Oncology Practice Questions

Q: A 65-year-old patient presents with hematuria, weight loss, and flank pain. CT shows a solid renal mass with calcifications and renal vein invasion. Laboratory results indicate hemoglobin of 10.8, ESR of 45, and creatinine of 1.6. What is the best diagnosis?

Renal cell carcinoma. ***Renal cell carcinoma*** - The classic triad of **hematuria, flank pain, and palpable mass** (though a palpable mass isn't explicitly stated, flank pain and hematuria are present) combined with **weight loss** and a **solid renal mass with calcifications and renal vein invasion** on CT are highly indicative of **renal cell carcinoma (RCC)** [1]. - The lab findings of **anemia (Hb 10.8)**, **elevated ESR (45)**, and mild renal dysfunction (creatinine 1.6) further support a diagnosis of RCC, especially with paraneoplastic syndromes. *Transitional cell carcinoma* - This typically arises in the **renal pelvis or ureter** and often presents with painless gross hematuria, but **solid mass with calcifications and renal vein invasion** is less characteristic of TCC. - While it can cause hematuria and flank pain, the imaging findings of a solid renal mass with calcifications and invasion are more typical of parenchymal tumors like RCC. *Angiomyolipoma* - This is a **benign tumor** composed of blood vessels, smooth muscle, and fat, making it appear hyperechoic or fat-containing on imaging, rather than a solid mass with calcifications. - It usually presents with symptoms only when large or hemorrhaging, and **weight loss and renal vein invasion** are not characteristic features. *Wilms' tumor* - Primarily affects **children**, typically presenting as an asymptomatic abdominal mass, hematuria, and hypertension. - This patient's age (65-year-old) makes Wilms' tumor an **extremely unlikely diagnosis** [1].

Q: A patient with non-small cell lung cancer (NSCLC) who is resistant to first-line chemotherapy should have which molecular marker evaluated to guide second-line targeted therapy?

EGFR mutation. ### EGFR mutation - **EGFR mutations** are common in NSCLC and can lead to resistance to first-line chemotherapy, specifically **tyrosine kinase inhibitors (TKIs)** [1]. - Identifying specific EGFR mutations, such as **T790M**, can guide the use of second-generation or third-generation EGFR TKIs like **osimertinib** as second-line therapy. *BRCA1 mutation* - **BRCA1 mutations** are primarily associated with an increased risk of **breast and ovarian cancers**, and occasionally prostate and pancreatic cancers. - They are not routinely evaluated or considered a primary target for guiding second-line therapy in NSCLC. *BCR-ABL fusion gene* - The **BCR-ABL fusion gene** is a hallmark of **chronic myeloid leukemia (CML)** and some cases of acute lymphoblastic leukemia (ALL) [1]. - This gene is a target for **tyrosine kinase inhibitors** like imatinib in these hematological malignancies but is not relevant for NSCLC [1]. *HER2 overexpression* - **HER2 overexpression** or amplification is a significant prognostic and predictive marker in **breast cancer** and some gastric cancers, guiding **trastuzumab** therapy [1]. - While HER2 alterations can occur in a small subset of NSCLC, they are less common and less established as a primary driver for second-line targeted therapy compared to EGFR mutations.

Q: A 40-year-old man presents with generalized lymphadenopathy and a mediastinal mass. Histology reveals Reed-Sternberg cells. Which combination of treatments offers the best chance of remission?

Chemotherapy and radiation therapy. The original explanation provided already accurately details that chemotherapy and radiation therapy are the standard treatment for Hodgkin's lymphoma [1], as the disease originates in lymphoid tissues and is identified by Reed-Sternberg cells [1]. Chemotherapy functions to reduce tumor burden, while radiation therapy is used to eliminate localized disease [1]. Historically, radiation alone was used for localized (stage IA/IIA) disease [1]. Immunotherapy and surgery are generally not first-line options. While stem cell transplant is used for relapsed or refractory cases, it is not the initial treatment strategy [1].

Q: A 25-year-old woman presents with painless hematuria and a history of recurrent urinary tract infections. Urine cytology reveals atypical cells, and cystoscopy shows a papillary lesion. What is the most likely diagnosis?

Transitional cell carcinoma. ***Transitional cell carcinoma*** - Characterized by **painless hematuria** [1] and often occurs in patients with a history of **urinary tract infections**. - The presence of **atypical cells in urine cytology** and a **papillary lesion** found via cystoscopy supports this diagnosis. *Renal cell carcinoma* - Typically presents with **flank pain**, **weight loss**, and **hematuria**, but is less common in young women compared to transitional cell carcinoma. - Uncommonly associated with cystoscopic findings of **papillary lesions**; it usually manifests as solid renal mass rather than urinary tract lesions. *Adenocarcinoma* - Generally arises in **glandular tissue** of the kidney and shows variable presentation, not typically linked to **hematuria** in the bladder. - Rare in the bladder environment and does not align well with **urinary tract infection** history or cystoscopy findings. *Squamous cell carcinoma* - More commonly associated with chronic irritation from **schistosomiasis** or prolonged bladder catheterization rather than recurrent UTIs. - Presents with **painful urination** or hematuria [1] and is not typically related to **papillary lesions** seen in this case.

Q: A 65-year-old man presents with fatigue, weight loss, and abdominal pain. A CT scan of the abdomen reveals a pancreatic mass. What is the most likely diagnosis?

Pancreatic adenocarcinoma. ***Pancreatic adenocarcinoma*** - The combination of **fatigue, weight loss, and abdominal pain** in an elderly patient, alongside a **pancreatic mass** on CT, are classic signs of pancreatic adenocarcinoma [1]. - This cancer is often diagnosed at an advanced stage due to its subtle and nonspecific initial symptoms. *Chronic pancreatitis* - While chronic pancreatitis can cause abdominal pain and weight loss, it typically presents with a history of recurrent episodes of pancreatitis, often related to **alcohol abuse** [2] or **gallstones**. - A mass on CT in chronic pancreatitis is usually an **inflammatory pseudotumor** or **fibrotic change**, not a distinct solid mass with these systemic symptoms [2]. *Acute pancreatitis* - This condition presents with acute, severe upper abdominal pain, often radiating to the back, associated with elevated pancreatic enzymes (**amylase and lipase**). - It usually does not involve significant weight loss or prolonged fatigue unless it leads to severe complications. *Gastrointestinal stromal tumor* - GISTs are **mesenchymal tumors** that originate in the gastrointestinal tract, most commonly the stomach or small intestine, and rarely in the pancreas. - While they can cause abdominal pain and weight loss, a mass in the pancreas is less commonly a GIST compared to adenocarcinoma.

Q: A 25-year-old male presents with a painless swelling in the scrotum. An ultrasound shows a heterogeneous mass in the testis. Which marker is most likely to be elevated in this patient?

Alpha-fetoprotein. ***Beta-human chorionic gonadotropin*** - A **heterogeneous mass** in the testis along with painless swelling raises suspicion of **germ cell tumors**, particularly **choriocarcinoma**, which is known to elevate this marker [1]. - It is commonly associated with testicular **tumors** in young males and can help in diagnosis and monitoring treatment response [1]. Syncytiotrophoblast cells scattered within germ cell tumors also cause moderate elevation of serum hCG, and approximately 15% of seminomas contain syncytiotrophoblasts that elevate HCG levels. *Alpha-fetoprotein* - Typically elevated in **non-seminomatous germ cell tumors** like **yolk sac tumors** and **mixed germ cell tumors** [1], but not specifically for the mass described. - Less relevant in cases primarily associated with **choriocarcinoma** or **seminomas**, which are more common in this age group. *Prostate-specific antigen* - Mainly used as a marker for **prostate cancer** and conditions related to the **prostate**, not applicable to testicular masses [1]. - Elevated in older males and has no significance in the context of a **scrotal mass** in young men. *Carcinoembryonic antigen* - Generally associated with **colorectal and certain other cancers**, not typically relevant in testicular masses [1]. - Does not provide information about the type of tumor present in the **testis**, making it an inappropriate marker in this case.

Q: A 40-year-old man presents with a persistent cough and hemoptysis. Imaging shows a mass in the right upper lobe, and a biopsy reveals squamous cell carcinoma. What is the most likely etiological factor?

Cigarette smoking. ***Cigarette smoking*** [1] - Cigarette smoking is the **most significant risk factor** for the development of squamous cell carcinoma of the lung [1]. - It accounts for nearly **85% of lung cancer cases**, primarily due to the carcinogens present in tobacco smoke. *Radon exposure* - Radon exposure is a known risk factor for **lung cancer**, but it is more strongly associated with **adenocarcinoma** than with squamous cell carcinoma. - The risk from radon is generally lower than that posed by **cigarette smoking**, making it less likely in this scenario. [1] *Asbestos exposure* - Asbestos exposure is primarily associated with **mesothelioma** and lung cancer, but primarily the **adenocarcinoma** type, rather than squamous cell carcinoma. - It typically requires prolonged exposure and is not as directly linked to the risk seen with **cigarette smoking**. *Viral infection* - While viral infections like **HPV** can contribute to certain cancers, they are not a common etiology for **squamous cell carcinoma of the lung**. - Other environmental and lifestyle factors, especially **tobacco**, play a much more prominent role in lung cancer development. [1]

Q: A 70-year-old woman presents with fatigue, weight loss, and anorexia. Physical examination reveals hepatomegaly and jaundice. Laboratory results show elevated alpha-fetoprotein. What is the most likely diagnosis?

Hepatocellular carcinoma. ***Hepatocellular carcinoma*** - The constellation of **fatigue, weight loss, anorexia, hepatomegaly, jaundice**, and elevated **alpha-fetoprotein** strongly points to hepatocellular carcinoma (HCC) [1]. - **Alpha-fetoprotein (AFP)** is a well-established tumor marker for HCC, often elevated in a significant proportion of cases [3]. *Pancreatic cancer* - While it can cause weight loss, fatigue, and jaundice, **hepatomegaly** is less common, and **elevated alpha-fetoprotein** is not a characteristic marker for pancreatic cancer [1]. - Typical markers include **CA 19-9**, and jaundice is often due to **biliary obstruction**. *Gallbladder cancer* - This cancer can present with weight loss and jaundice due to biliary obstruction, but **hepatomegaly** is not a primary feature unless there's extensive metastasis [2]. - **Elevated alpha-fetoprotein** is not typically associated with gallbladder cancer. *Cholangiocarcinoma* - Similar to gallbladder cancer, cholangiocarcinoma can cause **jaundice and weight loss** due to involvement of the bile ducts [2]. - However, **alpha-fetoprotein** is not a typical tumor marker for cholangiocarcinoma; **CEA and CA 19-9** are more commonly elevated.

Q: A 65-year-old female presents with progressive dysphagia. A barium swallow shows multiple areas of narrowing with proximal dilatation. What is the most likely diagnosis?

Esophageal cancer. ***Esophageal cancer*** - Progressive dysphagia, especially in an elderly patient, along with narrowing and proximal dilation seen on barium swallow, is highly concerning for **esophageal cancer**. - This presentation often signifies an **obstructive lesion** that is gradually worsening [1]. *Achalasia* - Achalasia is characterized by dysphagia for both solids and liquids due to **failure of lower esophageal sphincter (LES) relaxation** and aperistalsis [2]. - While it causes proximal dilation, the classic barium swallow finding is a **bird's beak appearance**, with smooth narrowing at the LES, not multiple areas of narrowing [2]. *Peptic stricture* - A peptic stricture typically causes **intermittent or progressive dysphagia** for solids due to chronic acid reflux leading to inflammation and scarring [1]. - While it presents with narrowing and upstream dilation, the history usually includes **heartburn** and **regurgitation**, and there's often *a single, shorter stricture* rather than multiple areas of narrowing. *Esophageal varices* - Esophageal varices are **dilated veins** in the lower esophagus, usually a complication of **portal hypertension**. - They typically present with **hematemesis** or melena due to rupture and bleeding, not progressive dysphagia as the primary symptom.

Question 1

A 65-year-old patient presents with hematuria, weight loss, and flank pain. CT shows a solid renal mass with calcifications and renal vein invasion. Laboratory results indicate hemoglobin of 10.8, ESR of 45, and creatinine of 1.6. What is the best diagnosis?

Accepted Answer

Renal cell carcinoma

Answer

Transitional cell carcinoma

Answer

Angiomyolipoma

Answer

Wilms' tumor

Question 2

A patient with non-small cell lung cancer (NSCLC) who is resistant to first-line chemotherapy should have which molecular marker evaluated to guide second-line targeted therapy?

Accepted Answer

EGFR mutation

Answer

BRCA1 mutation

Answer

BCR-ABL fusion gene

Answer

HER2 overexpression

Question 3

Which statement best describes the use of central venous catheters versus peripheral intravenous lines for chemotherapy administration?

Accepted Answer

Central venous catheters are advantageous for long-term chemotherapy despite their infection risks.

Answer

Peripheral lines are associated with lower infection risk and greater patient comfort, making them suitable for short-term use.

Answer

Peripheral lines should be used when minimizing infection risk is a priority.

Answer

Central venous catheters should be avoided due to their higher infection risk compared to peripheral lines.

Question 4

A 40-year-old man presents with generalized lymphadenopathy and a mediastinal mass. Histology reveals Reed-Sternberg cells. Which combination of treatments offers the best chance of remission?

Accepted Answer

Chemotherapy and radiation therapy

Answer

Surgery and radiotherapy

Answer

Chemotherapy and stem cell transplant

Answer

Immunotherapy and radiation therapy

Question 5

A 25-year-old woman presents with painless hematuria and a history of recurrent urinary tract infections. Urine cytology reveals atypical cells, and cystoscopy shows a papillary lesion. What is the most likely diagnosis?

Accepted Answer

Transitional cell carcinoma

Answer

Renal cell carcinoma

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Question 6

A 65-year-old man presents with fatigue, weight loss, and abdominal pain. A CT scan of the abdomen reveals a pancreatic mass. What is the most likely diagnosis?

Accepted Answer

Pancreatic adenocarcinoma

Answer

Chronic pancreatitis

Answer

Acute pancreatitis

Answer

Gastrointestinal stromal tumor

Question 7

A 25-year-old male presents with a painless swelling in the scrotum. An ultrasound shows a heterogeneous mass in the testis. Which marker is most likely to be elevated in this patient?

Accepted Answer

Alpha-fetoprotein

Answer

Prostate-specific antigen

Answer

Carcinoembryonic antigen

Answer

Beta-human chorionic gonadotropin

Question 8

A 40-year-old man presents with a persistent cough and hemoptysis. Imaging shows a mass in the right upper lobe, and a biopsy reveals squamous cell carcinoma. What is the most likely etiological factor?

Accepted Answer

Cigarette smoking

Answer

Asbestos exposure

Answer

Radon exposure

Answer

Viral infection

Question 9

A 70-year-old woman presents with fatigue, weight loss, and anorexia. Physical examination reveals hepatomegaly and jaundice. Laboratory results show elevated alpha-fetoprotein. What is the most likely diagnosis?

Accepted Answer

Hepatocellular carcinoma

Answer

Pancreatic cancer

Answer

Gallbladder cancer

Answer

Cholangiocarcinoma

Question 10

A 65-year-old female presents with progressive dysphagia. A barium swallow shows multiple areas of narrowing with proximal dilatation. What is the most likely diagnosis?

Accepted Answer

Esophageal cancer

Answer

Achalasia

Answer

Peptic stricture

Answer

Esophageal varices

Oncology — MCQs

Oncology — MCQs

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