypercalcemia [1]. * **Option C (Growth Hormone):** Ectopic GH is rare in lung cancer; however, Growth Hormone-Releasing Hormone (GHRH) can occasionally be secreted by bronchial carcinoids. * **Option D (VIP):** VIP secretion is typically associated with **VIPomas** (pancreatic islet cell tumors) or neuroblastomas, causing watery diarrhea, hypokalemia, and achlorhydria (WDHA syndrome). **High-Yield Clinical Pearls for NEET-PG:** * **SCLC Associations:** SIADH (most common), Ectopic ACTH (Cushing’s Syndrome) [1], [3], and Lambert-Eaton Myasthenic Syndrome (LEMS). * **Rule of "S":** **S**quamous cell carcinoma and **S**mall cell carcinoma are both **S**moking-related and **S**entrally (centrally) located. * **Hypercalcemia in Lung Cancer:** If it's Squamous cell, think **PTHrP** [1]. If it's Small cell, hypercalcemia is rare and usually due to bone metastasis, not hormones.

Q: A 65-year-old man with a 45-pack-per-year history of smoking presents with hematuria, flank pain, and unintentional weight loss. He has no fever, chills, or dysuria. Physical examination reveals no abdominal mass or flank tenderness. Laboratory findings show a hemoglobin of 18.5 g/dL and normal liver enzymes. An abdominal CT scan demonstrates a left kidney mass involving the renal vein. What is the most likely diagnosis?

Renal cell carcinoma. **Explanation:** The clinical presentation of **Renal Cell Carcinoma (RCC)** is classically described by the "triad" of hematuria, flank pain, and a palpable abdominal mass [1]. However, this triad is seen in only about 10% of cases and often signifies advanced disease. **Why Renal Cell Carcinoma is correct:** 1. **Risk Factors:** The patient’s age (65) and significant smoking history (45 pack-years) are major risk factors [1]. 2. **Paraneoplastic Syndrome:** The hemoglobin of 18.5 g/dL indicates **polycythemia**, a classic paraneoplastic manifestation of RCC caused by the ectopic production of **Erythropoietin (EPO)**. 3. **Imaging:** A solid mass involving the renal vein is highly characteristic of RCC, as it has a notorious propensity for **vascular invasion** (extending into the renal vein and potentially the inferior vena cava). **Why other options are incorrect:** * **Renal cyst:** Typically asymptomatic and incidentally found; simple cysts do not cause weight loss, polycythemia, or vascular invasion. * **Renal metastases:** While possible, primary renal tumors are more common than metastases to the kidney [1]. Furthermore, polycythemia specifically points toward a primary EPO-secreting renal tumor. * **Renal abscess:** Usually presents with systemic signs of infection such as high-grade fever, chills, and leukocytosis, which are absent here. **NEET-PG High-Yield Pearls:** * **Most common histological type:** Clear cell carcinoma (derived from proximal convoluted tubule) [1]. * **Genetic association:** Deletion of the **VHL gene** on chromosome 3p. * **Stauffer Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases, another classic paraneoplastic syndrome of RCC. * **Left-sided varicocele:** May occur if the tumor obstructs the left renal vein, preventing drainage of the left gonadal vein.

Q: All of the following are associated with paraneoplastic syndromes except?

Progressive multifocal leukoencephalopathy. **Explanation:** The core concept in this question is distinguishing between a **Paraneoplastic Syndrome (PNS)** and an **Opportunistic Infection** occurring in a malignancy-associated immunocompromised state. **Why Option B is the correct answer:** **Progressive Multifocal Leukoencephalopathy (PML)** is not a paraneoplastic syndrome. It is a demyelinating disease of the CNS caused by the reactivation of the **JC virus** (a polyomavirus). While it occurs frequently in patients with hematological malignancies (like CLL or Lymphoma) due to profound immunosuppression, it is an **infectious process**, not an immune-mediated response to the tumor itself. **Analysis of Incorrect Options:** * **A. Cerebellar Degeneration:** A classic PNS (Subacute Cerebellar Degeneration) often associated with **anti-Yo** (Breast/Ovarian cancer), **anti-Hu** (SCLC), or **anti-Tr** (Hodgkin’s) antibodies. * **C. Amyotrophic Lateral Sclerosis (ALS):** While most ALS is idiopathic, a "motor neuron disease" phenotype can occur as a paraneoplastic manifestation, particularly in patients with **Lymphoma** or **Renal Cell Carcinoma**. * **D. Opsoclonus Myoclonus:** Known as "dancing eyes, dancing feet" syndrome. In children, it is highly suggestive of **Neuroblastoma**; in adults, it is often associated with **Small Cell Lung Cancer (SCLC)** (anti-Ri antibodies). **High-Yield Clinical Pearls for NEET-PG:** 1. **Lambert-Eaton Myasthenic Syndrome (LEMS):** Most common paraneoplastic neuromuscular junction disorder (associated with SCLC; anti-VGCC antibodies). 2. **Anti-NMDA Receptor Encephalitis:** Classically associated with **Ovarian Teratoma** in young females. 3. **Syndrome of Inappropriate Antidiuretic Hormone (SIADH):** The most common endocrine PNS, typically seen in **SCLC**. 4. **Hypercalcemia:** Most commonly caused by **PTHrP** production in **Squamous Cell Carcinoma** (Lung).

Question 1

A 45-year-old man presents with splenomegaly and weight loss. Peripheral smear shows leukocytosis with a left shift. Bone marrow is hypercellular. Cytogenetic analysis reveals t(9;22). What is the treatment of choice?

Accepted Answer

Imatinib

Answer

Rituximab

Answer

IFN alpha

Answer

Hydroxyurea

Question 2

A patient was detected to have a medullary carcinoma of thyroid and has a family history of endocrine tumors, and genetic counseling is advised. The clinician plans further evaluation to identify associated inherited syndromes and guide family screening. Which of the following statements regarding this condition is correct?

Accepted Answer

Patients should be screened for RET gene mutations associated with MEN 2A and MEN 2B

Answer

Menin proto-oncogene mutation is associated with MEN 1

Answer

Medullary thyroid carcinoma arises from follicular cells and is associated with BRAF mutation

Answer

Prophylactic thyroidectomy is not indicated in asymptomatic family members

Question 3

Which of the following hormones is elevated in small cell carcinoma of the lung?

Accepted Answer

Atrial natriuretic factor (ANF)

Answer

Parathyroid hormone (PTH)

Answer

Growth hormone

Answer

Vasoactive intestinal peptide (VIP)

Question 4

A 65-year-old man with a 45-pack-per-year history of smoking presents with hematuria, flank pain, and unintentional weight loss. He has no fever, chills, or dysuria. Physical examination reveals no abdominal mass or flank tenderness. Laboratory findings show a hemoglobin of 18.5 g/dL and normal liver enzymes. An abdominal CT scan demonstrates a left kidney mass involving the renal vein. What is the most likely diagnosis?

Accepted Answer

Renal cell carcinoma

Answer

Renal cyst

Answer

Renal metastases

Answer

Renal abscess

Question 5

All of the following are associated with paraneoplastic syndromes except?

Accepted Answer

Progressive multifocal leukoencephalopathy

Answer

Cerebellar degeneration

Answer

Amyotrophic lateral sclerosis

Answer

Opsoclonus myoclonus

Oncology — MCQs

Oncology — MCQs

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