Oncology — MCQs
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Which of the following conditions is associated with normal serum alpha-fetoprotein levels?
Which congenital syndromes are associated with lymphoproliferative malignancy?
Diagnosis of carcinoid tumors is done by?
A 55-year-old man, a chronic smoker, presents to the emergency department with a two-day history of polyuria, polydipsia, nausea, and altered sensorium. He was diagnosed with squamous cell carcinoma of the lung two months prior. On examination, he is lethargic and confused. An ECG is normal except for a narrowed QT interval. Which one of the following is the most likely metabolic abnormality?
Which of the following is NOT considered a premalignant condition?
Which of the following is a poor prognostic factor for childhood ALL?
A 16-year-old boy presents with multiple episodes of abdominal pain and a history of passing blood in his stools. On examination, he has darkly pigmented spots on his lips and oral mucosa. Endoscopy reveals multiple hamartomatous polyps in the small intestine. What is the most likely diagnosis?
A 60-year-old female presents with weakness, back pain and repeated infections. Work up shows M spike on serum electrophoresis. Prognosis is determined by which of the following factors?
A patient has developed a cough and weight loss for the last 3 months. Biopsy of lung mass shows expression of chromogranin and synaptophysin. Which paraneoplastic syndrome will most likely occur in this patient?
A patient with a history of breast cancer underwent Cobalt-60 radiotherapy. She now presents with respiratory distress, and imaging shows haziness in the left lung. What is the most likely diagnosis?
Oncology Indian Medical PG Practice Questions and MCQs
Question 191: Which of the following conditions is associated with normal serum alpha-fetoprotein levels?
- A. Ovarian dysgerminoma (Correct Answer)
- B. Hepatoblastoma
- C. Embryonal carcinoma
- D. Yolk sac tumors
Explanation: **Explanation:** The correct answer is **Ovarian dysgerminoma**. Alpha-fetoprotein (AFP) is a glycoprotein normally produced by the fetal yolk sac and liver [1]. In oncology, it serves as a highly specific tumor marker for germ cell tumors (GCTs) containing yolk sac elements and for hepatocellular carcinomas. **1. Why Ovarian Dysgerminoma is correct:** Dysgerminoma is the female counterpart of the testicular seminoma. These tumors are characterized by primitive germ cells that have not differentiated into extra-embryonic structures. Consequently, they **do not produce AFP**. The characteristic tumor marker for dysgerminoma is **Lactate Dehydrogenase (LDH)**; they may also show mild elevations in hCG, but AFP remains normal. **2. Why the other options are incorrect:** * **Hepatoblastoma:** This is the most common primary liver tumor in children. It is almost always associated with extremely high levels of AFP, which is used for both diagnosis and monitoring treatment response. * **Yolk Sac Tumors (Endodermal Sinus Tumors):** These tumors histologically mimic the fetal yolk sac. Since the yolk sac is the primary physiological source of AFP, these tumors are the **most classic producers of AFP** [1]. * **Embryonal Carcinoma:** These are aggressive GCTs consisting of undifferentiated cells. They often contain focal areas of yolk sac or trophoblastic differentiation, leading to elevated levels of both **AFP and hCG** [1]. **Clinical Pearls for NEET-PG:** * **Pure Seminoma/Dysgerminoma:** Never produces AFP. If AFP is elevated in a suspected seminoma, it indicates a mixed germ cell tumor (likely a yolk sac component). * **Schiller-Duval Bodies:** Pathognomonic histological finding in Yolk Sac Tumors. * **AFP Elevations:** Also seen in non-neoplastic conditions like cirrhosis, viral hepatitis, and neural tube defects (in maternal serum).
Question 192: Which congenital syndromes are associated with lymphoproliferative malignancy?
- A. Bloom syndrome
- B. Fanconi's anemia
- C. Turner syndrome
- D. Chediak Higashi syndrome (Correct Answer)
Explanation: Explanation: The correct answer is Chediak-Higashi Syndrome (CHS). 1. Why Chediak-Higashi Syndrome is correct: CHS is an autosomal recessive disorder caused by a mutation in the LYST gene, leading to defective vesicle trafficking and the formation of giant lysosomal granules. The primary immunological defect involves impaired Natural Killer (NK) cell function and cytotoxic T-cell activity. A hallmark of CHS is the "Accelerated Phase," a hemophagocytic lymphohistiocytosis (HLH)-like syndrome characterized by a non-neoplastic but aggressive lymphoproliferative infiltration of organs (liver, spleen, lymph nodes), which often progresses to or mimics high-grade lymphoma. 2. Why the other options are incorrect: * Bloom Syndrome: While associated with a high risk of various cancers due to DNA helicase deficiency (sister chromatid exchanges), it is more classically linked to leukemias (AML/ALL) and solid tumors rather than primary lymphoproliferative syndromes. * Fanconi’s Anemia: This is a DNA repair defect primarily associated with Acute Myeloid Leukemia (AML) and squamous cell carcinomas. It is not typically categorized under lymphoproliferative malignancies. * Turner Syndrome (45, XO): This chromosomal anomaly is associated with an increased risk of gonadoblastoma (if Y chromatin is present) and germ cell tumors, but not lymphoproliferative disorders. 3. High-Yield Clinical Pearls for NEET-PG: * Chediak-Higashi Triad: Partial oculocutaneous albinism, recurrent pyogenic infections (Staph/Strep), and peripheral neuropathy. * Peripheral Smear: Look for pathognomonic giant azurophilic granules in neutrophils and precursors. * Other Immunodeficiencies with Lymphoma risk: Wiskott-Aldrich Syndrome, Ataxia-Telangiectasia, and Common Variable Immunodeficiency (CVID) are also high-yield associations for lymphoproliferative malignancy.
Question 193: Diagnosis of carcinoid tumors is done by?
- A. 5-HIAA (Correct Answer)
- B. DHEA
- C. DHEA
- D. Metanephrines
Explanation: **Explanation:** **Carcinoid tumors** are neuroendocrine tumors that arise most commonly from the enterochromaffin cells of the gastrointestinal tract (especially the terminal ileum) and the bronchus [1]. These tumors have the unique ability to produce and secrete various vasoactive amines, most notably **serotonin (5-HT)**. 1. **Why 5-HIAA is the correct answer:** Serotonin is metabolized in the liver and lungs by the enzyme monoamine oxidase (MAO) into **5-hydroxyindoleacetic acid (5-HIAA)**, which is then excreted in the urine. A **24-hour urinary 5-HIAA** test is the gold standard initial screening test for diagnosing Carcinoid Syndrome. It has high specificity (approx. 90%) for identifying tumors that overproduce serotonin. 2. **Why the other options are incorrect:** * **DHEA (Dehydroepiandrosterone):** This is an androgenic steroid produced by the adrenal cortex. It is used as a marker for adrenal tumors or Congenital Adrenal Hyperplasia (CAH), not neuroendocrine carcinoid tumors. * **Metanephrines:** These are metabolites of catecholamines (epinephrine/norepinephrine). Urinary or plasma metanephrines are the diagnostic markers of choice for **Pheochromocytoma**, not carcinoid tumors. **High-Yield Clinical Pearls for NEET-PG:** * **The Rule of 1/3rds:** Carcinoid tumors follow this rule—1/3 are multiple, 1/3 are in the small bowel, 1/3 have metastases, and 1/3 are associated with a second malignancy. * **Carcinoid Syndrome:** Characterized by the triad of **flushing, diarrhea, and wheezing**. It typically occurs only after the tumor has metastasized to the **liver** [1], bypassing the first-pass metabolism. * **Dietary Caution:** Patients must avoid serotonin-rich foods (bananas, walnuts, pineapples, avocados) for 24–48 hours before the 5-HIAA test to prevent false positives. * **Localization:** Once biochemically confirmed, **Somatostatin receptor scintigraphy (OctreoScan)** or Ga-68 DOTATATE PET/CT is used for localization.
Question 194: A 55-year-old man, a chronic smoker, presents to the emergency department with a two-day history of polyuria, polydipsia, nausea, and altered sensorium. He was diagnosed with squamous cell carcinoma of the lung two months prior. On examination, he is lethargic and confused. An ECG is normal except for a narrowed QT interval. Which one of the following is the most likely metabolic abnormality?
- A. Hypernatremia
- B. Hypercalcemia (Correct Answer)
- C. Hypokalemia
- D. Hyponatremia
Explanation: ### Explanation **Correct Option: B. Hypercalcemia** This patient presents with a classic **Paraneoplastic Syndrome** associated with **Squamous Cell Carcinoma (SCC) of the lung**. The primary mechanism is the secretion of **Parathyroid Hormone-related Protein (PTHrP)**, which mimics PTH action by increasing bone resorption and renal calcium reabsorption [1]. * **Clinical Correlation:** The symptoms of "stones, moans, groans, and psychiatric overtones" are evident here: polyuria/polydipsia (nephrogenic diabetes insipidus), nausea (GI distress), and altered sensorium (CNS effects) [2]. * **ECG Finding:** A **shortened/narrowed QT interval** is a pathognomonic ECG finding for hypercalcemia. --- ### Why Other Options are Incorrect: * **A. Hypernatremia:** While polyuria can lead to dehydration, it is a secondary effect. The primary metabolic driver in a lung cancer patient with these specific CNS and ECG changes is hypercalcemia. * **C. Hypokalemia:** While it can cause weakness and ECG changes (U waves, flattened T waves), it typically causes a *prolonged* QU interval, not a shortened QT interval. * **D. Hyponatremia:** Commonly associated with **Small Cell Lung Cancer** (via SIADH), not Squamous Cell [1]. Hyponatremia typically presents with cerebral edema and seizures but does not cause a narrowed QT interval. --- ### NEET-PG High-Yield Pearls: 1. **Lung Cancer Associations:** * **S**quamous Cell = **S**PTHrP (**S**tonelike Hypercalcemia) [1]. * **S**mall Cell = **S**IADH / **S**H (ACTH) / **S**pinal cord (Lambert-Eaton) [1]. 2. **ECG in Electrolyte Imbalances:** * **Short QT:** Hypercalcemia. * **Long QT:** Hypocalcemia. * **Tall Peaked T waves:** Hyperkalemia. 3. **Treatment of Choice:** Immediate management of severe hypercalcemia involves aggressive **Normal Saline hydration**, followed by IV Bisphosphonates (Zoledronic acid) or Denosumab.
Question 195: Which of the following is NOT considered a premalignant condition?
- A. Retinitis pigmentosa (Correct Answer)
- B. Crohn's disease
- C. Ulcerative colitis
- D. Leukoplakia
Explanation: **Explanation:** The correct answer is **Retinitis pigmentosa (Option A)**. **1. Why Retinitis Pigmentosa is the correct answer:** Retinitis pigmentosa is a group of rare, **genetic disorders** involving a breakdown and loss of cells in the retina (photoreceptors). It is characterized by progressive vision loss, night blindness, and "bone-spicule" pigmentation. Crucially, it is a **degenerative condition**, not a neoplastic or pre-neoplastic one. It does not involve cellular dysplasia or carry an inherent risk of transforming into a malignancy. **2. Analysis of Incorrect Options (Premalignant Conditions):** * **Ulcerative Colitis (UC) & Crohn’s Disease (B & C):** Both are forms of Inflammatory Bowel Disease (IBD) [1]. Chronic inflammation leads to increased cellular turnover and oxidative stress, which can cause dysplastic changes. UC carries a higher risk of **Colorectal Carcinoma** than Crohn’s, but both require regular endoscopic surveillance. Inflammation invariably involves the rectum and spreads proximally; in long-standing cases, dysplasia characterized by heaping of cells within crypts can occur [1]. * **Leukoplakia (D):** This is a clinical term for a white patch or plaque on the oral mucosa that cannot be rubbed off. It is a classic premalignant lesion, with a significant percentage progressing to **Squamous Cell Carcinoma (SCC)**. **Clinical Pearls for NEET-PG:** * **High-Yield Premalignant Lesions:** Actinic keratosis (leads to SCC), Barrett’s esophagus (leads to Adenocarcinoma), and Xeroderma pigmentosum (leads to BCC, SCC, and Melanoma). * **IBD Risk:** The risk of malignancy in IBD increases with the **duration** of the disease (usually after 8–10 years) and the **extent** of colonic involvement (pancolitis > left-sided colitis). * **Retinitis Pigmentosa Association:** Often associated with **Usher Syndrome** (hearing loss) and **Laurence-Moon-Biedl Syndrome**.
Question 196: Which of the following is a poor prognostic factor for childhood ALL?
- A. Total Leukocyte count 4000-100,000
- B. Age < 2 years
- C. Testicular involvement (Correct Answer)
- D. Blasts in peripheral smear
Explanation: In childhood Acute Lymphoblastic Leukemia (ALL), prognostic factors are critical for risk stratification and determining treatment intensity. [1] ### **Explanation of the Correct Answer** **C. Testicular involvement:** This is considered a **high-risk feature** and a poor prognostic indicator. The testes (along with the CNS) are "pharmacological sanctuaries" where the blood-testis barrier prevents many standard chemotherapeutic agents from reaching therapeutic concentrations. Involvement at diagnosis suggests a higher systemic disease burden and an increased risk of sanctuary site relapse, necessitating intensified therapy or local radiation. ### **Analysis of Incorrect Options** * **A. Total Leukocyte Count (TLC):** A TLC **< 50,000/µL** is a favorable prognostic factor. While the option mentions up to 100,000, the standard "poor prognosis" threshold is typically defined as **> 50,000/µL**. [1] * **B. Age:** The best prognosis is seen in children aged **1 to 9 years**. Poor prognosis is associated with age **< 1 year (infants)** or **≥ 10 years**. Therefore, "Age < 2 years" is too broad and includes the favorable 1-2 year age bracket. * **D. Blasts in peripheral smear:** This is a diagnostic feature of leukemia, not a prognostic one. The presence of blasts is expected and does not inherently dictate the severity of the disease. [1] ### **High-Yield Clinical Pearls for NEET-PG** * **Most Important Prognostic Factor:** Response to initial therapy (Minimal Residual Disease - MRD) on day 7 or 14. * **Favorable Cytogenetics:** Hyperdiploidy (>50 chromosomes), t(12;21) [TEL-AML1]. * **Poor Cytogenetics:** Hypodiploidy (<44 chromosomes), t(9;22) [Philadelphia chromosome], t(4;11) [MLL rearrangement]. [1] * **Immunophenotype:** Early Pre-B cell has the best prognosis; Mature B-cell (Burkitt-type) and T-cell ALL have poorer outcomes.
Question 197: A 16-year-old boy presents with multiple episodes of abdominal pain and a history of passing blood in his stools. On examination, he has darkly pigmented spots on his lips and oral mucosa. Endoscopy reveals multiple hamartomatous polyps in the small intestine. What is the most likely diagnosis?
- A. Peutz-Jeghers Syndrome (Correct Answer)
- B. Cronkhite-Canada Syndrome
- C. Juvenile Polyposis Syndrome
- D. Familial Adenomatous Polyposis
Explanation: ***Peutz-Jeghers Syndrome*** - This is an autosomal dominant disorder characterized by the classic triad of **hamartomatous polyps** in the GI tract (especially the small intestine), **mucocutaneous hyperpigmentation** (dark spots on lips, oral mucosa), and an increased risk of cancer [1]. - The patient's symptoms of abdominal pain and GI bleeding are common complications due to the polyps, which can lead to **intussusception** or ulceration. *Familial Adenomatous Polyposis* - This syndrome is defined by the presence of hundreds to thousands of **adenomatous polyps** in the colon, not hamartomatous polyps as seen in this patient [1]. - It is not associated with the characteristic **perioral mucocutaneous pigmentation** which is a hallmark feature of Peutz-Jeghers syndrome. *Juvenile Polyposis Syndrome* - This condition also involves **hamartomatous polyps**, but they are most commonly found in the colon and rectum, and the syndrome lacks the distinct mucocutaneous pigmentation [1]. - While patients can present with GI bleeding, the combination of small intestine polyps and pigmented lip spots points away from this diagnosis. *Cronkhite-Canada Syndrome* - This is a rare, non-hereditary syndrome typically affecting older adults, characterized by GI polyposis along with ectodermal changes like **alopecia** (hair loss) and **onychodystrophy** (nail changes). - Patients often present with severe diarrhea and **protein-losing enteropathy**, which are not features described in this case.
Question 198: A 60-year-old female presents with weakness, back pain and repeated infections. Work up shows M spike on serum electrophoresis. Prognosis is determined by which of the following factors?
- A. Albumin and LDH
- B. IgM and albumin
- C. IgG and albumin
- D. Albumin and $\beta_{2}$-microglobulin (Correct Answer)
Explanation: ***Albumin and $\beta_{2}$-microglobulin*** - These two serum markers are the cornerstones of the **International Staging System (ISS)**, the most widely used system for determining prognosis in Multiple Myeloma. - High **$\beta_{2}$-microglobulin** levels reflect a high tumor burden and/or renal dysfunction, while low **serum albumin** indicates a more advanced disease state and poorer prognosis [1]. *IgG and albumin* - While **albumin** is a key prognostic factor, the specific type of immunoglobulin, such as **IgG**, is not a primary component of the main prognostic staging systems like the ISS. - The *quantity* of the monoclonal protein is used to monitor disease response, but the *type* is less critical for staging than **$\beta_{2}$-microglobulin**. *IgM and albumin* - A monoclonal gammopathy involving **IgM** is the hallmark of **Waldenström macroglobulinemia**, not Multiple Myeloma [1]. - Multiple Myeloma is characterized by the monoclonal proliferation of plasma cells that typically produce **IgG** or **IgA**, not **IgM** [1]. *Albumin and LDH* - While elevated **Lactate Dehydrogenase (LDH)** is an adverse prognostic factor, it is used in the **Revised-ISS (R-ISS)**, which builds upon the original ISS. - The foundational ISS, which is universally applied, is based on the combination of **serum albumin** and **$\beta_{2}$-microglobulin** levels.
Question 199: A patient has developed a cough and weight loss for the last 3 months. Biopsy of lung mass shows expression of chromogranin and synaptophysin. Which paraneoplastic syndrome will most likely occur in this patient?
- A. SIADH (Correct Answer)
- B. Gynaecomastia
- C. Cushing syndrome
- D. Hypercalcemia
Explanation: ***SIADH*** - The biopsy findings of positive **chromogranin** and **synaptophysin** are characteristic of a **neuroendocrine tumor**, with **Small Cell Lung Cancer (SCLC)** being the most likely diagnosis given the clinical presentation. - **SCLC** is well-known for causing paraneoplastic syndromes, the most common of which is the **Syndrome of Inappropriate Antidiuretic Hormone (SIADH)**, resulting from ectopic **ADH** production [1]. *Hypercalcemia* - Paraneoplastic hypercalcemia is most frequently associated with **Squamous Cell Carcinoma** of the lung [2]. - This occurs due to the tumor's production of **Parathyroid Hormone-related Peptide (PTHrP)**, which is not a typical feature of SCLC [2]. *Cushing syndrome* - Paraneoplastic Cushing syndrome results from the ectopic production of **Adrenocorticotropic Hormone (ACTH)**, which can also be seen in **SCLC** [1]. - However, **SIADH** is a more common paraneoplastic endocrine syndrome associated with SCLC compared to Cushing syndrome. *Gynaecomastia* - Gynaecomastia as a paraneoplastic syndrome is classically associated with **Large Cell Carcinoma** of the lung. - This is due to the ectopic secretion of **human chorionic gonadotropin (hCG)** by the tumor cells.
Question 200: A patient with a history of breast cancer underwent Cobalt-60 radiotherapy. She now presents with respiratory distress, and imaging shows haziness in the left lung. What is the most likely diagnosis?
- A. Radiation Pneumonitis (Correct Answer)
- B. Infective Pneumonia
- C. Pulmonary Embolism
- D. Recurrence of Breast Cancer
Explanation: ***Radiation Pneumonitis*** - This is a non-infectious inflammatory response of the lung parenchyma following radiotherapy, typically occurring **1-6 months** after treatment, which fits the patient's timeline after **Cobalt-60 therapy**. - Imaging findings classically show **diffuse haziness**, consolidation, or ground-glass opacities that are sharply demarcated and conform to the **radiation port**, as seen in the provided chest X-ray. *Recurrence of Breast Cancer* - **Pulmonary metastases** from breast cancer usually present as discrete **nodules**, masses, or lymphangitic carcinomatosis on imaging, not a diffuse haziness confined to a prior radiation field. - The onset of symptoms in this case is more acute and temporally related to radiation therapy, making an inflammatory process like pneumonitis more likely than metastatic recurrence. *Pulmonary Embolism* - While cancer is a risk factor for **pulmonary embolism (PE)**, a chest X-ray is often normal or shows non-specific findings like atelectasis or a **Hampton's hump**; the diffuse haziness seen here is not a typical feature of PE. - Diagnosis of PE requires a **CT pulmonary angiogram (CTPA)** or V/Q scan, as the clinical signs can overlap but the radiographic evidence points elsewhere. *Infective Pneumonia* - **Infective pneumonia** typically presents with symptoms like **fever**, chills, and a productive cough, which are not described in the clinical vignette. - The radiographic opacities in bacterial pneumonia are usually lobar or segmental and do not have the sharp, straight borders that correspond to a radiation field.
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Cancer Biology and Carcinogenesis
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Principles of Cancer Diagnosis and Staging
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Cancer Emergencies
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Principles of Chemotherapy, Immunotherapy and Targeted Therapy
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Palliative Care in Oncology
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Cancer Screening and Prevention
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Paraneoplastic Syndromes
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