Oncology Practice Questions

Q: What is the diagnostic tumor marker for medullary thyroid cancer?

Calcitonin. **Explanation:** **Medullary Thyroid Carcinoma (MTC)** originates from the **parafollicular C-cells** of the thyroid gland. These neuroendocrine cells are embryologically derived from the neural crest and are responsible for the secretion of **Calcitonin**, a hormone involved in calcium homeostasis. Because MTC cells retain this secretory function, serum Calcitonin levels serve as a highly sensitive and specific tumor marker for diagnosis, monitoring treatment response, and detecting recurrence. **Analysis of Options:** * **A. BRAF:** This is a genetic mutation (specifically BRAF V600E) commonly associated with **Papillary Thyroid Cancer**, not Medullary. It is used for prognosis rather than as a primary diagnostic serum marker. * **B. VMA (Vanillylmandelic Acid):** This is a urinary metabolite of catecholamines used to diagnose **Pheochromocytoma**. While Pheochromocytoma is associated with MTC in MEN 2A and 2B syndromes, VMA is not a marker for the thyroid cancer itself. * **D. Melatonin:** This is a hormone secreted by the pineal gland to regulate sleep-wake cycles and has no diagnostic relevance to thyroid oncology. **High-Yield Clinical Pearls for NEET-PG:** * **Carcinoembryonic Antigen (CEA):** Also elevated in MTC and used alongside Calcitonin for prognosis. * **Genetic Screening:** All patients with MTC must be screened for **RET proto-oncogene** mutations to rule out Multiple Endocrine Neoplasia (MEN) type 2. * **Amyloid Stroma:** Histologically, MTC is characterized by nests of cells separated by amyloid deposits (formed by altered calcitonin). * **Screening:** In families with known RET mutations, prophylactic thyroidectomy is often indicated.

Q: Which of the following conditions can present with recurrent episodes of upper limb thrombosis?

All of the above. This question tests your understanding of **Trousseau Syndrome** (Migratory Thrombophlebitis), a classic paraneoplastic manifestation of underlying malignancy. ### **Explanation** The underlying medical concept is **Cancer-Associated Thrombosis (CAT)**. Malignant cells produce procoagulant factors (like tissue factor and cysteine proteases) and inflammatory cytokines that activate the coagulation cascade. **Trousseau Syndrome** is characterized by recurrent, migratory episodes of venous thrombosis at unusual sites, such as the upper limbs or superficial veins [1]. While it is most classically associated with **mucin-secreting adenocarcinomas**, any advanced malignancy can trigger a hypercoagulable state [2]. * **Pancreatic Carcinoma (Option B):** This is the most common association [2]. Mucin produced by the tumor cells directly interacts with selectins, leading to microthrombi formation. * **Prostatic Carcinoma (Option A):** As an adenocarcinoma, it is a well-documented cause of systemic hypercoagulability and recurrent venous thromboembolism (VTE). * **Osteosarcoma (Option C):** While less common than adenocarcinomas, sarcomas are highly prothrombotic due to the release of membrane-bound tissue factor and tumor-derived microvesicles. ### **Clinical Pearls for NEET-PG** * **Trousseau Sign of Malignancy:** Migratory thrombophlebitis (not to be confused with Trousseau sign of latent tetany/hypocalcemia). * **Most common site:** Pancreas (tail and body > head) [2]. * **Management:** Low Molecular Weight Heparin (LMWH) is generally preferred over Warfarin for cancer-associated thrombosis, as Warfarin is often ineffective in these patients. * **High-Yield Association:** If a patient presents with "spontaneous" or "migratory" clots without obvious risk factors, the first step is to screen for an occult malignancy.

Q: What is the commonest carcinoma in elderly males?

Prostate. **Explanation:** The correct answer is **Prostate (Option D)**. In the elderly male population (typically defined as >65 years), **Prostate Carcinoma** is the most frequently diagnosed malignancy. The incidence of prostate cancer is strongly age-dependent; it is rare before age 40 but increases exponentially thereafter. Autopsy studies have shown that nearly 50-60% of men over the age of 80 have histological evidence of prostatic adenocarcinoma, often referred to as "latent carcinoma." **Analysis of Incorrect Options:** * **Stomach (Option A):** While historically common in India and East Asia, its incidence is declining globally. It is not the most common cancer in the elderly compared to prostate or lung. * **Lung (Option B):** Lung cancer is the leading cause of **cancer-related mortality** (deaths) in men worldwide [2], but in terms of **incidence** (new cases) in the elderly, prostate cancer ranks higher. * **Esophagus (Option C):** This is common in specific geographical belts (like the "Asian Esophageal Cancer Belt") and is associated with smoking and alcohol, but it does not surpass the prevalence of prostate cancer. **High-Yield Clinical Pearls for NEET-PG:** * **Global vs. India:** Globally, Prostate is the commonest cancer in males. However, in **India**, according to recent ICMR data, **Lung cancer** or **Oral cavity cancer** often tops the list for males, but for the specific demographic of "elderly males" in a general medical context, Prostate remains the classic textbook answer. * **Screening:** PSA (Prostate Specific Antigen) is the screening marker, though its routine use is controversial due to overdiagnosis. * **Metastasis:** Prostate cancer characteristically spreads to the bone, causing **osteoblastic (sclerotic) lesions**, commonly involving the lumbar spine [1].

Q: Which of the following is NOT a paraneoplastic manifestation of bronchogenic carcinoma?

Acanthosis nigricans. **Explanation:** Paraneoplastic syndromes are clinical syndromes involving non-metastatic systemic effects that accompany malignant disease [3]. While many cancers share similar paraneoplastic manifestations, certain signs are classically associated with specific primary tumors. **Why Acanthosis Nigricans is the correct answer:** Acanthosis nigricans (specifically the malignant type) is most strongly associated with **intra-abdominal adenocarcinomas**, with **gastric carcinoma** being the most common (approx. 55-60% of cases). While it can rarely occur with other cancers, it is not a classic paraneoplastic manifestation of bronchogenic carcinoma. **Analysis of other options:** * **Dermatomyositis (A):** This inflammatory myopathy has a strong association with several malignancies, particularly **Small Cell Lung Cancer (SCLC)** and non-small cell lung cancer, as well as ovarian and breast cancers [1]. * **Cerebellar degeneration (C):** Paraneoplastic cerebellar degeneration is a well-documented neurological manifestation of **Small Cell Lung Cancer**, often mediated by anti-Hu or anti-VGCC antibodies [3]. * **Hyperkeratosis of palms and soles (D):** Also known as **Tylosis**, this is a recognized paraneoplastic feature of **Squamous Cell Carcinoma of the Lung** (and esophagus). **NEET-PG High-Yield Pearls:** * **Small Cell Lung Cancer (SCLC):** Most common cause of SIADH, Ectopic ACTH (Cushing’s), and Lambert-Eaton Myasthenic Syndrome [1], [3]. * **Squamous Cell Carcinoma:** Most common cause of Hypercalcemia (due to PTHrP) [1]. * **Hypertrophic Osteoarthropathy (HOA):** Classically associated with Adenocarcinoma of the lung [2]. * **Leser-Trélat sign:** Sudden onset of multiple seborrheic keratoses; like malignant acanthosis nigricans, it points toward **Gastric Adenocarcinoma**.

Q: Migratory thrombophlebitis is associated with all of the following malignancies, except:

Testis. **Explanation:** **Migratory Thrombophlebitis (Trousseau’s Syndrome)** is a paraneoplastic syndrome characterized by recurrent, spontaneous episodes of venous thrombosis that appear in different locations over time. It is classically associated with **mucin-secreting adenocarcinomas**. **1. Why Testis is the Correct Answer:** Testicular cancers (such as seminomas or non-seminomatous germ cell tumors) [1] are not typically mucin-secreting. While they can cause a hypercoagulable state due to tumor bulk or chemotherapy, they are not classically associated with the "migratory" pattern of thrombophlebitis seen in Trousseau’s Syndrome. **2. Analysis of Other Options:** * **Pancreas (Option D):** This is the **most common** association [2]. Carcinoma of the body and tail of the pancreas is the classic "textbook" cause of Trousseau’s Syndrome. * **Lung (Option B) and Colon (Option C):** Both are common sites for adenocarcinomas. These tumors produce procoagulants like **tissue factor** and **cancer procoagulant**, as well as mucins that interact with P-selectin and L-selectin, triggering the formation of microthrombi [2]. **Clinical Pearls for NEET-PG:** * **Pathophysiology:** The syndrome is driven by the interaction of circulating mucins with selectins and the release of tissue factor, leading to chronic disseminated intravascular coagulation (DIC). * **Trousseau’s Sign vs. Syndrome:** Do not confuse *Trousseau’s Syndrome* (migratory thrombophlebitis) with *Trousseau’s Sign of Latent Tetany* (carpopedal spasm induced by BP cuff inflation in hypocalcemia). * **Management:** The treatment of choice for malignancy-associated thrombosis is **Low Molecular Weight Heparin (LMWH)**, as these patients are often resistant to Warfarin.

Q: Which of the following is the only form of Hodgkin disease (HD) more common in women?

Nodular-sclerosing Hodgkin disease. **Explanation:** In Hodgkin Lymphoma (HL), there is a distinct gender distribution pattern. While the overall incidence of Hodgkin Lymphoma is higher in males, **Nodular Sclerosis Hodgkin Lymphoma (NSHL)** is the notable exception. It is the only subtype that shows a **female preponderance** (or an equal gender distribution depending on the study population) and is the most common subtype overall, accounting for approximately 60–80% of cases [1]. It typically affects adolescents and young adults and frequently presents with a mediastinal mass [2]. **Analysis of Options:** * **Nodular Sclerosis (Correct):** Characterized by broad bands of collagen fibrosis surrounding nodules of tumor cells and the presence of **Lacunar cells** (a variant of Reed-Sternberg cells). It is the most common subtype in females and young adults [1]. * **Lymphocyte-Predominant (Incorrect):** This subtype has a strong male predominance (approx. 3:1). It is characterized by "Popcorn cells" (L&H cells) and generally carries the best prognosis. * **Mixed-Cellularity (Incorrect):** More common in males and older patients. It is strongly associated with EBV infection and presents with a diverse inflammatory background. * **Lymphocyte-Depleted (Incorrect):** The rarest subtype, seen most often in elderly or HIV-positive males. It carries the worst prognosis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common subtype:** Nodular Sclerosis. * **Best prognosis:** Lymphocyte-Predominant. * **Worst prognosis:** Lymphocyte-Depleted. * **EBV Association:** Highest in Mixed-Cellularity and Lymphocyte-Depleted subtypes. * **Bimodal Age Distribution:** HL peaks at 15–35 years and again after 50 years. * **Reed-Sternberg (RS) Cells:** The hallmark of HL; they are CD15+ and CD30+ (except in the Nodular Lymphocyte Predominant type, which is CD20+).

Q: Central nervous system involvement in diffuse large B-cell lymphoma (DLBCL) is not typically seen with involvement of which of the following organs?

Ovary. In Diffuse Large B-cell Lymphoma (DLBCL), certain extranodal sites are associated with a significantly higher risk of secondary Central Nervous System (CNS) relapse. This is often due to the biological behavior of the tumor or the presence of "sanctuary sites" where systemic chemotherapy penetration is poor. [1] **Explanation of the Correct Option:** * **A. Ovary:** While DLBCL can involve the ovaries, it is **not** classically associated with an increased risk of CNS dissemination. In contrast to the male gonads, ovarian involvement does not mandate routine CNS prophylaxis in the same high-risk category as the other options listed. **Explanation of Incorrect Options:** * **B. Testis:** The testis is a classic "sanctuary site" due to the blood-testis barrier. Primary or secondary testicular DLBCL has a very high propensity (up to 15-30%) for CNS relapse. [1] * **C & D. Kidney and Adrenal Gland:** Involvement of the retroperitoneal organs, specifically the kidneys and adrenal glands, is a well-recognized independent risk factor for CNS involvement. [3] The **CNS-IPI (International Prognostic Index)** specifically includes "kidney or adrenal involvement" as a high-risk criterion. **High-Yield Clinical Pearls for NEET-PG:** * **CNS-IPI Score:** Used to predict CNS relapse. It includes the 5 standard IPI factors (Age >60, LDH >normal, Performance Status ≥2, Stage III/IV, >1 Extranodal site) **PLUS** kidney/adrenal involvement. [3] * **High-Risk Sites:** The "Rule of T's and R's" for CNS risk: **T**estis, **R**etroperitoneum (Kidney/Adrenal), and sometimes **B**one Marrow or **B**reast. * **Prophylaxis:** Patients with involvement of the testis, kidney, or adrenal glands often require CNS-directed therapy (e.g., Intrathecal Methotrexate or high-dose systemic Methotrexate) alongside R-CHOP. [2]

Question 1

A 65-year-old woman is admitted to the hospital after a stroke resulting in left hemiparesis. She has no trouble swallowing and is on a full diet. One week later, on routine biochemistry, her sodium is 128 mEq/L and osmolality is 270 mOsm/kg. She has no symptoms and is euvolemic on clinical examination. Urine sodium is 40 mEq/L and urine osmolality is 450 mOsm/kg. For the above patient with hyponatremia, select the most likely diagnosis?

Accepted Answer

SIADH

Answer

Congestive heart failure (CHF)

Answer

Extrarenal sodium and fluid losses

Answer

Polydipsia

Question 2

Which of the following is NOT recommended for the management of Tumour lysis syndrome?

Accepted Answer

Urinary alkalinisation using soda bicarbonate

Answer

Allopurinol

Answer

Febuxostat

Answer

Rasburicase

Question 3

What is the diagnostic tumor marker for medullary thyroid cancer?

Accepted Answer

Calcitonin

Answer

BRAF

Answer

VMA

Answer

Melatonin

Question 4

Which of the following conditions can present with recurrent episodes of upper limb thrombosis?

Accepted Answer

All of the above

Answer

Prostatic carcinoma

Answer

Pancreatic carcinoma

Answer

Osteosarcoma

Question 5

What is the commonest carcinoma in elderly males?

Accepted Answer

Prostate

Answer

Stomach

Answer

Lung

Answer

Esophagus

Question 6

Which of the following is NOT a paraneoplastic manifestation of bronchogenic carcinoma?

Accepted Answer

Acanthosis nigricans

Answer

Dermatomyositis

Answer

Cerebellar degeneration

Answer

Hyperkeratosis of palm and soles

Question 7

Migratory thrombophlebitis is associated with all of the following malignancies, except:

Accepted Answer

Testis

Answer

Lung

Answer

Colon

Answer

Pancreas

Question 8

Which of the following is the only form of Hodgkin disease (HD) more common in women?

Accepted Answer

Nodular-sclerosing Hodgkin disease

Answer

Lymphocyte-predominant Hodgkin disease

Answer

Mixed-cellularity Hodgkin disease

Answer

Lymphocyte-depleted Hodgkin disease, reticular type

Question 9

In tumor lysis syndrome, all of the following are seen except?

Accepted Answer

Hypercalcemia

Answer

Hypernatremia

Answer

Hyperkalemia

Answer

Hyperphosphatemia

Question 10

Central nervous system involvement in diffuse large B-cell lymphoma (DLBCL) is not typically seen with involvement of which of the following organs?

Accepted Answer

Ovary

Answer

Testis

Answer

Kidney

Answer

Adrenal gland

Oncology — MCQs

Oncology — MCQs

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