Oncology Practice Questions

Q: Which marker is most commonly elevated in hepatocellular carcinoma?

Alpha-fetoprotein. ***Alpha-fetoprotein*** - ***Alpha-fetoprotein (AFP)*** is the most common tumor marker elevated in **hepatocellular carcinoma (HCC)**, with levels often significantly higher in affected individuals [1]. - Its elevation is associated with **liver disease**, making it a crucial marker in the diagnosis and monitoring of HCC [1]. *PSA* - **Prostate-specific antigen (PSA)** is primarily elevated in **prostate cancer** and does not correlate with hepatocellular carcinoma [2]. - It is a marker for **prostate disease**, not liver pathology, distinguishing it from AFP [2]. *CEA* - **Carcinoembryonic antigen (CEA)** is more commonly associated with **colorectal** and other cancers but is not specific to hepatocellular carcinoma [2]. - Levels may be elevated in various malignancies, making it less reliable as a specific marker for HCC. *CA 19-9* - **CA 19-9** is mainly associated with **pancreatic** and **biliary tract cancers**, not hepatocellular carcinoma. - Elevated levels usually indicate gastrointestinal malignancies rather than liver issues.

Q: A patient with known breast cancer presents with shortness of breath. A chest CT reveals multiple nodules throughout both lungs. What is the most likely diagnosis?

Metastatic disease. Metastatic disease - The presence of **multiple lung nodules** in a patient with a known history of **breast cancer** strongly suggests hematogenous spread to the lungs [1]. - Breast cancer frequently metastasizes to the lungs, and these **multiple, widespread nodules** are a classic presentation of such progression [1]. Patients with two or more pulmonary nodules can often be assumed to have metastases [2]. *Primary lung cancer* - While lung cancer can manifest as nodules, the presence of **multiple, scattered nodules in both lungs** in a patient with an existing primary cancer makes this less likely to be a *de novo* primary lung cancer. - Primary lung cancer typically presents as a **single mass** or a more localized process, although multifocal primary lung cancers can occur, they are less common than metastatic disease in this context [2]. *Pneumonia* - Pneumonia would typically present with **infiltrates or consolidation**, often associated with fever, cough with sputum, and elevated inflammatory markers. - **Multiple, discrete lung nodules** are not a typical presentation of pneumonia. *Pulmonary embolism* - Pulmonary embolism causes **filling defects** in the pulmonary arteries and can lead to infarcts, which might appear as wedge-shaped opacities, but usually not as **multiple, diffuse nodules** throughout both lungs. - Symptoms would typically include sudden onset of **pleuritic chest pain** and hypoxemia, which may or may not be present with shortness of breath.

Q: A 55-year-old man with a history of smoking presents with chronic cough and dyspnea. His chest X-ray reveals a mass. Which imaging study is the most appropriate next step for further evaluation?

Low-dose CT scan. ***Low-dose CT scan*** - A **CT scan** provides much greater detail and **cross-sectional imaging** compared to a chest X-ray, allowing for better characterization of the mass, including its size, location, and potential involvement of surrounding structures [1]. - This detailed information is crucial for determining the next steps in diagnosis and staging, such as guiding biopsies or surgical planning for suspected lung cancer [1]. *Chest X-ray* - A chest X-ray has already been performed and revealed the mass, but it offers **limited resolution** and **three-dimensional information**, making it insufficient for detailed characterization or staging of a suspicious lesion [1]. - Further evaluation requires a more advanced imaging modality to better define the mass and assess for potential malignancy. *Sputum cytology* - **Sputum cytology** is a non-invasive test that can identify **malignant cells** in respiratory secretions, but its sensitivity is generally low, especially for peripheral lesions. - While it can be part of a diagnostic workup, it is not the most appropriate immediate next step for further evaluating a mass seen on imaging, which requires better anatomical definition. *MRI* - **MRI** is excellent for soft tissue contrast and can be used in some cases of lung cancer for **staging**, particularly for assessing **chest wall invasion** or **brain metastases**. - However, for initial evaluation of a pulmonary mass, its role is typically secondary to CT, as CT offers superior resolution for lung parenchyma and is faster and more cost-effective for primary characterization.

Q: A patient presents with chest pain and a pericardial effusion. Histology reveals malignant mesothelial cells. Which risk factor is most strongly associated with malignant mesothelioma?

Asbestos exposure. ***Asbestos exposure*** - Asbestos exposure is the most significant risk factor associated with **malignant mesothelioma**, particularly affecting the pleura and pericardium [1]. - This malignancy often presents with **pericardial effusion** and pleuritic chest pain, aligning with the patient's symptoms. - Mesothelioma is exceptionally rare in the absence of asbestos exposure [1]. *Silica dust exposure* - While silica exposure is a risk factor for lung diseases, particularly **silicosis** and **lung cancer**, it is not strongly linked to mesothelioma. - Mesothelioma is predominantly associated with **asbestos**, not silica [1]. *Tobacco smoke* - Tobacco smoke is primarily linked to **lung cancer** and respiratory diseases, but does not have a significant correlation with **mesothelioma**. - Mesothelioma can occur in non-smokers, indicating a separation from tobacco exposure. *Alcohol consumption* - Alcohol consumption is linked to various health conditions but is not recognized as a risk factor for **mesothelioma**. - The disease's association is predominantly with **asbestos exposure**, not lifestyle factors like alcohol use [1].

Q: A 55-year-old female presents with a gradually enlarging, painless mass in her left breast. She also reports recent nipple retraction and peau d'orange skin changes. What is the most likely diagnosis?

Invasive ductal carcinoma. ***Invasive ductal carcinoma*** - The combination of a **gradually enlarging, painless mass**, **nipple retraction**, and **peau d'orange skin changes** are classic signs of advanced **invasive ductal carcinoma** [1]. - **Peau d'orange** occurs due to **lymphatic obstruction** by tumor cells, leading to edema and thickening of the skin, mimicking an orange peel. *Fibroadenoma* - This is a **benign tumor** typically found in younger women, presenting as a **mobile, rubbery, well-defined mass**. - It does not usually cause **nipple retraction** or **peau d'orange** changes. *Breast cyst* - **Breast cysts** are fluid-filled sacs that are often **tender** or **painful** and can fluctuate in size with the menstrual cycle. - They typically present as **smooth, mobile masses** and do not cause the advanced signs like **nipple retraction** or **peau d'orange**. *Ductal carcinoma in situ* - **Ductal carcinoma in situ (DCIS)** is a **non-invasive cancer** confined to the milk ducts [1]. - It often presents as **microcalcifications on mammography** and typically does not manifest with palpable masses, nipple retraction, or peau d'orange unless associated with an invasive component [1].

Q: A 50-year-old woman with metastatic melanoma has started a new immunotherapy drug. Which of the following is a common side effect of immune checkpoint inhibitors?

Pneumonitis. ***Pneumonitis*** - **Pneumonitis** is a common and potentially severe immune-related adverse event (irAE) associated with immune checkpoint inhibitors, occurring when the activated immune system targets lung tissue. - Patients may present with cough, dyspnea, and hypoxia, and imaging often shows ground-glass opacities or interstitial infiltrates. *Nephrotoxicity* - While **renal irAEs** can occur, leading to **acute kidney injury** or interstitial nephritis, they are less common than pneumonitis or colitis. - The incidence of severe **nephrotoxicity** is relatively low compared to other organ toxicities. *Hepatotoxicity* - **Hepatotoxicity** in the form of **immune-mediated hepatitis** is a recognized irAE that can range from asymptomatic transaminitis to acute liver failure. - However, it occurs with a lower frequency than pneumonitis in many studies of immune checkpoint inhibitors. *Cardiotoxicity* - **Immune-mediated myocarditis** is a rare but life-threatening irAE, often presenting with non-specific symptoms like fatigue or dyspnea, or more severely as **heart failure** or arrhythmias. - Though highly morbid, its overall incidence is much lower than that of pneumonitis.

Q: A 70-year-old man presents with fatigue, weight loss, and jaundice. Laboratory tests show elevated alkaline phosphatase and bilirubin levels. Imaging reveals bile duct dilation and a mass at the pancreatic head. A biopsy confirms adenocarcinoma. What is the likely diagnosis?

Pancreatic adenocarcinoma. ***Pancreatic adenocarcinoma*** - The presence of a **mass at the pancreatic head**, alongside elevated alkaline phosphatase and bilirubin levels, is indicative of pancreatic adenocarcinoma, often causing obstructive jaundice [1]. - **Fatigue** and **weight loss** are common systemic symptoms due to malignancy and are consistent with this diagnosis [2]. *Gallbladder carcinoma* - While it can present with jaundice, it more commonly involves **gallbladder-related symptoms** and typically does not manifest as a mass at the **pancreatic head**. - Imaging findings would show issues focused on the **gallbladder** or nearby structures rather than the **pancreatic duct**. *Hepatocellular carcinoma* - This type of cancer usually arises in the presence of **chronic liver disease** and may show liver lesions rather than a mass in the **pancreas**. - The imaging would likely demonstrate **focal liver lesions** rather than bile duct dilation associated with obstruction. *Cholangiocarcinoma* - Although it involves the bile ducts and can cause jaundice, it would typically present with a mass specifically in the **bile duct** rather than the **pancreatic head**. - Patients often showcase different imaging characteristics and potential intrahepatic lesions compared to the described findings [3].

Q: What is the best tumor marker for pancreatic cancer?

CA 19-9. **CA 19-9** - **CA 19-9** is the most widely accepted and commonly used tumor marker for **pancreatic adenocarcinoma**, particularly for monitoring response to treatment and recurrence. - Elevated levels are often seen in patients with pancreatic cancer and can correlate with **tumor burden** and prognosis. *CA 15-3* - **CA 15-3** is primarily used as a tumor marker for **breast cancer**, not pancreatic cancer. - It is utilized for monitoring treatment response and detecting recurrence in patients with breast cancer, especially **metastatic disease**. *CEA* - **CEA (Carcinoembryonic Antigen)** is a general tumor marker elevated in various cancers, including **colorectal**, **lung**, and **gastric cancer**. - While it can be elevated in some pancreatic cancer cases, it is less specific and sensitive for pancreatic cancer than CA 19-9. *AFP* - **AFP (Alpha-fetoprotein)** is the primary tumor marker for **hepatocellular carcinoma (HCC)** and **germ cell tumors**. - It is not routinely used for the diagnosis or monitoring of pancreatic cancer.

Q: A 60-year-old female with chronic kidney disease presents with generalized weakness and hyperreflexia. Her serum calcium level is 14 mg/dL. What is the most likely cause?

Primary hyperparathyroidism. ***Primary hyperparathyroidism*** - In patients with **chronic kidney disease (CKD)**, the kidneys may struggle to activate Vitamin D, which can lead to **secondary hyperparathyroidism**. However, if hypercalcemia is present alongside hyperreflexia, this points to **primary disease**, where one or more parathyroid glands are overactive independently of serum calcium levels. - While CKD typically involves complications like **renal osteodystrophy** and **low calcium/high phosphate**, persistent hypercalcemia with hyperreflexia, especially at this critical level, despite CKD, strongly suggests autonomous **parathyroid gland dysfunction**. *Sarcoidosis* - Sarcoidosis causes **hypercalcemia** due to extrarenal production of **1,25-dihydroxyvitamin D** by activated macrophages. - While it can cause generalized weakness, hyperreflexia is not a typical neurological manifestation of sarcoidosis. *Thiazide diuretics* - Thiazide diuretics can cause mild **hypercalcemia** by increasing **renal calcium reabsorption**. - However, the serum calcium level of 14 mg/dL is usually more severe than what is typically caused by thiazide diuretics alone, and chronic kidney disease typically makes this less likely given impaired calcium and phosphate handling. *Malignancy-associated hypercalcemia* - **Malignancy-associated hypercalcemia** can present with severe hypercalcemia and generalized weakness, due to the release of **PTHrP** or bone destruction. - While possible, the combination of **chronic kidney disease** and hyperreflexia makes primary hyperparathyroidism a more specific and likely underlying cause in this scenario.

Question 1

Which marker is most commonly elevated in hepatocellular carcinoma?

Accepted Answer

Alpha-fetoprotein

Answer

CEA

Answer

CA 19-9

Answer

PSA

Question 2

A patient with known breast cancer presents with shortness of breath. A chest CT reveals multiple nodules throughout both lungs. What is the most likely diagnosis?

Accepted Answer

Metastatic disease

Answer

Primary lung cancer

Answer

Pneumonia

Answer

Pulmonary embolism

Question 3

A 55-year-old man with a history of smoking presents with chronic cough and dyspnea. His chest X-ray reveals a mass. Which imaging study is the most appropriate next step for further evaluation?

Accepted Answer

Low-dose CT scan

Answer

Chest X-ray

Answer

Sputum cytology

Answer

MRI

Question 4

Which of the following is the most appropriate screening test for colorectal cancer in average-risk individuals?

Accepted Answer

Comprehensive endoscopic examination of the colon (Colonoscopy)

Answer

Stool-based test for hidden blood (FOBT)

Answer

Imaging-based colon examination (CT colonography)

Answer

Endoscopic examination of the lower colon (Flexible sigmoidoscopy)

Question 5

A patient presents with chest pain and a pericardial effusion. Histology reveals malignant mesothelial cells. Which risk factor is most strongly associated with malignant mesothelioma?

Accepted Answer

Asbestos exposure

Answer

Consumption of alcohol

Answer

Exposure to silica dust

Answer

Exposure to tobacco smoke

Question 6

A 55-year-old female presents with a gradually enlarging, painless mass in her left breast. She also reports recent nipple retraction and peau d'orange skin changes. What is the most likely diagnosis?

Accepted Answer

Invasive ductal carcinoma

Answer

Fibroadenoma

Answer

Breast cyst

Answer

Ductal carcinoma in situ

Question 7

A 50-year-old woman with metastatic melanoma has started a new immunotherapy drug. Which of the following is a common side effect of immune checkpoint inhibitors?

Accepted Answer

Pneumonitis

Answer

Nephrotoxicity

Answer

Hepatotoxicity

Answer

Cardiotoxicity

Question 8

A 70-year-old man presents with fatigue, weight loss, and jaundice. Laboratory tests show elevated alkaline phosphatase and bilirubin levels. Imaging reveals bile duct dilation and a mass at the pancreatic head. A biopsy confirms adenocarcinoma. What is the likely diagnosis?

Accepted Answer

Pancreatic adenocarcinoma

Answer

Cholangiocarcinoma

Answer

Hepatocellular carcinoma

Answer

Gallbladder carcinoma

Question 9

What is the best tumor marker for pancreatic cancer?

Accepted Answer

CA 19-9

Answer

CA 15-3

Answer

CEA

Answer

AFP

Question 10

A 60-year-old female with chronic kidney disease presents with generalized weakness and hyperreflexia. Her serum calcium level is 14 mg/dL. What is the most likely cause?

Accepted Answer

Primary hyperparathyroidism

Answer

Sarcoidosis

Answer

Thiazide diuretics

Answer

Malignancy-associated hypercalcemia

Oncology — MCQs

Oncology — MCQs

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