Oncology — MCQs

Oncology Indian Medical PG Practice Questions and MCQs

Question 281: Which of the following conditions is the most common cause of unintentional weight loss in elderly patients?

A. Hyperthyroidism
B. Diabetes mellitus
C. Malignancy (Correct Answer)
D. Chronic obstructive pulmonary disease

Explanation: ***Malignancy*** - **Malignancy** is the most common cause of unintentional weight loss in elderly patients, accounting for 20-30% of cases [1]. - Cancers often increase **metabolic demand** and produce cytokines that can cause **cachexia**, leading to significant weight loss [1]. *Hyperthyroidism* - While hyperthyroidism can cause **unintentional weight loss** due to an increased metabolic rate, it is less common than malignancy as a cause in the elderly population. - Other typical symptoms of hyperthyroidism, such as **tachycardia**, **tremors**, and **heat intolerance**, would usually be present. *Diabetes mellitus* - **Uncontrolled diabetes** (especially type 1 or severe type 2) can lead to weight loss due to **glucosuria** and fat/muscle breakdown. - However, it is not as frequent a cause of unintentional weight loss in the elderly as malignancy, and would often be accompanied by symptoms like **polyuria**, **polydipsia**, and **blurred vision**. *Chronic obstructive pulmonary disease* - Severe **COPD** can lead to weight loss due to increased **work of breathing**, **systemic inflammation**, and reduced oral intake. - While a significant cause of weight loss in some elderly patients, overall prevalence as the primary cause of unintentional weight loss is lower than malignancy.

Question 282: A 70-year-old smoker presents with hemoptysis, weight loss, and chest pain. Chest X-ray shows a mass in the right upper lobe. What is the most likely diagnosis?

A. Tuberculosis
B. Lung cancer (Correct Answer)
C. Bronchiectasis
D. Pneumonia

Explanation: ***Lung cancer*** - The patient's age, history of **smoking**, and symptoms of **hemoptysis**, **weight loss**, and **chest pain** are highly suggestive of lung cancer. - A **mass in the right upper lobe** on Chest X-ray further supports this diagnosis, as lung cancer often presents as a solitary pulmonary nodule or mass. *Tuberculosis* - While tuberculosis can cause **hemoptysis** and **weight loss**, it is often associated with a history of exposure, night sweats, and typically infiltrates or cavitations rather than a discrete mass in an elderly smoker without other risk factors for TB. - While it can present with a solitary pulmonary nodule, the high-risk smoking history and specific symptom complex point away from TB as the most likely diagnosis. *Bronchiectasis* - Bronchiectasis is characterized by permanent **dilation of the bronchi**, leading to chronic cough with copious sputum production and recurrent infections. - It does not typically present with a discrete lung mass or significant weight loss without underlying chronic infection. *Pneumonia* - Pneumonia usually presents with acute onset of fever, cough with productive sputum, and shortness of breath. - A lung mass is not a typical presentation of acute pneumonia; rather, it manifests as infiltrates or consolidation on chest imaging.

Question 283: A 60-year-old man with advanced prostate cancer presents with severe, constant back pain. X-ray reveals vertebral metastases. What is the most appropriate management?

A. Chemotherapy
B. Surgical decompression
C. Radiation therapy (Correct Answer)
D. NSAIDs

Explanation: ***Radiation therapy*** - **Radiation therapy** is highly effective for localized pain control in **vertebral metastases** and can prevent further spinal cord compression [1]. - It works by shrinking the tumor, thereby alleviating pain and restoring neurological function in many cases. *Chemotherapy* - While chemotherapy is a systemic treatment for prostate cancer, its **pain-relieving effects are often slower** and less immediate compared to radiation for localized bone pain. - It may be used in conjunction with radiation, but it is typically not the **most appropriate initial management** for severe, constant pain due to vertebral metastases. *Surgical decompression* - **Surgical decompression** is primarily considered for patients with **spinal cord compression** leading to neurological deficits or intractable pain unresponsive to radiation [1]. - The patient's presentation of severe, constant back pain due to vertebral metastases, without mentioned neurological compromise, makes **radiation therapy a more appropriate first-line treatment** in this context [1]. *NSAIDs* - **NSAIDs** might provide some mild pain relief, but they are **insufficient for severe pain** caused by progressive vertebral metastases. - They also carry risks like **gastrointestinal complications** and **renal impairment**, especially in elderly patients with advanced cancer.

Question 284: A 45-year-old female with a history of breast cancer presents with new-onset shortness of breath. A chest X-ray reveals a pleural effusion. What is the most appropriate next step in management?

A. Thoracentesis (Correct Answer)
B. Chest CT with contrast
C. Repeat chest X-ray in one week
D. Bronchoscopy

Explanation: ***Thoracentesis*** - **Thoracentesis** is the most appropriate next step to both diagnose the cause of the pleural effusion and provide symptomatic relief from shortness of breath. - Analysis of the pleural fluid can differentiate between **transudative** and **exudative** effusions and identify malignant cells, which is crucial in a patient with a history of breast cancer. *Chest CT with contrast* - While a chest CT might provide more detailed imaging of the lungs and pleura, it does not directly address the need for fluid analysis or symptom relief. - It would be a useful *subsequent step* if the thoracentesis is inconclusive or to look for underlying masses, but not the immediate priority for a new, symptomatic effusion. *Repeat chest X-ray in one week* - Re-imaging in a week would delay diagnosis and treatment for a potentially serious condition, especially in a patient with a history of malignancy presenting with new symptoms. - It doesn't offer any diagnostic information about the nature of the fluid or immediate symptom relief. *Bronchoscopy* - **Bronchoscopy** is primarily used for evaluating intraluminal airway pathology or diffuse lung disease, such as tumors or infections within the bronchi. - It is not the initial procedure of choice for investigating a pleural effusion unless there is suspicion of an endobronchial lesion causing post-obstructive pneumonia and effusion, which is not indicated here.

Question 285: Which pancreatic tumor is associated with elevated CA 19-9 levels and jaundice?

A. Pancreatic neuroendocrine tumor
B. Pancreatic adenocarcinoma (Correct Answer)
C. Intraductal papillary mucinous neoplasm
D. Solid pseudopapillary tumor

Explanation: ***Pancreatic adenocarcinoma*** [1] - **Elevated CA 19-9 levels** are commonly associated with pancreatic adenocarcinoma, making it a key marker in diagnosis. - Jaundice often occurs due to **biliary obstruction** caused by the tumor, particularly when located in the head of the pancreas [1]. *Intraductal papillary mucinous neoplasm* [1] - While it can cause obstructive symptoms, it typically does not lead to **significantly elevated CA 19-9 levels** like pancreatic adenocarcinoma. - This tumor is often characterized by **mucin secretion** and can present with less severe jaundice. *Pancreatic neuroendocrine tumor* - These tumors usually do not elevate **CA 19-9** but instead can elevate other markers like **chromogranin A**. - Jaundice is less commonly associated as they tend to have different clinical behaviors compared to adenocarcinomas. *Solid pseudopapillary tumor* - This type of tumor is **rare** and typically not associated with elevated **CA 19-9 levels** like pancreatic adenocarcinoma is. - It usually presents in a younger demographic and does not typically cause jaundice unless obstructive. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, pp. 897, 899-900.

Question 286: A patient with metastatic prostate cancer has been found to have osteoblastic bone metastases. Which treatment approach would provide the best control of his disease?

A. Localized radiation therapy to bone metastases
B. Bisphosphonate therapy to increase bone density
C. Androgen deprivation therapy (Correct Answer)
D. Chemotherapy with a platinum-based regimen

Explanation: ***Androgen deprivation therapy*** - Prostate cancer growth is primarily driven by **androgens**, making androgen deprivation therapy (ADT) the **first-line systemic treatment** for metastatic disease. - ADT aims to reduce androgen levels, thereby inhibiting the proliferation of prostate cancer cells, including those in **osteoblastic bone metastases** [1]. *Localized radiation therapy to bone metastases* - While **radiation therapy** can effectively manage localized pain from bone metastases, it does not address the underlying systemic progression of the cancer. - It is a **palliative measure** for symptomatic relief rather than a curative or comprehensive disease control strategy for widespread metastatic disease. *Bisphosphonate therapy to increase bone density* - **Bisphosphonates** are used to prevent skeletal-related events (SREs) like fractures and pain in patients with bone metastases, by inhibiting osteoclast activity and strengthening bone. - However, they do not treat the underlying cancer itself and are **not a primary treatment** for controlling disease progression. *Chemotherapy with a platinum-based regimen* - **Chemotherapy** is typically reserved for patients with more advanced prostate cancer that has become **castration-resistant** (i.e., no longer responds to ADT). - Platinum-based regimens are not typically the first choice for initial treatment of metastatic castration-sensitive prostate cancer, as ADT is more effective and less toxic in this setting.

Question 287: A 50-year-old woman with chronic hepatitis B presents with an abdominal mass, and serum alpha-fetoprotein is elevated. What is the most likely diagnosis?

A. Hepatocellular carcinoma (Correct Answer)
B. Cholangiocarcinoma
C. Hepatic adenoma
D. Metastatic colon cancer

Explanation: ***Hepatocellular carcinoma*** - The **elevated alpha-fetoprotein (AFP)** level [1] and history of **chronic hepatitis B** strongly indicate hepatocellular carcinoma, as these factors are closely associated with this type of liver cancer [1]. - It commonly presents as an **abdominal mass** [1] in patients with underlying liver disease, particularly in those with chronic hepatitis or cirrhosis. *Metastatic colon cancer* - Typically presents with **elevated tumor markers** like CEA, not AFP, making it less likely in this case. - It often involves multiple liver lesions rather than a singular **abdominal mass** [1] due to liver metastases. *Cholangiocarcinoma* - While associated with liver lesions, it usually leads to **elevated CA 19-9 levels** rather than AFP. - Patients often present with **jaundice and bile duct obstruction**, which are not noted in this scenario. *Hepatic adenoma* - Generally seen in younger individuals, often associated with **oral contraceptive use**, and tends not to elevate AFP significantly. - Usually asymptomatic or may present with abdominal pain, unlike the strong association with chronic liver disease seen in this case.

Question 288: Management of acute lymphoblastic leukemia (ALL) in adults includes which of the following treatments?

A. High-dose chemotherapy (Correct Answer)
B. Supportive care only
C. Low-dose oral chemotherapy
D. Surgical removal of the lymph nodes

Explanation: ***High-dose chemotherapy*** - **Adult ALL** requires intensive treatment due to its aggressive nature and propensity for relapse. [1] - **High-dose chemotherapy**, often involving **multi-agent regimens** and potentially followed by **hematopoietic stem cell transplantation**, is the cornerstone of inducing remission and preventing recurrence. [1] *Supportive care only* - **Supportive care** is crucial for managing complications and side effects but is insufficient as a standalone treatment for ALL, which is a rapidly progressive and life-threatening cancer. [1] - Delaying definitive treatment with chemotherapy would lead to **rapid disease progression** and poor outcomes. *Low-dose oral chemotherapy* - **Low-dose oral chemotherapy** is typically used for less aggressive malignancies or as maintenance therapy in certain contexts but is inadequate for the initial treatment of **acute lymphoblastic leukemia (ALL)** in adults. [1] - ALL requires an **intensive regimen** to achieve and maintain remission due to the rapid proliferation of leukemic cells. *Surgical removal of the lymph nodes* - **Surgical removal of lymph nodes** is not a primary treatment for **leukemia**, which is a cancer of the blood and bone marrow, not a localized solid tumor. - While ALL can involve lymph nodes, the disease is **systemic** and requires systemic therapy, such as chemotherapy, to target malignant cells throughout the body.

Question 289: A 60-year-old man with a history of smoking presents with a cough and weight loss. A chest X-ray shows a mass in the upper lobe of the right lung. Which metabolic change is most associated with his likely condition?

A. Increased anaerobic glycolysis (Correct Answer)
B. Decreased protein synthesis
C. Increased lipid oxidation
D. Decreased gluconeogenesis

Explanation: ***Increased anaerobic glycolysis*** - Many cancers, including lung cancer, exhibit the **Warburg effect**, characterized by a high rate of **glycolysis** even in the presence of oxygen [1]. - This allows cancer cells to rapidly produce ATP and metabolic intermediates for proliferation, often associated with a switch in pyruvate kinase isozymes to build biomass [1]. *Decreased protein synthesis* - While systemic illness like cancer can lead to muscle wasting (cachexia) due to increased protein breakdown, cancer cells themselves generally have **increased protein synthesis** to support rapid growth. - Decreased protein synthesis is not a primary metabolic hallmark directly associated with the *cancer cells* themselves. *Increased lipid oxidation* - While some cancer cells may utilize **lipid oxidation** as an energy source, it is not the most universally characteristic or significant metabolic alteration compared to the Warburg effect [1]. - Many cancer cells primarily rely on glucose for energy and biomass production. *Decreased gluconeogenesis* - **Decreased gluconeogenesis** is not directly associated with the metabolic changes within cancer cells themselves; rather, cancer cachexia can sometimes lead to altered systemic glucose metabolism [1]. - The liver is the primary site of gluconeogenesis, and its regulation is complex and not directly down-regulated by the presence of a lung mass.

Question 290: A 55-year-old man presents with fatigue and splenomegaly. His complete blood count reveals a marked increase in mature lymphocytes. What condition is consistent with these findings?

A. Acute myeloid leukemia
B. Chronic myeloid leukemia
C. Chronic lymphocytic leukemia (Correct Answer)
D. Acute lymphoblastic leukemia

Explanation: ***Chronic lymphocytic leukemia*** - Characterized by a marked increase in **mature lymphocytes** and often presents with **fatigue and splenomegaly** [1][2]. - Typically seen in older adults, with a **slow progression** and lymphocytic predominance in the blood and bone marrow [2]. *Acute myeloid leukemia* - Presents with **immature myeloid cells** and often involves severe **anemia**, thrombocytopenia, and neutropenia. - Symptoms frequently include **rapid onset of fatigue** and bleeding, not typically splenomegaly as a primary feature. *Acute lymphoblastic leukemia* - Characterized by **immature lymphoblasts** rather than mature lymphocytes, leading to more aggressive symptoms. - Often presents with **bone pain**, lymphadenopathy, and more severe cytopenias, different from the chronic features noted here. *Chronic myeloid leukemia* - Features an increase in **myeloid cells**, particularly **granulocytes**, and is commonly associated with the **Philadelphia chromosome**. - Splenomegaly is common [3][4], but it primarily involves a **myeloid lineage**, not mature lymphocytes as seen in this case. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, p. 602. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 612-613. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 611-612. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 625-626.

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Oncology — MCQs

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