Oncology Practice Questions

Q: The MOST important risk factor for pancreatic cancer among the following is:

Cigarette smoking. Cigarette smoking - Cigarette smoking is the leading modifiable risk factor for pancreatic cancer, accounting for approximately 25% of cases [1]. - The risk increases with the number of cigarettes smoked and the duration of smoking, with a higher risk for heavy smokers. *Alcohol* - While heavy alcohol consumption can lead to chronic pancreatitis, it is not considered a direct and independent risk factor for pancreatic cancer to the same extent as smoking. - The association is often indirect, mediated through its role in developing chronic pancreatitis. *Chronic pancreatitis* - Chronic pancreatitis significantly increases the risk of pancreatic cancer, but it is often a consequence of other underlying factors like alcohol abuse or genetic predispositions. - Although it's a strong risk factor, its prevalence as a primary cause is less than that of smoking directly. *Diabetes* - Diabetes, particularly new-onset diabetes in older adults, can be an early symptom of pancreatic cancer rather than solely a risk factor. - While it is associated with an increased risk, it is not as strong a modifiable risk factor as smoking.

Q: Which of the following most commonly produces osteoblastic secondaries?

Carcinoma prostate. ***Carcinoma prostate*** - **Prostate cancer** has a strong predilection for metastasizing to bone and typically results in **osteoblastic (bone-forming) lesions** [1]. - Tumors from the prostate release factors, such as **prostate-specific antigen (PSA)** and factors that stimulate osteoblasts, leading to new bone formation. *Carcinoma urinary bladder* - **Urinary bladder carcinoma** can metastasize to bone, but it usually produces **osteolytic (bone-destroying) lesions**, rather than osteoblastic ones. - Bone metastases from bladder cancer are less common than from prostate or breast cancer, and often indicate advanced disease. *Carcinoma breast* - **Breast cancer** is a very common cause of bone metastases, which can be **osteolytic, osteoblastic, or mixed** . - However, purely osteoblastic lesions are less common in breast cancer compared to prostate cancer, and osteolytic lesions are more frequently observed, especially in certain subtypes. *Carcinoma lung* - **Lung cancer** commonly metastasizes to bone, with **osteolytic lesions** being the predominant type. - While some subtypes can rarely cause osteoblastic changes, the vast majority of bone metastases from lung cancer involve bone destruction rather than bone formation.

Q: Cranial Irradiation" is given for:

Small cell cancer. ***Small cell cancer*** - **Cranial irradiation** is often used as prophylactic treatment for **small cell lung cancer (SCLC)** due to its high propensity for early **brain metastasis**. [1] - This therapy aims to eradicate micrometastases in the brain, thereby improving disease-free survival and reducing neurological complications. *Anaplastic cancer* - While anaplastic cancers can metastasize, **prophylactic cranial irradiation (PCI)** is not a standard or primary treatment approach specifically for preventing brain metastases in all anaplastic cancers. - The treatment for anaplastic cancers is highly dependent on the primary tumor type and specific anaplastic features. *Squamous cell cancer* - **Squamous cell carcinoma** (SCC) rarely metastasize to the brain from extracranial primary sites compared to other cancer types like SCLC, and therefore, PCI is not routinely indicated for SCC. - Brain metastases from SCC, when they occur, are typically treated with **stereotactic radiosurgery** or whole brain radiation therapy as therapeutic, not prophylactic, measures. *Adenocarcinoma* - **Adenocarcinoma** from various primary sites (e.g., lung, breast, colon) can lead to brain metastases, but **prophylactic cranial irradiation (PCI)** is not a standard treatment for preventing these. [2] - Treatment for brain metastases from adenocarcinoma usually involves targeted therapies, surgery, or radiation therapy when metastases are already detected.

Q: A 73-year-old woman has noticed a 10-kg weight loss in the past 3 months. She is becoming increasingly icteric and has constant vague epigastric pain, nausea, and episodes of bloating and diarrhea. On physical examination, she is afebrile. There is mild tenderness to palpation in the upper abdomen, but bowel sounds are present. Her stool is negative for occult blood. Laboratory findings include a total serum bilirubin concentration of 11.6 mg/dL and a direct bilirubin level of 10.5 mg/dL. Which of the following conditions involving the pancreas is most likely to be present?

Adenocarcinoma. ***Adenocarcinoma*** - The patient's age (73 years), significant **weight loss**, progressive **jaundice** (elevated direct bilirubin), **epigastric pain**, nausea, bloating, and diarrhea are all classic signs of **pancreatic adenocarcinoma**, particularly when it obstructs the bile duct [1]. - The high **direct bilirubin** indicates an **obstructive pattern of jaundice**, common with tumors in the **head of the pancreas** compressing the common bile duct [1]. *Cystic fibrosis* - While it affects the pancreas, symptoms typically manifest in **childhood or early adulthood** with recurrent pulmonary infections and malabsorption [2]. - It would not typically cause acute, obstructive jaundice in a 73-year-old with these specific symptoms. *Islet cell adenoma* - These tumors (e.g., insulinoma, gastrinoma) are functional and typically present with symptoms related to **hormone overproduction**, such as hypoglycemia or peptic ulcers. - They are less likely to cause obstructive jaundice or significant weight loss unless they grow very large. *Chronic pancreatitis* - This condition is characterized by recurrent episodes of **abdominal pain**, pancreatic insufficiency, and often calcifications on imaging [3]. - While it can lead to malabsorption and weight loss, the rapid onset of severe obstructive jaundice and significant weight loss in a 3-month period without a history of recurrent pancreatitis makes adenocarcinoma more likely [3].

Q: Most common cancer worldwide among the following -

Lung. ***Lung*** - **Lung cancer** is the most common cancer worldwide, based on incidence and mortality rates [1]. - It is strongly associated with **smoking** and environmental factors [1], [2]. *Liver* - **Liver cancer** is a significant global health problem, but it ranks below lung cancer in overall incidence [1]. - Risk factors include **hepatitis B and C infections** and **alcohol abuse** [1]. *Kidney* - **Kidney cancer**, while relatively common, has a lower incidence rate compared to lung cancer [1]. - Its incidence is often higher in developed countries and is linked to **obesity and smoking** [1]. *Prostate* - **Prostate cancer** is the most common cancer among men in many Western countries, but its worldwide incidence is lower than that of lung cancer. - It is primarily seen in **older men** and is influenced by genetic and hormonal factors.

Q: Mucositis heals after ___ months of radiotherapy:

2 Months. ***2 Months*** - **Oral mucositis** typically resolves within **2-4 weeks** after the cessation of radiotherapy. The question asks about healing *after* radiotherapy, implying a timeframe of recovery following the treatment completion. Therefore, 2 months is a reasonable timeframe for complete resolution, especially for severe cases. - While acute mucositis can appear during treatment, the healing phase usually begins post-treatment, with most symptoms subsiding completely within a couple of months. *6 Months* - This is an excessively long duration for the healing of typical mucositis. Most cases resolve much sooner unless there are severe complications or chronic issues such as fibrosis. - Persistent symptoms beyond 2-3 months would suggest a chronic problem or a different underlying cause rather than typical mucositis healing. *5 Months* - Similar to 6 months, 5 months is a prolonged period. While some very severe cases might have residual effects, complete healing of mucositis usually occurs much earlier. - This timeframe might be associated with long-term complications or secondary infections, not the standard healing process of mucositis itself. *3 Months* - While closer to the typical resolution time than 5 or 6 months, 3 months is still longer than the average for complete healing of mucositis. - Most patients experience significant improvement and resolution of acute symptoms well before the 3-month mark after radiotherapy completion.

Q: Which of the following conditions can produce hemothorax?

malignancy. ***Malignancy*** - **Malignant pleural effusions** can be hemorrhagic due to tumor invasion of blood vessels and increased vascular fragility [1]. - Tumors frequently metastasize to the pleura, often leading to **hemothorax** due to friable microvasculature [1]. *Congestive heart failure* - Typically causes a **transudative pleural effusion** due to increased hydrostatic pressure, which is usually serous, not bloody [1]. - While fluid overload occurs, it does not directly lead to **blood accumulation** in the pleural space. *Myxoma* - A **benign cardiac tumor** that can embolize or cause constitutional symptoms, but it does not directly cause hemothorax. - Pleural effusions associated with myxomas are generally serous and related to **cardiac dysfunction**, not hemorrhage. *Rheumatoid arthritis* - Can cause **pleural effusions** (rheumatoid pleurisy), which are typically exudative and lymphocytosis-predominant [1]. - These effusions are rarely hemorrhagic and generally do not lead to **gross blood** in the pleural space.

Q: The most chemoresistant tumor amongst the following:

Undifferentiated pleomorphic sarcoma. ***Undifferentiated pleomorphic sarcoma*** - **Undifferentiated pleomorphic sarcoma (UPS)** is known for its aggressive nature and inherent resistance to conventional chemotherapy. - Its **heterogeneous genetic profile** and lack of specific therapeutic targets contribute to its poor response to systemic treatments. *Osteosarcoma* - While osteosarcoma is a highly aggressive bone tumor, it is generally considered **chemosensitive**, particularly to agents like **methotrexate, doxorubicin, and cisplatin**. - **Neoadjuvant chemotherapy** is a standard part of treatment, often leading to significant tumor necrosis and improved outcomes. *Clear cell sarcoma* - **Clear cell sarcoma** is a rare soft tissue sarcoma with a distinct genetic translocation, t(12;22), involving the **EWSR1 gene**. - Although it can be challenging to treat, it is not consistently ranked as the most chemoresistant among sarcomas; specific targeted therapies are being investigated. *Synovial sarcoma* - **Synovial sarcoma** is often sensitive to chemotherapy, particularly regimens containing **ifosfamide and doxorubicin**. - Its response to chemotherapy can be variable, but it is generally *more chemosensitive* than undifferentiated pleomorphic sarcoma.

Q: Which of the following tumors is cured by radiation?

Seminoma. ***Seminoma*** - **Seminoma** is a highly radiosensitive tumor, making radiation therapy a primary curative modality, especially for localized disease [1]. - Due to its exquisite sensitivity, even relatively low doses of radiation can achieve **high cure rates** [1]. *Rhabdomyosarcoma* - While radiation therapy is often part of the treatment for **rhabdomyosarcoma**, it is typically used in conjunction with **chemotherapy and surgery** and is not curative on its own. - Its cure usually requires a **multimodal approach** due to its aggressive nature and potential for metastasis. *Renal cell cancer* - **Renal cell carcinoma** is generally considered **radioresistant**, meaning radiation therapy is not effective as a primary curative treatment. - Surgery (nephrectomy) is the **primary curative modality** for localized renal cell cancer. *Chloroma* - A **chloroma**, also known as granulocytic sarcoma, is a solid tumor of myeloid cells that often occurs in patients with acute myeloid leukemia. - Treatment focuses on systemic chemotherapy for the underlying leukemia, and while radiation can be used for local control, it is **not curative** for the underlying disease.

Q: A 45-year-old woman with metastatic melanoma on pembrolizumab develops symmetrical vitiligo-like depigmentation. Most appropriate management is:

Continue therapy with monitoring. ***Continue therapy with monitoring*** - **Vitiligo-like depigmentation** on pembrolizumab (a PD-1 inhibitor) is a common, often benign, and sometimes even a **favorable prognostic sign** associated with treatment response in melanoma. - As long as the depigmentation is not causing significant distress or rapid progression, continuing therapy with close monitoring is the appropriate initial approach. *Discontinue pembrolizumab* - Discontinuing pembrolizumab would be premature given that **vitiligo** in this context is often a mild immune-related adverse event (irAE) and may correlate with a better treatment outcome. - Early cessation of an effective immunotherapy without compelling reason could negatively impact the patient's cancer control. *Start topical tacrolimus* - **Topical tacrolimus** can be used for localized vitiligo, but its primary role is to **promote repigmentation** or halt progression. - In the context of immunotherapy-induced vitiligo, the depigmentation is often widespread and may be an indicator of a systemic anti-tumor immune response, making repigmentation a secondary concern compared to oncology treatment. *Add systemic steroids* - **Systemic steroids** are typically reserved for more severe or symptomatic immune-related adverse events (irAEs), such as severe colitis, pneumonitis, or hepatitis. - Mild or moderate vitiligo is generally not an indication for systemic immunosuppression, which could also potentially **attenuate the anti-tumor effects** of pembrolizumab.

Question 1

The MOST important risk factor for pancreatic cancer among the following is:

Accepted Answer

Cigarette smoking

Answer

Alcohol

Answer

Chronic pancreatitis

Answer

Diabetes

Question 2

Which of the following most commonly produces osteoblastic secondaries?

Accepted Answer

Carcinoma prostate

Answer

Carcinoma urinary bladder

Answer

Carcinoma breast

Answer

Carcinoma lung

Question 3

Cranial Irradiation" is given for:

Accepted Answer

Small cell cancer

Answer

Anaplastic cancer

Answer

Squamous cell cancer

Answer

Adenocarcinoma

Question 4

A 73-year-old woman has noticed a 10-kg weight loss in the past 3 months. She is becoming increasingly icteric and has constant vague epigastric pain, nausea, and episodes of bloating and diarrhea. On physical examination, she is afebrile. There is mild tenderness to palpation in the upper abdomen, but bowel sounds are present. Her stool is negative for occult blood. Laboratory findings include a total serum bilirubin concentration of 11.6 mg/dL and a direct bilirubin level of 10.5 mg/dL. Which of the following conditions involving the pancreas is most likely to be present?

Accepted Answer

Adenocarcinoma

Answer

Cystic fibrosis

Answer

Islet cell adenoma

Answer

Chronic pancreatitis

Question 5

Most common cancer worldwide among the following -

Accepted Answer

Lung

Answer

Liver

Answer

Kidney

Answer

Prostate

Question 6

Mucositis heals after ___ months of radiotherapy:

Accepted Answer

2 Months

Answer

6 Months

Answer

5 Months

Answer

3 Months

Question 7

Which of the following conditions can produce hemothorax?

Accepted Answer

malignancy

Answer

Congestive heart failure

Answer

Myxoma

Answer

Rheumatoid arthritis

Question 8

The most chemoresistant tumor amongst the following:

Accepted Answer

Undifferentiated pleomorphic sarcoma

Answer

Osteosarcoma

Answer

Clear cell sarcoma

Answer

Synovial sarcoma

Question 9

Which of the following tumors is cured by radiation?

Accepted Answer

Seminoma

Answer

Rhabdomyosarcoma

Answer

Renal cell cancer

Answer

Chloroma

Question 10

A 45-year-old woman with metastatic melanoma on pembrolizumab develops symmetrical vitiligo-like depigmentation. Most appropriate management is:

Accepted Answer

Continue therapy with monitoring

Answer

Discontinue pembrolizumab

Answer

Start topical tacrolimus

Answer

Add systemic steroids

Oncology — MCQs

Oncology — MCQs

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