Oncology — MCQs
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Which of the following are risk factors for the development of pancreatic cancer? 1. Cigarette smoking 2. Diabetes mellitus 3. Obesity 4. Caucasian ethnicity Select the correct answer using the code given below.
Which of the following are correct with regard to lung cancer? 1. Surgical resection has a limited role in curative treatment of lung cancer. 2. Pattern of disease and prognosis of oat cell carcinoma are different to other varieties in the lungs. 3. Small cell lung cancer is a type of Neuroendocrine Tumour (NET). 4. Squamous cancer appears as a cavitating tumour in the lungs.
The most common brain tumour in an adult is
Following the immunotherapy, in patients undergoing renal transplantation, the skin cancer most commonly seen is
Carcinoma of pyriform fossa usually presents with :
The most common site of skeletal metastases in carcinoma of the breast is
A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from:
Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?
A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = 106/min, BP = 100/70 mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size 13 x 8 cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is
Serum thyroglobulin level is an important tumor marker for
Oncology Indian Medical PG Practice Questions and MCQs
Question 211: Which of the following are risk factors for the development of pancreatic cancer? 1. Cigarette smoking 2. Diabetes mellitus 3. Obesity 4. Caucasian ethnicity Select the correct answer using the code given below.
- A. 1, 2 and 3 (Correct Answer)
- B. 2, 3 and 4
- C. 1, 3 and 4
- D. 1, 2 and 4
Explanation: ***1, 2 and 3*** - **Cigarette smoking** is a well-established and significant modifiable risk factor for pancreatic cancer, increasing the risk two to three-fold [1]. - **Long-standing diabetes mellitus**, particularly type 2, is both an independent risk factor and can be an early symptom of pancreatic cancer. **Obesity** is also clearly linked to an increased risk of pancreatic cancer, likely due to chronic inflammation and metabolic changes. *2, 3 and 4* - While diabetes mellitus and obesity are risk factors, **Caucasian ethnicity** is not considered a primary isolated risk factor for pancreatic cancer; rather, the incidence is slightly higher in certain other ethnic groups like African Americans. - This option incorrectly includes ethnicity as a primary risk factor while excluding **cigarette smoking**, which is a major contributor [1]. *1, 3 and 4* - This option correctly identifies **cigarette smoking** and **obesity** as risk factors. However, it incorrectly includes **Caucasian ethnicity** as a specific risk factor while omitting **diabetes mellitus**, which is a strong and well-documented risk factor. - **Diabetes mellitus** is a more significant risk factor than ethnicity. *1, 2 and 4* - This option correctly identifies **cigarette smoking** and **diabetes mellitus** as risk factors. However, it incorrectly includes **Caucasian ethnicity** and omits **obesity**, which is a well-established and significant risk factor. - **Obesity** has a stronger and more direct link to pancreatic cancer risk than ethnicity.
Question 212: Which of the following are correct with regard to lung cancer? 1. Surgical resection has a limited role in curative treatment of lung cancer. 2. Pattern of disease and prognosis of oat cell carcinoma are different to other varieties in the lungs. 3. Small cell lung cancer is a type of Neuroendocrine Tumour (NET). 4. Squamous cancer appears as a cavitating tumour in the lungs.
- A. 1, 3 and 4
- B. 2, 3 and 4 (Correct Answer)
- C. 1, 2 and 3
- D. 1, 2 and 4
Explanation: ***2, 3 and 4*** - **Oat cell carcinoma** (small cell lung cancer) is known for its **aggressive behavior**, rapid growth, early metastasis, and distinct response to chemotherapy and radiation rather than surgery, making its pattern and prognosis different from **non-small cell lung cancer (NSCLC)** types [1]. - **Small cell lung cancer (SCLC)** originates from **neuroendocrine cells** in the lung, classifying it as a type of **Neuroendocrine Tumour (NET)**, which explains its unique biological and clinical characteristics [1]. - **Squamous cell carcinoma** is often centrally located and can undergo central necrosis, leading to **cavitation** which appears as a cavitating tumor on imaging [1]. *1, 3 and 4* - This option is incorrect because statement 1, which suggests surgical resection has a limited role in curative treatment, is generally **false for non-small cell lung cancer (NSCLC)**, where surgery is the primary curative modality in early stages [1]. - While statements 3 and 4 are correct, the inclusion of incorrect statement 1 makes this option invalid. *1, 2 and 3* - This option is incorrect as statement 1 claiming a limited role for surgical resection in curative treatment is generally **false for NSCLC**, where localized tumors are ideally treated with surgery [1]. - Statements 2 and 3 are correct, but the inaccuracy of statement 1 renders this option incorrect. *1, 2 and 4* - This option is incorrect because statement 1, which states that surgical resection has a limited role in curative treatment, is generally **incorrect for early-stage NSCLC** [1]. - Although statements 2 and 4 are accurate, the error in statement 1 makes this combination incorrect.
Question 213: The most common brain tumour in an adult is
- A. glioma
- B. pituitary tumour
- C. cerebral metastasis (Correct Answer)
- D. vestibular schwannoma
Explanation: ***Cerebral metastasis*** - **Cerebral metastases** are the **most common brain tumours in adults**, originating from primary cancers elsewhere in the body (e.g., lung, breast, melanoma). - They often present as **multiple lesions** and can cause focal neurological deficits, seizures, and increased intracranial pressure. *Glioma* - While **gliomas** (including astrocytomas, glioblastoma multiforme) are the most common primary brain tumours, they are less common than metastatic lesions overall in adults. - They arise from **glial cells** within the brain and can be highly aggressive. *Pituitary tumour* - **Pituitary tumours** are benign adenomas originating from the pituitary gland. - They are common but constitute a smaller proportion of all adult brain tumours compared to metastases or gliomas, and often present with **endocrine disturbances** or **visual field defects**. *Vestibular schwannoma* - **Vestibular schwannomas** (acoustic neuromas) are benign tumours arising from the **vestibulocochlear nerve (cranial nerve VIII)**. - They are relatively rare and typically present with **hearing loss**, **tinnitus**, and **balance issues**.
Question 214: Following the immunotherapy, in patients undergoing renal transplantation, the skin cancer most commonly seen is
- A. Non-melanoma skin cancers (Squamous cell carcinoma and Basal cell carcinoma) (Correct Answer)
- B. Hepatomas
- C. Kaposi's sarcoma
- D. Mycosis fungoides
Explanation: ***Non-melanoma skin cancers (Squamous cell carcinoma and Basal cell carcinoma)*** - **Immunosuppression** following renal transplantation significantly increases the risk of skin cancers, with non-melanoma types like **squamous cell carcinoma (SCC)** and **basal cell carcinoma (BCC)** being the most common [1]. - This increased risk is due to the impaired immune surveillance against oncogenic viruses (e.g., HPV) and DNA damage from UV radiation [2]. *Hepatomas* - While patients with chronic liver disease are at risk for hepatocellular carcinoma (hepatomas), they are **not the most common cancer** specifically associated with immunosuppression after renal transplantation. - The primary risk factors for hepatomas are chronic **hepatitis B** or **C infection**, alcohol abuse, and **cirrhosis**, not directly the immunosuppressive regimen itself. *Kaposi's sarcoma* - **Kaposi's sarcoma (KS)** is associated with **human herpesvirus 8 (HHV-8)** infection and is more prevalent in immunosuppressed individuals, especially those with AIDS or solid organ transplant recipients [2]. - Although its incidence is increased, it is still **less common** than non-melanoma skin cancers in this patient population. *Mycosis fungoides* - **Mycosis fungoides** is a type of **cutaneous T-cell lymphoma**, characterized by malignant T-lymphocytes infiltrating the skin. - It is a **rare cancer** and is not typically considered the most common skin cancer to occur in transplant recipients undergoing immunotherapy.
Question 215: Carcinoma of pyriform fossa usually presents with :
- A. Lump in the neck
- B. Cough
- C. Dysphagia (Correct Answer)
- D. Hoarseness
Explanation: ***Dysphagia*** - Carcinoma of the **pyriform fossa** is a type of hypopharyngeal cancer, and given its anatomical location, it commonly interferes with swallowing [1]. - The pyriform fossa lies immediately lateral to the laryngeal inlet, and involvement here directly impacts the ability to form a **food bolus** and propel it into the esophagus. *Lump in the neck* - A neck lump can occur, especially if there is **lymph node metastasis**, but it's often a later symptom [1]. - **Dysphagia** usually precedes the development of a palpable neck mass as the primary tumor expands within the pyriform fossa [1]. *Cough* - While aspiration might lead to coughing, it's not the primary presenting symptom. - Cough is more commonly associated with laryngeal involvement or **tracheal invasion**, which can occur with advanced disease. *Hoarseness* - **Hoarseness** is a prominent symptom if the **vocal cords** or recurrent laryngeal nerve are directly involved [2]. - The pyriform fossa is adjacent but distinct from the vocal cords, so hoarseness is not typically the initial or most common symptom unless the tumor extends medially.
Question 216: The most common site of skeletal metastases in carcinoma of the breast is
- A. Thoracic vertebrae (Correct Answer)
- B. Skull
- C. Pelvis
- D. Lumbar vertebrae
Explanation: ***Thoracic vertebrae*** - The **thoracic spine** is the most frequent site for skeletal metastases from breast carcinoma due to its rich vascular supply and proximity to the primary tumor. - Metastases can lead to **vertebral compression fractures**, spinal cord compression, and severe back pain. *Skull* - While the skull can be a site of bone metastases, it is **less common** as the primary site compared to the thoracic vertebrae. - Skull metastases often present as **punched-out lytic lesions** and can involve cranial nerves. *Pelvis* - The **pelvis** is a common site for bone metastases, but it is **not the most frequent** compared to the axial skeleton, particularly the thoracic spine. - Pelvic metastases can cause pain, fractures, and affect mobility. *Lumbar vertebrae* - The **lumbar spine** is a common site for metastases, but it is generally **less frequently involved** than the thoracic spine in breast cancer. - Lumbar metastases also carry a risk of spinal cord compression affecting the lower limbs.
Question 217: A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from:
- A. Carcinoma head of pancreas (Correct Answer)
- B. Carcinoma stomach
- C. Choledocholithiasis
- D. Klatskin tumour
Explanation: A 60 year old man presents with painless progressive jaundice for two months. He has a history of weight loss. On examination, his gallbladder is palpable which is smooth, non‐tender and globular. His serum bilirubin is 18.2 mg/dL. He is most likely suffering from: ***Carcinoma head of pancreas*** - The classic triad of **painless progressive jaundice**, **weight loss**, and a **palpable, non-tender gallbladder** (Courvoisier's sign) strongly indicates carcinoma of the head of the pancreas due to obstruction of the common bile duct [1]. - The high serum bilirubin value further supports a severe obstructive process, typical of a pancreatic head mass compressing the bile duct [1]. *Carcinoma stomach* - Carcinoma of the stomach typically presents with upper abdominal pain, dyspepsia, early satiety, and weight loss, but **jaundice is rare** unless there is extensive metastasis to the liver or porta hepatis. - It usually does not directly lead to **obstructive jaundice** with a palpable gallbladder, as the tumor's location is remote from the common bile duct. *Choledocholithiasis* - While choledocholithiasis can cause obstructive jaundice, it is often associated with **pain** (biliary colic) and fluctuating jaundice rather than the painless, progressive pattern described. - A gallbladder obstructed by a stone would typically be **tender** if inflamed, or decompressed if the obstruction is intermittent, rather than smooth and non-tender due to chronic distal obstruction. *Klatskin tumour* - A Klatskin tumor (hilar cholangiocarcinoma) causes obstructive jaundice, but it typically obstructs the bile ducts above the cystic duct insertion, meaning the **gallbladder would usually be decompressed and non-palpable** [2]. - These tumors often present with **jaundice and itching**, but the presence of a palpable gallbladder makes a pancreatic head mass more likely [2].
Question 218: Which one of the following is NOT correct regarding Adenocarcinoma of the kidney ?
- A. It may be associated with Pyrexia of unknown origin
- B. It always presents with haematuria (Correct Answer)
- C. Renal vein extention may embolize to lungs
- D. It is also called Grawitz tumour
Explanation: ***It always presents with haematuria*** - This statement is incorrect because **renal cell carcinoma** (adenocarcinoma of the kidney) often remains asymptomatic until a late stage, meaning **hematuria** is not always present, especially in early disease [1]. - While hematuria is a common symptom in later stages, occurring in about 60% of cases, its absence does not rule out the diagnosis, and many tumors are found incidentally [1]. *It may be associated with Pyrexia of unknown origin* - **Renal cell carcinoma** can produce various paraneoplastic syndromes, including **pyrexia of unknown origin (PUO)** [2]. - The tumor may release **pyrogenic cytokines** that lead to unexplained fever, making this a recognized systemic manifestation. *Renal vein extention may embolize to lungs* - **Renal cell carcinoma** has a propensity to invade the **renal vein** and extend into the inferior vena cava. - Tumor thrombi can then break off and travel to the lungs, resulting in **pulmonary embolism** of tumor cells or even macroscopic tumor emboli. *It is also called Grawitz tumour* - **Grawitz tumor** is an older, historical term used to refer to **renal cell carcinoma**, particularly the clear cell subtype. - This name originated from Paul Grawitz, who first described the tumor's histological features.
Question 219: A 50 year old male patient presents to the emergency with sudden onset of upper abdominal pain, nausea, vomiting and haematemesis. On examination, PR = 106/min, BP = 100/70 mm Hg and pallor is present. CECT abdomen reveals a large exophytic tumor of size 13 x 8 cm at the fundus of the stomach. On upper GI endoscopy, the mucosa overlying the tumor is intact. The staining for CD117 in the upper GI endoscopic biopsy is positive. The most probable clinical diagnosis in this patient is
- A. Carcinoid tumor
- B. Gastric lymphoma
- C. Carcinoma stomach
- D. Gastrointestinal stromal tumor (Correct Answer)
Explanation: ***Gastrointestinal stromal tumor*** - The rapid onset of symptoms like **upper abdominal pain**, **nausea**, **vomiting**, and **hematemesis**, along with signs of **hypovolemia** (tachycardia, hypotension, pallor), suggests acute gastrointestinal bleeding from a tumor [1]. - A **large exophytic tumor** in the stomach fundus with **intact overlying mucosa** on endoscopy points to a **submucosal lesion**, and **positive CD117 (c-Kit)** staining is a hallmark diagnostic feature of GISTs. *Carcinoid tumor* - While carcinoid tumors can occur in the gastrointestinal tract, they are typically **neuroendocrine tumors** and less commonly present as large, exophytic masses causing acute massive bleeding with the same frequency as GISTs. - Carcinoid tumors typically stain positive for **chromogranin A** and **synaptophysin**, not CD117. *Gastric lymphoma* - Gastric lymphoma commonly presents with **ulcerations** or infiltrative lesions of the gastric wall, which would typically cause mucosal disruption on endoscopy [2]. - Lymphomas are characterized by lymphoid markers like **CD20** or **CD3**, and not CD117 [2]. *Carcinoma stomach* - **Gastric carcinoma** often presents with **mucosal irregularities**, **ulcerations**, or **masses** that arise directly from the gastric epithelium, which would be visible on endoscopy as an invasive lesion [3]. - Gastric carcinomas are typically epithelial in origin and would not stain positive for **CD117**.
Question 220: Serum thyroglobulin level is an important tumor marker for
- A. Thyroid lymphoma
- B. Medullary carcinoma thyroid
- C. Papillary carcinoma thyroid (Correct Answer)
- D. Anaplastic carcinoma thyroid
Explanation: ***Papillary carcinoma thyroid*** - **Serum thyroglobulin** is produced by follicular cells of the thyroid and serves as an excellent tumor marker for **differentiated thyroid cancers**, including papillary carcinoma, particularly after thyroidectomy [1]. - Elevated thyroglobulin levels in a patient with a history of papillary thyroid cancer, especially after removal of the thyroid gland, suggest **recurrence or persistent disease**. *Thyroid lymphoma* - **Thyroid lymphoma** is a lymphoid malignancy, and its primary tumor marker is typically associated with lymphocytic origin, such as **beta-2 microglobulin** or **LDH**, not thyroglobulin. - Thyroglobulin is a product of thyroid follicular cells, which are not the cell of origin for lymphoma. *Medullary carcinoma thyroid* - **Medullary thyroid carcinoma** originates from the parafollicular C cells, which produce **calcitonin**. - **Calcitonin** is the primary tumor marker for medullary thyroid carcinoma, not thyroglobulin. *Anaplastic carcinoma thyroid* - **Anaplastic thyroid carcinoma** is an undifferentiated tumor with very aggressive behavior and often does not produce significant amounts of thyroglobulin. - While some anaplastic carcinomas may have elevated thyroglobulin, it's not a reliable or specific marker due to the **dedifferentiated nature** of the cells.
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