Oncology Practice Questions

Q: Age for regular mammography screening in average-risk women is

40. ***40*** - Current guidelines from organizations like the **American Cancer Society (ACS)** recommend that women at **average risk** begin regular annual mammography screening at **age 40**. - While other organizations have slightly different recommendations, **age 40** is a commonly cited starting point to maximize benefits for average-risk women. *55* - **Age 55** is typically when some guidelines suggest transitioning to **biennial** (every other year) mammography screening, rather than initiating it. - Delaying initial screening until 55 would miss potential early detection opportunities for many women. *25* - **Age 25** is generally considered too young for routine mammography screening in **average-risk women**, as breast tissue is denser and cancer incidence is very low. - Screening this early is reserved for high-risk individuals with specific genetic mutations or strong family histories. *35* - While **age 35** is closer to the recommended starting age, it is generally earlier than the standard guidelines for **average-risk women**. - Some high-risk individuals might begin screening around this age, but it's not the universal recommendation for the general population.

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

Esophageal cancer is more lethal than colorectal cancer.. Esophageal cancer is more lethal than colorectal cancer. - Esophageal cancer generally has a poorer prognosis and a lower 5-year survival rate compared to colorectal cancer, making it more lethal. - This is often due to its aggressive nature and tendency to be diagnosed at advanced stages. Small lesions generally have a better prognosis. - While true for some cancers, this statement is misleading in the context of esophageal cancer because even small esophageal lesions can be highly aggressive and already involve deeper layers or lymph nodes. - Early detection of seemingly "small" lesions does improve outcomes, but the overall prognosis remains challenging due to the disease's inherent aggressiveness, even at early stages. Asymptomatic benign esophageal lesions are usually monitored. - The question is about esophageal cancer, not benign lesions. Asymptomatic benign lesions are typically managed based on their specific type and risk of progression, but this statement does not address esophageal cancer. [1] - This option introduces a different diagnostic and management consideration, shifting focus from the malignancy. Squamous cell carcinoma is declining globally and is now less common than adenocarcinoma worldwide. - While the incidence of adenocarcinoma has been rising in Western countries, squamous cell carcinoma (SCC) still accounts for the majority of esophageal cancers worldwide, especially in undeveloped nations. - The global shift where adenocarcinoma supersedes SCC is not universally true, especially when considering the global burden of the disease. [2]

Q: What is the most common cause of brain metastasis?

Carcinoma lung. ***Carcinoma lung*** - Lung cancer is the most common source of **brain metastases**, accounting for a significant proportion of cases [1]. - Typically spreads via the **hematogenous route**, leading to multiple lesions in the brain [1]. *Prostate cancer* - While prostate cancer can metastasize to the brain, it is less common than lung cancer. - More frequently it spreads to **bone**, making it a relatively rare cause of brain metastases. *HCC* - Hepatocellular carcinoma (HCC) has a tendency to metastasize to the **lungs** and **bone**, but brain metastases are rare. - It typically performs worse in terms of brain involvement compared to lung carcinoma. *Seminoma* - Seminomas primarily spread to regional **lymph nodes** and can metastasize to other organs, but brain involvement is quite rare. - Common sites of metastasis include the **lungs** and **liver**, not the brain.

Q: Which type of tumor is most amenable to chemotherapy?

Choriocarcinoma. ***Choriocarcinoma*** - **Choriocarcinoma** is highly sensitive to chemotherapy, often achieving **cure rates greater than 90%** even in metastatic settings, especially when treated with combination regimens such as EMA-CO. - Its rapid growth rate and high mitotic index make it particularly susceptible to **cytotoxic agents** that target rapidly dividing cells. *Embryonal rhabdomyosarcoma* - While treatable with chemotherapy, **rhabdomyosarcoma**, especially the embryonal subtype, typically requires a combination of **surgery, chemotherapy, and radiation**, and its response to chemotherapy alone is not as uniformly curative as choriocarcinoma. - The efficacy of chemotherapy is often dependent on the tumor's stage, location, and the completeness of surgical resection. *Hepatocellular carcinoma* - **Hepatocellular carcinoma (HCC)** is notoriously resistant to traditional systemic chemotherapy, with limited response rates and often requiring targeted therapies like sorafenib or lenvatinib. - Its management is primarily based on **surgical resection, liver transplantation**, or locoregional therapies such as **transarterial chemoembolization (TACE)** or radiofrequency ablation (RFA). *Thyroid carcinoma* - Most types of thyroid carcinoma, especially **differentiated thyroid cancers (papillary and follicular)**, are managed primarily with **surgery and radioactive iodine (RAI)** therapy, showing limited responsiveness to conventional chemotherapy. - Anaplastic thyroid carcinoma, while aggressive, also typically responds poorly to standard chemotherapy regimens, often requiring multimodal treatment.

Q: Most common symptom of lung carcinoma is

Cough. ***Cough*** - **Chronic cough** is the most frequently reported symptom in patients with lung carcinoma, often progressing in severity or character. [1] - It results from irritation of the **bronchial tree** by the tumor or associated inflammation. [1] *Dyspnoea* - While common, **shortness of breath** typically occurs when the tumor significantly obstructs airways, causes pleural effusion, or spreads to lymphatics. [1] - It usually presents later in the disease progression compared to cough. *Weight loss* - **Unexplained weight loss** is a common systemic symptom of malignancy, including lung cancer, but is often a sign of advanced disease. [1] - This symptom is non-specific and can be associated with many chronic illnesses. *Chest pain* - **Chest pain** in lung carcinoma often indicates involvement of the pleura, chest wall, or mediastinum by the tumor. - It is a common symptom but is less frequent than cough as the initial presenting complaint.

Q: Which of the following is typically not elevated in multiple myeloma?

Increase in alkaline phosphatase. ***Increase in alkaline phosphatase*** - While multiple myeloma leads to **bone destruction**, it primarily involves **osteoclast activation** and bone resorption, rather than osteoblast activity. - Therefore, markers of osteoblast activity, like **alkaline phosphatase**, are typically not elevated and may even be normal or low, unless there's an associated complication like fracture healing or hepatobiliary disease. *Lytic lesions in bone* - Multiple myeloma cells produce factors that enhance **osteoclast activity** and inhibit osteoblast function, leading to the characteristic **punch-out lytic lesions** visible on imaging [1]. - These lesions are a hallmark of the disease and are caused by the destruction of bone tissue, not new bone formation [1]. *Hypercalcemia* - The extensive **bone destruction** caused by lytic lesions leads to the release of calcium into the bloodstream, resulting in **hypercalcemia**. - This is a common and serious complication of multiple myeloma, contributing to symptoms like fatigue, confusion, and kidney problems. *Hypercalciuria* - The increased serum calcium from **bone breakdown** often leads to an excessive excretion of calcium in the urine, known as **hypercalciuria**. - This can contribute to kidney stone formation and further worsen kidney function in patients with multiple myeloma.

Q: A 65-year-old white male in previously good health starts to notice blood in his urine, develops pain with urination, and experiences a weakened urinary stream. He seeks medical attention from his family doctor due to these symptoms. Laboratory findings reveal anemia, and urinalysis is positive for red cells, white cells, and gram-negative rods. A cystogram shows a tumor, and a transurethral biopsy confirms a malignant bladder tumor. Which of the following is true about this patient's tumor?

Is likely to recur after treatment. ***Is likely to recur after treatment*** - Bladder cancers, especially **urothelial carcinomas**, have a high rate of recurrence, often requiring ongoing surveillance after initial treatment [1]. - Recurrence can occur in the bladder or other parts of the **urothelial tract**, even after successful primary tumor resection [1]. *It is unlikely to be an adenocarcinoma* - This statement is actually **false** because the most common type of bladder cancer is **urothelial carcinoma** (transitional cell carcinoma), making adenocarcinoma less common but still a possibility [1]. - The symptoms described (hematuria, dysuria, weakened stream) are general for bladder cancer and do not specifically rule out adenocarcinoma. *Typically does not present with a palpable abdominal mass* - While bladder tumors *can* present with a palpable mass in advanced stages, the initial symptoms of **hematuria** and **dysuria** are more common. - A palpable mass in the abdomen would indicate a significantly large or invasive tumor, which is not suggested as the primary presentation here. *Does not typically cause an elevated serum acid phosphatase* - **Elevated serum acid phosphatase** is commonly associated with advanced **prostate cancer**, especially with bone metastases. - Bladder cancer does not typically cause an elevation in this specific marker.

Q: In which of the following conditions is emergency radiotherapy indicated?

Superior vena cava syndrome. ### Superior vena cava syndrome - **Emergency radiotherapy** is indicated in SVC syndrome, especially if caused by radiation-sensitive tumors, to rapidly reduce tumor burden and relieve **venous compression**. [3] - Rapid intervention is crucial due to the potential for **life-threatening compromise** of venous return from the head and upper extremities. [2] *Neoplastic cardiac tamponade* - The primary emergency treatment for **cardiac tamponade** is **pericardiocentesis** to urgently relieve fluid pressure around the heart. - Radiotherapy is not the immediate intervention for acute tamponade, though it may be used later to manage the underlying malignancy. *Acute epidural spinal cord compression* - **Acute spinal cord compression** requires immediate intervention, often with **high-dose corticosteroids** to reduce edema and emergent surgical decompression to prevent permanent neurological damage. [1] - Radiotherapy may be used as an adjunct or for less acute cases, but surgery is usually prioritized for acute compression. [1] *Tumor lysis syndrome* - **Tumor lysis syndrome** is a metabolic emergency managed with aggressive **hydration**, **allopurinol**, or **rasburicase** to prevent renal failure and electrolyte abnormalities. - Radiotherapy is not a treatment for the acute metabolic derangements of tumor lysis syndrome.

Q: PSA greater than 20 ng/mL is commonly seen in:

Prostate cancer. ***Prostate cancer*** - A **prostate-specific antigen (PSA)** level greater than **20 ng/mL** is highly suggestive of **prostate cancer**, especially advanced disease, and prompts further evaluation. - While other conditions can elevate PSA, such levels significantly increase the **positive predictive value** for malignancy. *BPH* - **Benign prostatic hyperplasia (BPH)** can elevate PSA, but levels typically remain below **10 ng/mL**, rarely exceeding **20 ng/mL**. - The PSA elevation in BPH is proportional to the **gland size**, which usually doesn't lead to such high values. *Prostatitis* - **Prostatitis** (inflammation of the prostate) can cause a transient, significant increase in PSA, sometimes above **20 ng/mL**. - However, the elevation typically **normalizes** after treatment of the infection or inflammation, unlike in prostate cancer. *Bladder cancer* - **Bladder cancer** does not typically cause an elevation in PSA unless there is concurrent **prostatic involvement** or other prostate pathology. - PSA is a **prostate-specific marker**, so its elevation is not directly indicative of bladder malignancy.

Question 1

Age for regular mammography screening in average-risk women is

Accepted Answer

40

Answer

55

Answer

25

Answer

35

Question 2

Which of the following statements about esophageal cancer is true?

Accepted Answer

Esophageal cancer is more lethal than colorectal cancer.

Answer

Small lesions generally have a better prognosis.

Answer

Asymptomatic benign esophageal lesions are usually monitored.

Answer

Squamous cell carcinoma is declining globally and is now less common than adenocarcinoma worldwide.

Question 3

What is the most common cause of brain metastasis?

Accepted Answer

Carcinoma lung

Answer

Prostate cancer

Answer

HCC

Answer

Seminoma

Question 4

Which type of tumor is most amenable to chemotherapy?

Accepted Answer

Choriocarcinoma

Answer

Embryonal rhabdomyosarcoma

Answer

Hepatocellular carcinoma

Answer

Thyroid carcinoma

Question 5

Most common symptom of lung carcinoma is

Accepted Answer

Cough

Answer

Dyspnoea

Answer

Weight loss

Answer

Chest pain

Question 6

Which of the following is typically not elevated in multiple myeloma?

Accepted Answer

Increase in alkaline phosphatase

Answer

Hypercalcemia

Answer

Hypercalciuria

Answer

Lytic lesions in bone

Question 7

A 65-year-old white male in previously good health starts to notice blood in his urine, develops pain with urination, and experiences a weakened urinary stream. He seeks medical attention from his family doctor due to these symptoms. Laboratory findings reveal anemia, and urinalysis is positive for red cells, white cells, and gram-negative rods. A cystogram shows a tumor, and a transurethral biopsy confirms a malignant bladder tumor. Which of the following is true about this patient's tumor?

Accepted Answer

Is likely to recur after treatment

Answer

It is unlikely to be an adenocarcinoma

Answer

Typically does not present with a palpable abdominal mass

Answer

Does not typically cause an elevated serum acid phosphatase

Question 8

In which of the following conditions is emergency radiotherapy indicated?

Accepted Answer

Superior vena cava syndrome

Answer

Neoplastic cardiac tamponade

Answer

Acute epidural spinal cord compression

Answer

Tumor lysis syndrome

Question 9

What is the best method for screening prostate cancer?

Accepted Answer

PSA test

Answer

DRE and PSA together

Answer

PET scan

Answer

DRE

Question 10

PSA greater than 20 ng/mL is commonly seen in:

Accepted Answer

Prostate cancer

Answer

BPH

Answer

Prostatitis

Answer

Bladder cancer

Oncology — MCQs

Oncology — MCQs

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