Oncology Practice Questions

Q: A 60-year-old woman with a history of breast cancer presents with new-onset back pain and difficulty walking. An MRI shows spinal cord compression. What is the next best step?

Corticosteroids. ***Corticosteroids*** - **Corticosteroids** are the immediate next step in managing **spinal cord compression** [1] to reduce **edema** around the cord and alleviate pressure, preventing further neurological damage. - This provides temporary relief and time for definitive treatment planning. *Chemotherapy* - **Chemotherapy** is a systemic treatment for cancer and is typically not the initial emergent therapy for acute **spinal cord compression**, though it may be part of the long-term management after stabilization [2]. - Its effects are often delayed, and it doesn't provide the rapid anti-inflammatory action needed to protect the spinal cord. *Radiation therapy* - **Radiation therapy** is a crucial definitive treatment for malignant spinal cord compression but usually follows initial stabilization with corticosteroids and a thorough evaluation [1]. - While effective, it takes time to administer and has a slower onset of action in reducing tumor bulk and edema compared to corticosteroids [2]. *Surgery* - **Surgery** (decompression) is an option for certain cases of spinal cord compression, particularly when there is bony compression, neurological deficit progression despite steroids, or an unknown primary tumor [1]. - However, in many cases, especially with an immediate need to reduce swelling and improve symptoms, **corticosteroids** are administered first to stabilize the patient before considering surgical intervention [1].

Q: A 40-year-old man with a history of chronic alcohol use presents with epigastric pain and weight loss. Imaging reveals a pancreatic mass. What is the most likely diagnosis?

Pancreatic adenocarcinoma. ***Pancreatic adenocarcinoma*** - The combination of **epigastric pain**, **weight loss**, and a **pancreatic mass** in a 40-year-old, especially with a history of chronic alcohol use (which is a risk factor), is highly suspicious for pancreatic adenocarcinoma. - This cancer often presents late with non-specific symptoms, leading to advanced disease at diagnosis. *Pancreatitis* - While chronic alcohol use is a major cause of **pancreatitis** [1], the presence of a distinct **pancreatic mass** along with significant **weight loss** makes malignancy more likely than simple inflammation, especially in this age group. - Pancreatitis typically causes acute, severe pain, and while chronic pancreatitis can lead to pain and weight loss, a mass points towards a neoplastic process [1]. *Gastric ulcer* - A **gastric ulcer** would typically present with epigastric pain, but it is less likely to cause a **pancreatic mass** or significant, unexplained **weight loss** specific to pancreatic involvement. - The imaging specificity for a pancreatic mass rules out a primary gastric ulcer as the sole diagnosis. *Liver metastasis* - **Liver metastasis** implies a primary cancer elsewhere that has spread to the liver, not originating as a primary pancreatic mass. - While pancreatic cancer can metastasize to the liver, the initial finding of a "pancreatic mass" points to the pancreas as the primary site of concern.

Q: A 50-year-old woman with a history of breast cancer presents with new-onset seizures. An MRI shows multiple ring-enhancing lesions. What is the most likely cause?

Metastatic brain disease. ### Metastatic brain disease - A patient with a history of **breast cancer** who develops new-onset seizures and **multiple ring-enhancing lesions** on MRI is highly suspicious for **brain metastases** [1]. - Breast cancer is one of the most common primary tumors that metastasize to the brain, and ring-enhancing lesions are a classic imaging finding for metastases [1]. ### Primary brain tumor - While primary brain tumors can cause seizures and ring-enhancing lesions, the presence of a **known primary cancer** strongly biases towards metastatic disease. - Primary brain tumors are typically solitary rather than multiple, though exceptions exist. ### Cerebral abscess - Cerebral abscesses also present with ring-enhancing lesions and can cause seizures [2], but typically there are signs of infection (e.g., fever, elevated inflammatory markers) or a **source of infection**, which are not mentioned here. - The history of breast cancer points away from infection as the primary cause. ### Multiple sclerosis - Multiple sclerosis lesions are typically **periventricular** or in the **corpus callosum** and often show incomplete or "open-ring" enhancement, not classical ring-enhancement. - MS is also not typically associated with a history of breast cancer and new-onset seizures in this manner.

Q: A 50-year-old man with a history of alcohol use presents with a painless, ulcerated lesion on the floor of the mouth. What is the most likely diagnosis?

Oral squamous cell carcinoma. ***Oral squamous cell carcinoma*** - A **painless, ulcerated lesion** in the **floor of the mouth** in a patient with a history of **alcohol use** is highly suspicious for oral squamous cell carcinoma. Alcohol use is a significant risk factor. - The floor of the mouth is a common site for oral squamous cell carcinoma, and the **painless nature** of the lesion may lead to delayed diagnosis. *Oral candidiasis* - Typically presents as **creamy white, wipeable plaques** on the oral mucosa, often associated with immunocompromised states or antibiotic use. - While it can be ulcerated in severe cases, the primary presentation is not usually a solitary, persistent ulcer, and it is often **painful**. *Aphthous ulcer* - These are typically **painful, shallow ulcers** with a characteristic red halo, and they tend to recur [1]. - They are usually small, self-limiting, and not associated with specific risk factors like extensive alcohol use in the same way as malignancy [1]. *Leukoplakia* - **Leukoplakia** appears as a **white patch or plaque** that cannot be rubbed off and cannot be characterized clinically as any other definable lesion. - While leukoplakia is a **premalignant lesion** that can transform into squamous cell carcinoma, the description here is of an **ulcerated lesion**, suggesting a more advanced stage of disease or a different entity.

Q: A 50-year-old male presents with painless hematuria. A CT scan reveals a large mass in the bladder. What is the most likely diagnosis?

Bladder carcinoma. ***Bladder carcinoma*** - **Painless hematuria** is the classic presenting symptom of bladder cancer, especially in older adults [1]. - The presence of a **large mass** on CT scan in the bladder strongly suggests a malignant tumor [1]. *Bladder stone* - While bladder stones can cause hematuria, it is typically accompanied by **pain**, especially during urination or with movement. - A stone would appear as a calcification on CT, not typically described as a "large mass" in the tissue itself. *Bladder polyp* - Bladder polyps are usually **benign growths** and are much less likely to present as a "large mass" with hematuria in a 50-year-old male [1]. - Though some polyps may bleed, the term "large mass" points more towards a neoplastic process in this age group and presentation [1]. *Bladder infection* - Bladder infections (cystitis) typically cause **painful urination**, urgency, frequency, and sometimes hematuria. - However, a large mass would not be seen with a simple infection; instead, the bladder wall might be thickened.

Q: Which of the following tumors most commonly presents with upper gastrointestinal bleeding?

Primary gastric cancer. ***Primary gastric cancer*** - Gastric cancers frequently present with **upper gastrointestinal bleeding** due to ulceration or erosion of the tumor into the gastric mucosa [1]. - This is a common and often early symptom that leads to diagnosis, manifesting as **hematemesis** or **melena** [1]. *Esophageal carcinoma* - While esophageal carcinoma can cause bleeding, it is more commonly associated with **dysphagia** and **weight loss** as primary presenting symptoms [1]. - Bleeding from esophageal tumors is generally less frequent and often less severe than from gastric tumors, unless significant ulceration or invasion of large vessels occurs. *Metastases to stomach* - Metastatic tumors to the stomach are relatively rare, and when they occur, they are **often asymptomatic** or present with non-specific symptoms like pain or early satiety. - Clinically significant **upper gastrointestinal bleeding** as the primary presentation is uncommon compared to primary gastric malignancies. *Hepatic adenocarcinoma* - Hepatic adenocarcinoma originates in the liver and typically presents with symptoms related to **liver dysfunction**, such as jaundice, ascites, or right upper quadrant pain [1]. - **Upper gastrointestinal bleeding** is not a direct symptom of hepatic adenocarcinoma, though variceal bleeding can occur secondary to portal hypertension in advanced liver disease [2].

Q: Which of the following statements about esophageal carcinoma is true?

More lethal than the colorectal cancers. ### More lethal than the colorectal cancers - Esophageal carcinoma has a **higher mortality rate** due to late presentation and aggressive behavior compared to colorectal cancers. - The overall five-year survival rate for esophageal cancer is significantly **lower** than that of colorectal cancer, emphasizing its lethality [1]. ### Asymptomatic benign lesions should be excised immediately - Not all asymptomatic lesions are malignant; many can be monitored rather than excised, especially if they're **benign**. - **Immediate excision** is not standard practice unless there's a clear risk of malignancy or progression. ### Smaller size esophageal lesions have better survival - While size can influence prognosis, stating that smaller lesions universally equate to **better survival** is an oversimplification. - Other factors like histological type and stage at diagnosis also significantly impact survival, regardless of lesion size [1]. ### These show an increasing trend towards the number of squamous cell carcinomas - Although there was a period of high prevalence of squamous cell carcinoma, the trend is shifting towards **adenocarcinoma**, especially in Western countries. - The overall incidence of esophageal cancers is influenced by lifestyle factors, leading to an increase in adenocarcinomas more than squamous types. **References:** [1] Brian Walker. Davidson's Principles and Practice of Medicine. 22E ed. Treat any precipitating cause, pp. 891-892.

Q: Previous radiation therapy for which disease particularly increases the risk of breast carcinoma development?

Hodgkin's lymphoma. No relevant citations met the criteria for inclusion based on the provided references.

Q: Which malignancy is most commonly associated with hypercalcemia?

Breast cancer. ***Breast cancer*** - While other malignancies can cause hypercalcemia, **breast cancer** is the most common solid tumor associated with **hypercalcemia of malignancy (HCM)** [1], [3]. - Hypercalcemia in breast cancer is commonly due to **bone metastases** causing osteolysis or the tumor secreting **parathyroid hormone-related protein (PTHrP)** [1]. *Small cell lung cancer* - **Small cell lung cancer** is more often associated with **syndrome of inappropriate antidiuretic hormone (SIADH)** leading to hyponatremia [1], [2]. - Although it can cause **HCM**, it is less frequent compared to breast cancer [2]. *Multiple myeloma* - **Multiple myeloma** is a hematologic malignancy that very commonly causes hypercalcemia due to **osteolytic bone lesions** and local cytokine release (e.g., IL-6) [2], [3]. - However, among all malignancies (both solid and hematologic), **breast cancer** remains the most prevalent cause of HCM overall. *Prostate cancer* - **Prostate cancer** often metastasizes to bone, leading to predominantly **osteoblastic** (bone-forming) lesions, which are less likely to cause hypercalcemia. - While osteolytic metastases can occur and lead to hypercalcemia, it's not the most common malignancy to do so.

Q: Most common cancer to occur in organ transplant patients?

Squamous cell carcinoma. ***Squamous cell carcinoma*** - Organ transplant patients are on lifelong **immunosuppressive therapy**, which significantly increases the risk of **skin cancers**, especially squamous cell carcinoma (SCC) [1]. - The risk of SCC in transplant recipients is 65-250 times higher than in the general population, making it the most common malignancy in this group [1]. *Melanoma* - While the risk of **melanoma** is also increased in transplant patients due to immunosuppression, it is **less common** than squamous cell carcinoma [1]. - The increased risk for melanoma in transplant recipients is roughly 2-5 times higher than the general population, which is considerably lower than the increase for SCC. *Lung cancer* - The risk of **lung cancer** is elevated in transplant patients, particularly in those with a history of smoking, but it is **not the most common cancer** overall. - The incidence is influenced by the patient's age, smoking history, and the type of immunosuppression, but skin cancers consistently rank higher in frequency [2]. *Colorectal cancer* - There is a **modest increase** in the risk of **colorectal cancer** among organ transplant recipients, but it is not the most prevalent malignancy [2]. - The elevation in risk is generally much lower than for skin cancers and certain lymphomas linked to post-transplant immunosuppression [2].

Question 1

A 60-year-old woman with a history of breast cancer presents with new-onset back pain and difficulty walking. An MRI shows spinal cord compression. What is the next best step?

Accepted Answer

Corticosteroids

Answer

Chemotherapy

Answer

Radiation therapy

Answer

Surgery

Question 2

A 40-year-old man with a history of chronic alcohol use presents with epigastric pain and weight loss. Imaging reveals a pancreatic mass. What is the most likely diagnosis?

Accepted Answer

Pancreatic adenocarcinoma

Answer

Pancreatitis

Answer

Gastric ulcer

Answer

Liver metastasis

Question 3

A 50-year-old woman with a history of breast cancer presents with new-onset seizures. An MRI shows multiple ring-enhancing lesions. What is the most likely cause?

Accepted Answer

Metastatic brain disease

Answer

Primary brain tumor

Answer

Cerebral abscess

Answer

Multiple sclerosis

Question 4

A 50-year-old man with a history of alcohol use presents with a painless, ulcerated lesion on the floor of the mouth. What is the most likely diagnosis?

Accepted Answer

Oral squamous cell carcinoma

Answer

Oral candidiasis

Answer

Aphthous ulcer

Answer

Leukoplakia

Question 5

A 50-year-old male presents with painless hematuria. A CT scan reveals a large mass in the bladder. What is the most likely diagnosis?

Accepted Answer

Bladder carcinoma

Answer

Bladder stone

Answer

Bladder polyp

Answer

Bladder infection

Question 6

Which of the following tumors most commonly presents with upper gastrointestinal bleeding?

Accepted Answer

Primary gastric cancer

Answer

Esophageal carcinoma

Answer

Metastases to stomach

Answer

Hepatic adenocarcinoma

Question 7

Which of the following statements about esophageal carcinoma is true?

Accepted Answer

More lethal than the colorectal cancers

Answer

Most esophageal carcinomas are diagnosed at early stages

Answer

Tumor size is the only significant prognostic factor in esophageal carcinoma

Answer

These show a decreasing trend in the number of adenocarcinomas globally

Question 8

Previous radiation therapy for which disease particularly increases the risk of breast carcinoma development?

Accepted Answer

Hodgkin's lymphoma

Answer

Mantle cell lymphoma

Answer

Nasopharyngeal carcinoma

Answer

Lung carcinoma

Question 9

Which malignancy is most commonly associated with hypercalcemia?

Accepted Answer

Breast cancer

Answer

Prostate cancer

Answer

Small cell lung cancer

Answer

Multiple myeloma

Question 10

Most common cancer to occur in organ transplant patients?

Accepted Answer

Squamous cell carcinoma

Answer

Melanoma

Answer

Lung cancer

Answer

Colorectal cancer

Oncology — MCQs

Oncology — MCQs

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