Oncology Practice Questions

Q: The highest life time risk of pancreatic malignancy is seen with:

Peutz-Jeghers syndrome. ***Peutz-Jeghers syndrome*** - **Peutz-Jeghers syndrome** is an autosomal dominant disorder characterized by **hamartomatous polyps** in the gastrointestinal tract and mucocutaneous pigmentation. - It significantly increases the lifetime risk of various cancers, including **pancreatic cancer**, with estimates as high as 11-36% by age 70 [1]. *Familial adenomatous polyposis* - **Familial adenomatous polyposis (FAP)** is primarily associated with a very high lifetime risk of **colorectal cancer** [2]. - While there is a slightly increased risk of pancreatic cancer in FAP patients, it is considerably lower than the risk seen in Peutz-Jeghers syndrome. *Hereditary nonpolyposis colorectal cancer* - **Hereditary nonpolyposis colorectal cancer (HNPCC)**, also known as **Lynch syndrome**, is mainly associated with a high risk of **colorectal** and **endometrial cancers**. - While it does increase the risk of other extra-colonic cancers like gastric, ovarian, and urinary tract cancers, the lifetime risk of pancreatic cancer is lower compared to Peutz-Jeghers syndrome. *Li-Fraumeni syndrome* - **Li-Fraumeni syndrome** is caused by a germline mutation in the **TP53 tumor suppressor gene**, leading to a high predisposition to a wide variety of cancers at a young age. - Common cancers include soft tissue sarcomas, osteosarcomas, breast cancer, brain tumors, and adrenocortical carcinomas; however, the lifetime risk for **pancreatic cancer** is not as prominently high as in Peutz-Jeghers syndrome.

Q: Which one of the following is not sensitive to chemotherapy in advanced stage?

Pancreatic carcinoma. ***Pancreatic carcinoma*** - **Pancreatic carcinoma** is notoriously difficult to treat with chemotherapy, especially in advanced stages, due to its **aggressive biology**, inherent resistance mechanisms, and late presentation [1]. - The disease often presents with **metastatic spread** before diagnosis, and the response rates to even combination chemotherapy regimens are typically poor, highlighting its poor sensitivity [1]. *Wilm's tumor* - **Wilm's tumor (nephroblastoma)** is a pediatric kidney cancer that is highly sensitive to chemotherapy, even in advanced stages. - Combination chemotherapy regimens are a cornerstone of treatment, often leading to **excellent prognosis** and cure rates. *Ovarian carcinoma* - **Ovarian carcinoma**, particularly epithelial ovarian cancer, is often initially sensitive to **platinum-based chemotherapy**. - While it frequently recurs, the initial response to chemotherapy, even in advanced stages, can be significant, leading to periods of **remission**. *Ewing's sarcoma* - **Ewing's sarcoma** is a highly aggressive bone and soft tissue tumor that is very sensitive to chemotherapy, which is a critical component of its multidisciplinary treatment. - Modern multidisciplinary approaches, including intensive chemotherapy, have significantly improved survival rates for patients with both localized and **metastatic disease**.

Q: Compared to the other options, radiotherapy is LEAST commonly used as a primary treatment modality in:

Stomach cancer. ***Stomach cancer*** - **Radiotherapy** is generally *not* a primary treatment for **stomach cancer** due to the high radiosensitivity of surrounding organs (e.g., small bowel, liver, kidneys) and the difficulty in delivering a curative dose without significant toxicity. - While it may be used as an **adjuvant therapy** post-surgery or for **palliative care** (e.g., pain, bleeding), it is rarely the initial standalone treatment. *Esophageal cancer* - **Radiotherapy** is a common primary or neoadjuvant treatment for **esophageal cancer**, often in combination with chemotherapy (**chemoradiation**), especially for unresectable cases or to downstage tumors before surgery. - It plays a significant role in both curative intent and **palliative management** for dysphagia. *Brain tumor* - **Radiotherapy** is a cornerstone of treatment for many primary and metastatic **brain tumors**, often following surgical resection or as a standalone primary treatment. - Techniques like **stereotactic radiosurgery (SRS)** and **intensity-modulated radiation therapy (IMRT)** allow for precise targeting, minimizing damage to healthy brain tissue. *Cervical cancer* - **Radiotherapy**, particularly external beam radiation therapy (EBRT) combined with **brachytherapy**, is a highly effective primary treatment for **locally advanced cervical cancer**, especially if surgery is not feasible or desired [1]. - It can achieve high cure rates and is often given concurrently with chemotherapy (**chemoradiation**) [1].

Q: A 44 year old man goes to his physician for an employment physical examination. The clinician notices that the patient's fingers are clubbed. He also demonstrates tenderness over the distal ends of the radius, ulna, and fibula. This patient should be explicitly evaluated to exclude which of the following?

Lung cancer. ***Lung cancer*** - The combination of **clubbing** (hypertrophic osteoarthropathy) and **periosteal tenderness** (typically of the long bones) is highly suggestive of paraneoplastic syndrome associated with **bronchogenic carcinoma**, particularly **non-small cell lung cancer** [1]. - **Hypertrophic osteoarthropathy** is characterized by proliferation of skin and bone at distal extremities, often leading to clubbing and pain in the long bones [1], which is a classic presentation with lung malignancies. *Renal cancer* - While renal cell carcinoma can present with various paraneoplastic syndromes, **hypertrophic osteoarthropathy** and clubbing are not typical or primary associations [2]. - Common paraneoplastic syndromes with renal cancer include **polycythemia** (due to erythropoietin production) [3] and **hypercalcemia** [2], [3]. *Liver cancer* - **Hepatocellular carcinoma** can be associated with paraneoplastic syndromes, but **clubbing** and **hypertrophic osteoarthropathy** are not among the classic presentations. - Paraneoplastic syndromes in liver cancer often involve **hypoglycemia** or **erythrocytosis** [3]. *Gastrointestinal cancer* - Although **gastrointestinal malignancies** can cause various systemic symptoms, **hypertrophic osteoarthropathy** with prominent clubbing is not a primary or common paraneoplastic manifestation [2]. - GI cancers might indirectly cause clubbing in settings of chronic malabsorption, but not typically as a direct paraneoplastic effect like lung cancer.

Q: Which isotope is used for treating bone cancer?

Sr. Phosphorus-32 is a radioisotope commonly used in the treatment of bone cancer and related conditions due to its ability to target bone tissues. Other isotopes used in the treatment of bone metastases include Strontium-89 and Samarium-153.

Q: A patient presented with a 3.5-cm size lymph node enlargement, which was hard and present in the submandibular region. Examination of the head and neck did not yield any lesion. Which of the following investigations should follow?

Triple endoscopy. ***Triple endoscopy*** - A **3.5 cm, hard, submandibular lymph node** without an obvious primary lesion suggests metastatic carcinoma, requiring a thorough search for the primary. - **Triple endoscopy** (laryngoscopy, esophagoscopy, and bronchoscopy) allows direct visualization and biopsy of mucosal surfaces in the upper aerodigestive tract, which is a common site for primary tumors metastasizing to the neck. *Chest X-ray* - While a Chest X-ray can detect **lung lesions** or mediastinal lymphadenopathy, it may not adequately identify a primary tumor in the upper aerodigestive tract. - It would be a useful adjunct later but does not provide the comprehensive mucosal surface evaluation needed to find a hidden primary. *Laryngoscopy* - **Laryngoscopy** is part of the triple endoscopy procedure but by itself is insufficient as it only examines the larynx and hypopharynx. - It would miss potential primary lesions in the nasopharynx, oral cavity, or esophagus. *Supravital oral mucosa staining* - **Supravital staining** (e.g., toluidine blue) is used to identify dysplastic or early malignant lesions on the oral mucosa. - While useful for oral cavity screening, it does not evaluate other potential primary sites in the pharynx, larynx, esophagus, or nasopharynx, which could be the source of the metastatic node.

Q: Which of the following is not a premalignant condition?

Fragile X syndrome. ***Fragile X syndrome*** - This is a genetic condition causing **intellectual disability** and developmental problems, primarily due to an **FRM1 gene mutation** leading to a fragile site on the X chromosome [1]. - It is **not associated with an increased risk of malignancy** and is therefore not considered a premalignant condition. *Bloom's syndrome* - This is a rare genetic disorder characterized by **growth deficiency**, a **photosensitive rash**, and a significantly **increased risk of various cancers**, including leukemias, lymphomas, and solid tumors. - It is associated with a mutation in the **BLM gene**, which plays a role in DNA repair and replication, leading to chromosomal instability. *Down's syndrome* - Individuals with Down's syndrome (trisomy 21) have a **20-fold increased risk of acute lymphoblastic leukemia (ALL)** and a 10-fold increased risk of acute myeloid leukemia (AML), particularly transient myeloproliferative disorder in infancy. - While it is a developmental disorder, the increased incidence of specific cancers classifies it as a **premalignant condition**. *Fanconi anemia* - This is a rare genetic disorder characterized by **bone marrow failure**, physical abnormalities, and an extraordinarily high risk of developing **acute myeloid leukemia (AML)** and myelodysplastic syndrome (MDS). - It is caused by mutations in genes involved in **DNA repair**, making cells highly susceptible to DNA damage and cancer.

Q: The standard radiation therapy dose for consolidation treatment in early-stage Hodgkin lymphoma is:

Standard dose: 20-30 Gy. **Standard dose: 20-30 Gy** - For **early-stage Hodgkin lymphoma**, a dose range of **20-30 Gy** is considered standard for **consolidation radiotherapy** following chemotherapy. - This dose balances efficacy in eradicating residual microscopic disease with minimizing **long-term toxicity**. *Moderate dose: 30-40 Gy* - This dose range is typically used in situations requiring **higher local control** where the risk of recurrence is elevated, or for certain **bulky disease** settings. - It exceeds the standard recommendation for **routine consolidation** in early-stage disease due to potential for increased side effects. *High dose: 50-60 Gy* - Doses in this range are usually reserved for **definitive radiation therapy** in primary malignancy treatment or for **palliation of symptomatic bulky disease**, not early-stage consolidation. - Such high doses would significantly increase the risk of **secondary malignancies** and other late toxicities in Hodgkin lymphoma. *Intermediate dose: 40-50 Gy* - This dose range is generally not a recognized standard for **early-stage Hodgkin lymphoma consolidation**. - It falls between standard consolidation and definitive treatment doses, potentially offering **unjustified toxicity** without a clear benefit over the lower standard dose.

Q: Commonest cause of skeletal metastasis is

Breast. ***Breast*** - **Breast cancer** is the most common cause of **skeletal metastasis** overall, especially in women, due to its high incidence and propensity to spread to bone. - Metastases often present as **osteolytic lesions**, sometimes mixed with osteoblastic features. *Prostate* - **Prostate cancer** is the most common cause of skeletal metastasis in **men**, frequently leading to **osteoblastic lesions**. - While very common in men, overall incidence is lower than breast cancer. *Thyroid* - **Thyroid cancer** can metastasize to bone, often presenting as **osteolytic lesions**, but it is less common than breast and prostate cancer. - Its overall contribution to skeletal metastases is significantly smaller. *Kidney* - **Renal cell carcinoma (RCC)** also metastasizes to bone, typically causing **osteolytic lesions** that can be highly vascular. - Similar to thyroid cancer, its incidence of bone metastasis is lower than that of breast and prostate cancer.

Q: CHOP is used in the treatment of?

NHL. ***NHL*** - **CHOP** is the **gold standard first-line chemotherapy regimen** for most types of **Non-Hodgkin Lymphoma**, particularly **diffuse large B-cell lymphoma (DLBCL)** [1]. - The regimen combines **cyclophosphamide** (alkylating agent), **hydroxydaunorubicin/doxorubicin** (anthracycline), **oncovin/vincristine** (vinca alkaloid), and **prednisone** (corticosteroid) for optimal efficacy [1]. *Head and neck cancer* - Treatment primarily involves **platinum-based regimens** such as **cisplatin or carboplatin** combined with **5-fluorouracil** or **taxanes**. - **CHOP is not a standard chemotherapy regimen** for head and neck malignancies, which are solid tumors requiring different therapeutic approaches. *Ca Stomach* - Gastric cancer chemotherapy typically uses regimens like **FOLFOX** (fluorouracil, leucovorin, oxaliplatin) or **FLOT** (fluorouracil, leucovorin, oxaliplatin, docetaxel). - **CHOP is not used for gastric cancer** treatment, as it requires **platinum-based or fluoropyrimidine-based combinations**. *Ca Lung* - Lung cancer treatment involves **platinum-based doublets** such as **cisplatin/carboplatin** combined with **pemetrexed, paclitaxel, or gemcitabine** [2]. - **CHOP is not used for lung cancer** as it is specifically designed for **hematological malignancies**, not solid tumors like lung cancer.

Question 1

The highest life time risk of pancreatic malignancy is seen with:

Accepted Answer

Peutz-Jeghers syndrome

Answer

Familial adenomatous polyposis

Answer

Hereditary nonpolyposis colorectal cancer

Answer

Li-Fraumeni syndrome

Question 2

Which one of the following is not sensitive to chemotherapy in advanced stage?

Accepted Answer

Pancreatic carcinoma

Answer

Wilm's tumor

Answer

Ovarian carcinoma

Answer

Ewing's carcinoma

Question 3

Compared to the other options, radiotherapy is LEAST commonly used as a primary treatment modality in:

Accepted Answer

Stomach cancer

Answer

Esophageal cancer

Answer

Brain tumor

Answer

Cervical cancer

Question 4

A 44 year old man goes to his physician for an employment physical examination. The clinician notices that the patient's fingers are clubbed. He also demonstrates tenderness over the distal ends of the radius, ulna, and fibula. This patient should be explicitly evaluated to exclude which of the following?

Accepted Answer

Lung cancer

Answer

Renal cancer

Answer

Liver cancer

Answer

Gastrointestinal cancer

Question 5

Which isotope is used for treating bone cancer?

Accepted Answer

Sr

Answer

I-131

Answer

Tc

Answer

Ga

Question 6

A patient presented with a 3.5-cm size lymph node enlargement, which was hard and present in the submandibular region. Examination of the head and neck did not yield any lesion. Which of the following investigations should follow?

Accepted Answer

Triple endoscopy

Answer

Chest X-ray

Answer

Laryngoscopy

Answer

Supravital oral mucosa staining

Question 7

Which of the following is not a premalignant condition?

Accepted Answer

Fragile X syndrome

Answer

Bloom's syndrome

Answer

Down's syndrome

Answer

Fanconi anemia

Question 8

The standard radiation therapy dose for consolidation treatment in early-stage Hodgkin lymphoma is:

Accepted Answer

Standard dose: 20-30 Gy

Answer

Moderate dose: 30-40 Gy

Answer

High dose: 50-60 Gy

Answer

Intermediate dose: 40-50 Gy

Question 9

Commonest cause of skeletal metastasis is

Accepted Answer

Breast

Answer

Prostate

Answer

Thyroid

Answer

Kidney

Question 10

CHOP is used in the treatment of?

Accepted Answer

NHL

Answer

Head and neck cancer

Answer

Ca Stomach

Answer

Ca Lung

Oncology — MCQs

Oncology — MCQs

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