Oncology Practice Questions

Q: A patient developed paraplegia. On routine examination and X-ray it was found that there are osteoblastic lesions in his spine. What is the MOST probable diagnosis?

Ca. Prostate. ***Ca. Prostate*** - **Prostate cancer** has a strong predilection for metastasizing to bone and typically produces **osteoblastic lesions** (new bone formation) in the spine [2]. - The presence of **paraplegia** suggests spinal cord compression due to these metastatic lesions [1]. *Breast Ca.* - While **breast cancer** frequently metastasizes to bone (commonly spine, pelvis, ribs, skull), it typically causes **osteolytic lesions** (bone destruction), though mixed lesions can occur. - Paraplegia can result from breast cancer metastases but the primary lesion type is usually osteolytic. *Carcinoma thyroid* - **Thyroid cancer** metastases to bone are rare and generally lead to **osteolytic lesions**, not osteoblastic. - Although it can cause spinal cord compression, the characteristic osteoblastic appearance is not typical for thyroid cancer. *Pancreatic Ca.* - **Pancreatic cancer** rarely metastasizes to bone, and when it does, the lesions are almost exclusively **osteolytic**. - Therefore, it is highly unlikely to be the cause of osteoblastic spinal lesions and subsequent paraplegia.

Q: The MOST important risk factor for pancreatic cancer among the following is:

Cigarette smoking. Cigarette smoking - Cigarette smoking is the leading modifiable risk factor for pancreatic cancer, accounting for approximately 25% of cases [1]. - The risk increases with the number of cigarettes smoked and the duration of smoking, with a higher risk for heavy smokers. *Alcohol* - While heavy alcohol consumption can lead to chronic pancreatitis, it is not considered a direct and independent risk factor for pancreatic cancer to the same extent as smoking. - The association is often indirect, mediated through its role in developing chronic pancreatitis. *Chronic pancreatitis* - Chronic pancreatitis significantly increases the risk of pancreatic cancer, but it is often a consequence of other underlying factors like alcohol abuse or genetic predispositions. - Although it's a strong risk factor, its prevalence as a primary cause is less than that of smoking directly. *Diabetes* - Diabetes, particularly new-onset diabetes in older adults, can be an early symptom of pancreatic cancer rather than solely a risk factor. - While it is associated with an increased risk, it is not as strong a modifiable risk factor as smoking.

Q: CA 19-9 is a marker for which of the following:

Pancreatic carcinoma. ***Pancreatic carcinoma*** - **CA 19-9** is a widely used **tumor marker** primarily associated with **pancreatic cancer** [1]. - Its levels can be elevated in other conditions such as **cholangitis** or **gallstones**, but its most significant clinical utility is in monitoring pancreatic cancer progression and response to treatment [2], [4]. *Breast carcinoma* - The primary tumor markers for breast carcinoma are **CA 15-3** and **CA 27-29**, which are used for monitoring recurrence and treatment response. - While CA 19-9 can be slightly elevated in some breast cancer cases, it is not considered a primary or reliable marker for this type of cancer. *Lung carcinoma* - Common tumor markers for lung cancer include **CEA** (carcinoembryonic antigen) for non-small cell lung cancer and **NSE** (neuron-specific enolase) for small cell lung cancer [3]. - CA 19-9 has very limited utility in the diagnosis or monitoring of lung carcinoma. *Ovarian carcinoma* - **CA-125** is the primary tumor marker used for ovarian carcinoma, particularly for monitoring disease progression and treatment response. - Although CA 19-9 can be elevated in some gynecological malignancies, it is not the marker of choice for ovarian cancer.

Q: Which of the following is a testicular tumor marker?

HCG. ***HCG*** - **Human Chorionic Gonadotropin (HCG)** is a key tumor marker for **germ cell tumors** of the testis, especially **choriocarcinoma** and some **seminomas** [1]. - Its levels correlate with tumor burden and are used for diagnosis, staging, and monitoring response to treatment. *CA-125* - **CA-125** is primarily used as a tumor marker for **ovarian cancer**, not testicular tumors. - Elevated levels can also be seen in other conditions affecting the peritoneum or pleura. *a-1 antitrypsin* - **Alpha-1 antitrypsin** is a protein involved in inhibiting proteases, and its deficiency is linked to **emphysema** and **liver disease**, not testicular cancer. - It is not considered a tumor marker for any specific cancer. *PSA (Prostate Specific Antigen)* - **PSA** is a well-known tumor marker for **prostate cancer**, primarily used for screening, diagnosis, and monitoring treatment efficacy in men [1], [2]. - It is produced by the prostate gland and is not associated with testicular tumors.

Q: 20 years old female came with complaint of a palpable painless mass in right breast. On examination, mass was mobile and hard in consistency. Ultrasound of right breast was performed . Most likely diagnosis is?

Fibroadenoma. ***Fibroadenoma*** - A **painless**, **mobile**, and **hard mass** in a 20-year-old female is highly characteristic of a fibroadenoma, which is a common **benign breast tumor**. - Its **mobility** (often described as "breast mouse") is a key distinguishing feature from malignant masses. *Breast cyst* - While breast cysts can be **palpable** and **painless**, they are typically **soft or fluctuant** on palpation, not hard. - Cysts are fluid-filled sacs, and their mobile nature is less pronounced than the discrete, solid feel of a fibroadenoma. *Phyllodes tumor* - Phyllodes tumors can present as a **palpable mass**, but they usually grow **rapidly** and tend to be larger, often feeling lobulated. - While they can be benign, they have a potential for **malignant transformation** and are less common than fibroadenomas, especially in a 20-year-old. *Ductal papilloma* - Ductal papillomas are typically very small, located within milk ducts, and often present with **nipple discharge**, particularly bloody discharge, rather than a palpable mass. - They are rarely felt as a discrete, mobile, hard mass on routine physical examination.

Q: Which of the following most commonly produces osteoblastic secondaries?

Carcinoma prostate. ***Carcinoma prostate*** - **Prostate cancer** has a strong predilection for metastasizing to bone and typically results in **osteoblastic (bone-forming) lesions** [1]. - Tumors from the prostate release factors, such as **prostate-specific antigen (PSA)** and factors that stimulate osteoblasts, leading to new bone formation. *Carcinoma urinary bladder* - **Urinary bladder carcinoma** can metastasize to bone, but it usually produces **osteolytic (bone-destroying) lesions**, rather than osteoblastic ones. - Bone metastases from bladder cancer are less common than from prostate or breast cancer, and often indicate advanced disease. *Carcinoma breast* - **Breast cancer** is a very common cause of bone metastases, which can be **osteolytic, osteoblastic, or mixed** . - However, purely osteoblastic lesions are less common in breast cancer compared to prostate cancer, and osteolytic lesions are more frequently observed, especially in certain subtypes. *Carcinoma lung* - **Lung cancer** commonly metastasizes to bone, with **osteolytic lesions** being the predominant type. - While some subtypes can rarely cause osteoblastic changes, the vast majority of bone metastases from lung cancer involve bone destruction rather than bone formation.

Q: Cranial Irradiation" is given for:

Small cell cancer. ***Small cell cancer*** - **Cranial irradiation** is often used as prophylactic treatment for **small cell lung cancer (SCLC)** due to its high propensity for early **brain metastasis**. [1] - This therapy aims to eradicate micrometastases in the brain, thereby improving disease-free survival and reducing neurological complications. *Anaplastic cancer* - While anaplastic cancers can metastasize, **prophylactic cranial irradiation (PCI)** is not a standard or primary treatment approach specifically for preventing brain metastases in all anaplastic cancers. - The treatment for anaplastic cancers is highly dependent on the primary tumor type and specific anaplastic features. *Squamous cell cancer* - **Squamous cell carcinoma** (SCC) rarely metastasize to the brain from extracranial primary sites compared to other cancer types like SCLC, and therefore, PCI is not routinely indicated for SCC. - Brain metastases from SCC, when they occur, are typically treated with **stereotactic radiosurgery** or whole brain radiation therapy as therapeutic, not prophylactic, measures. *Adenocarcinoma* - **Adenocarcinoma** from various primary sites (e.g., lung, breast, colon) can lead to brain metastases, but **prophylactic cranial irradiation (PCI)** is not a standard treatment for preventing these. [2] - Treatment for brain metastases from adenocarcinoma usually involves targeted therapies, surgery, or radiation therapy when metastases are already detected.

Q: A 73-year-old woman has noticed a 10-kg weight loss in the past 3 months. She is becoming increasingly icteric and has constant vague epigastric pain, nausea, and episodes of bloating and diarrhea. On physical examination, she is afebrile. There is mild tenderness to palpation in the upper abdomen, but bowel sounds are present. Her stool is negative for occult blood. Laboratory findings include a total serum bilirubin concentration of 11.6 mg/dL and a direct bilirubin level of 10.5 mg/dL. Which of the following conditions involving the pancreas is most likely to be present?

Adenocarcinoma. ***Adenocarcinoma*** - The patient's age (73 years), significant **weight loss**, progressive **jaundice** (elevated direct bilirubin), **epigastric pain**, nausea, bloating, and diarrhea are all classic signs of **pancreatic adenocarcinoma**, particularly when it obstructs the bile duct [1]. - The high **direct bilirubin** indicates an **obstructive pattern of jaundice**, common with tumors in the **head of the pancreas** compressing the common bile duct [1]. *Cystic fibrosis* - While it affects the pancreas, symptoms typically manifest in **childhood or early adulthood** with recurrent pulmonary infections and malabsorption [2]. - It would not typically cause acute, obstructive jaundice in a 73-year-old with these specific symptoms. *Islet cell adenoma* - These tumors (e.g., insulinoma, gastrinoma) are functional and typically present with symptoms related to **hormone overproduction**, such as hypoglycemia or peptic ulcers. - They are less likely to cause obstructive jaundice or significant weight loss unless they grow very large. *Chronic pancreatitis* - This condition is characterized by recurrent episodes of **abdominal pain**, pancreatic insufficiency, and often calcifications on imaging [3]. - While it can lead to malabsorption and weight loss, the rapid onset of severe obstructive jaundice and significant weight loss in a 3-month period without a history of recurrent pancreatitis makes adenocarcinoma more likely [3].

Q: Okuda staging contains all except

AFP. ***AFP*** - The **Okuda staging system** for hepatocellular carcinoma (HCC) uses parameters related to liver function and tumor burden, but it does **not include AFP levels**. [1] - AFP is a common **tumor marker** for HCC but is not part of the specific criteria for Okuda staging. *Tumor size* - **Tumor size greater than 50%** of the liver parenchyma is one of the four parameters used in the Okuda staging system. - This criterion is crucial for assessing the **extent of the disease**, differentiating between early and advanced cases. *Ascites* - The presence of **ascites** (related to fluid retention) is another key parameter in the Okuda staging system. - Ascites indicates **decompensated liver function**, implying a more advanced stage of disease. *Bilirubin* - **Bilirubin levels higher than 3 mg/dL** are included in the Okuda staging system. - Elevated bilirubin reflects **severe liver dysfunction**, indicating reduced hepatic synthetic capacity and usually a poorer prognosis.

Q: Bilateral carcinoma breast is common in which of the following types of breast cancer?

Lobular. ***Lobular*** - **Invasive lobular carcinoma (ILC)** accounts for 5-15% of all invasive breast cancers and is characterized by its common presentation as bilateral disease. - The cells in lobular carcinoma often infiltrate in a single-file pattern, which can make it more challenging to detect on imaging and contributes to its higher incidence of bilaterality and multifocality. *Scirrhous* - This term refers to the **desmoplastic stromal reaction** common in many invasive ductal carcinomas, causing a firm, gritty feel. - While it's a common histological feature, it does not specifically indicate a higher risk of bilateral involvement. *Inflammatory* - **Inflammatory breast cancer (IBC)** is an aggressive and rare form of breast cancer characterized by rapid onset of edema, erythema, and warmth without a palpable mass. - It does not have a higher predilection for bilateral presentation compared to lobular carcinoma. *Colloid* - **Colloid (mucinous) carcinoma** is a rare subtype of invasive ductal carcinoma characterized by tumor cells floating in pools of extracellular mucin. - It tends to have a more favorable prognosis but is not known for a significantly increased risk of bilaterality.

Question 1

A patient developed paraplegia. On routine examination and X-ray it was found that there are osteoblastic lesions in his spine. What is the MOST probable diagnosis?

Accepted Answer

Ca. Prostate

Answer

Breast Ca.

Answer

Carcinoma thyroid

Answer

Pancreatic Ca.

Question 2

The MOST important risk factor for pancreatic cancer among the following is:

Accepted Answer

Cigarette smoking

Answer

Alcohol

Answer

Chronic pancreatitis

Answer

Diabetes

Question 3

CA 19-9 is a marker for which of the following:

Accepted Answer

Pancreatic carcinoma

Answer

Breast carcinoma

Answer

Lung carcinoma

Answer

Ovarian carcinoma

Question 4

Which of the following is a testicular tumor marker?

Accepted Answer

HCG

Answer

CA-125

Answer

a-1 antitrypsin

Answer

PSA (Prostate Specific Antigen)

Question 5

20 years old female came with complaint of a palpable painless mass in right breast. On examination, mass was mobile and hard in consistency. Ultrasound of right breast was performed . Most likely diagnosis is?

Accepted Answer

Fibroadenoma

Answer

Breast cyst

Answer

Phylloid's tumour

Answer

Ductal papilloma

Question 6

Which of the following most commonly produces osteoblastic secondaries?

Accepted Answer

Carcinoma prostate

Answer

Carcinoma urinary bladder

Answer

Carcinoma breast

Answer

Carcinoma lung

Question 7

Cranial Irradiation" is given for:

Accepted Answer

Small cell cancer

Answer

Anaplastic cancer

Answer

Squamous cell cancer

Answer

Adenocarcinoma

Question 8

A 73-year-old woman has noticed a 10-kg weight loss in the past 3 months. She is becoming increasingly icteric and has constant vague epigastric pain, nausea, and episodes of bloating and diarrhea. On physical examination, she is afebrile. There is mild tenderness to palpation in the upper abdomen, but bowel sounds are present. Her stool is negative for occult blood. Laboratory findings include a total serum bilirubin concentration of 11.6 mg/dL and a direct bilirubin level of 10.5 mg/dL. Which of the following conditions involving the pancreas is most likely to be present?

Accepted Answer

Adenocarcinoma

Answer

Cystic fibrosis

Answer

Islet cell adenoma

Answer

Chronic pancreatitis

Question 9

Okuda staging contains all except

Accepted Answer

AFP

Answer

Tumor size

Answer

Ascites

Answer

Bilirubin

Question 10

Bilateral carcinoma breast is common in which of the following types of breast cancer?

Accepted Answer

Lobular

Answer

Scirrhous

Answer

Inflammatory

Answer

Colloid

Oncology — MCQs

Oncology — MCQs

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