Oncology — MCQs

Oncology Indian Medical PG Practice Questions and MCQs

Question 301: What is the best tumor marker for pancreatic cancer?

A. CA 15-3
B. CA 19-9 (Correct Answer)
C. CEA
D. AFP

Explanation: **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.

Question 302: 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?

A. Primary hyperparathyroidism (Correct Answer)
B. Sarcoidosis
C. Thiazide diuretics
D. Malignancy-associated hypercalcemia

Explanation: ***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 303: A 65-year-old patient presents with hematuria, weight loss, and flank pain. CT shows a solid renal mass with calcifications and renal vein invasion. Laboratory results indicate hemoglobin of 10.8, ESR of 45, and creatinine of 1.6. What is the best diagnosis?

A. Renal cell carcinoma (Correct Answer)
B. Transitional cell carcinoma
C. Angiomyolipoma
D. Wilms' tumor

Explanation: ***Renal cell carcinoma*** - The classic triad of **hematuria, flank pain, and palpable mass** (though a palpable mass isn't explicitly stated, flank pain and hematuria are present) combined with **weight loss** and a **solid renal mass with calcifications and renal vein invasion** on CT are highly indicative of **renal cell carcinoma (RCC)** [1]. - The lab findings of **anemia (Hb 10.8)**, **elevated ESR (45)**, and mild renal dysfunction (creatinine 1.6) further support a diagnosis of RCC, especially with paraneoplastic syndromes. *Transitional cell carcinoma* - This typically arises in the **renal pelvis or ureter** and often presents with painless gross hematuria, but **solid mass with calcifications and renal vein invasion** is less characteristic of TCC. - While it can cause hematuria and flank pain, the imaging findings of a solid renal mass with calcifications and invasion are more typical of parenchymal tumors like RCC. *Angiomyolipoma* - This is a **benign tumor** composed of blood vessels, smooth muscle, and fat, making it appear hyperechoic or fat-containing on imaging, rather than a solid mass with calcifications. - It usually presents with symptoms only when large or hemorrhaging, and **weight loss and renal vein invasion** are not characteristic features. *Wilms' tumor* - Primarily affects **children**, typically presenting as an asymptomatic abdominal mass, hematuria, and hypertension. - This patient's age (65-year-old) makes Wilms' tumor an **extremely unlikely diagnosis** [1].

Question 304: A young male with a testicular mass is found to have elevated beta-hCG levels. What is the most likely diagnosis?

A. Embryonal Carcinoma (Correct Answer)
B. Choriocarcinoma
C. Seminoma
D. Teratoma

Explanation: ***Choriocarcinoma*** - Characterized by **elevated beta-hCG levels**, this indicates **germ cell tumors**, commonly associated with choriocarcinoma. - It often presents with a **testicular mass** and can metastasize to lungs and other organs. *Seminoma* - Typically presents with a **testicular mass** but usually has **normal beta-hCG levels** unless mixed with other germ cell tumors. - Most common germ cell tumor, but generally does not elevate **beta-hCG** significantly. *Embryonal Carcinoma* - Can produce beta-hCG but is usually seen in **mixed germ cell tumors** rather than isolated choriocarcinoma. - Typically presents with a **varied mass**, often painful, and may show **elevated AFP** levels if it's a mixed type. *Teratoma* - Often presents as a **benign mass** with **no elevation of beta-hCG**; typically does not produce hormones. - While teratomas can have malignant potential, they usually do not result in significant **beta-hCG elevation**.

Question 305: A 68-year-old male with a history of smoking presents with hemoptysis and weight loss. A chest X-ray shows a mass in the upper lobe, and laboratory results indicate hypercalcemia. Analyze and determine the diagnosis and initial treatment.

A. Tuberculosis; initial management includes sputum acid-fast bacilli test
B. COPD exacerbation; initial management includes bronchodilators and steroids
C. Pulmonary embolism; initial management includes CT angiography
D. Squamous cell carcinoma; initial management includes bronchoscopy and biopsy (Correct Answer)

Explanation: **Squamous cell carcinoma; initial management includes bronchoscopy and biopsy** - The combination of **hemoptysis**, **weight loss**, a **mass in the upper lobe**, and **hypercalcemia** in a smoker strongly suggests squamous cell carcinoma of the lung [1]. - **Bronchoscopy with biopsy** is essential for definitive diagnosis and staging. *Tuberculosis; initial management includes sputum acid-fast bacilli test* - While **hemoptysis** and **weight loss** can occur in TB, a solitary upper lobe mass and hypercalcemia are less typical [2]. - **Hypercalcemia** is not a common feature of TB; definitive diagnosis requires identifying **acid-fast bacilli**. *COPD exacerbation; initial management includes bronchodilators and steroids* - **COPD exacerbations** present with increased dyspnea, cough, or sputum production, not typically a discrete mass or hemoptysis as a primary symptom. - **Hypercalcemia** is not associated with COPD exacerbations. *Pulmonary embolism; initial management includes CT angiography* - **Pulmonary embolism** symptoms usually include acute dyspnea, pleuritic chest pain, and sometimes hemoptysis [2]. - **CT angiography** is the gold standard for diagnosing PE, but it would not explain the upper lobe mass or hypercalcemia.

Question 306: A 55-year-old woman with cirrhosis is found to have a liver lesion with elevated alpha-fetoprotein. What is the most likely diagnosis?

A. Hepatic adenoma
B. Liver metastasis
C. Hepatocellular carcinoma (Correct Answer)
D. Hemangioma

Explanation: ***Hepatocellular carcinoma*** - **Elevated alpha-fetoprotein (AFP)** levels in a patient with cirrhosis are strongly indicative of hepatocellular carcinoma, which commonly arises in this context [1]. - Hepatocellular carcinoma typically presents as a **liver lesion** and is associated with chronic liver disease and cirrhosis [1]. *Hemangioma* - Generally, hemangiomas are **benign vascular tumors** and do not cause elevated levels of alpha-fetoprotein. - They are often asymptomatic and discovered incidentally on imaging, unlike hepatocellular carcinoma, which will present more aggressively in this setting. *Liver metastasis* - Liver metastases can occur in cirrhotic patients but are less likely to be associated with significant elevations of alpha-fetoprotein unless specific primary tumors are involved. - Primary tumors, such as colorectal cancer, usually produce **different markers**, and the presence of AFP suggests a primary liver cancer rather than metastatic disease. *Hepatic adenoma* - Hepatic adenomas are also benign tumors but are less common in patients with cirrhosis and typically do not cause elevated alpha-fetoprotein levels. - More frequently found in women taking **oral contraceptives**, they generally lack the aggressive features seen in hepatocellular carcinoma.

Question 307: A patient with non-small cell lung cancer (NSCLC) who is resistant to first-line chemotherapy should have which molecular marker evaluated to guide second-line targeted therapy?

A. EGFR mutation (Correct Answer)
B. BRCA1 mutation
C. BCR-ABL fusion gene
D. HER2 overexpression

Explanation: ### EGFR mutation - **EGFR mutations** are common in NSCLC and can lead to resistance to first-line chemotherapy, specifically **tyrosine kinase inhibitors (TKIs)** [1]. - Identifying specific EGFR mutations, such as **T790M**, can guide the use of second-generation or third-generation EGFR TKIs like **osimertinib** as second-line therapy. *BRCA1 mutation* - **BRCA1 mutations** are primarily associated with an increased risk of **breast and ovarian cancers**, and occasionally prostate and pancreatic cancers. - They are not routinely evaluated or considered a primary target for guiding second-line therapy in NSCLC. *BCR-ABL fusion gene* - The **BCR-ABL fusion gene** is a hallmark of **chronic myeloid leukemia (CML)** and some cases of acute lymphoblastic leukemia (ALL) [1]. - This gene is a target for **tyrosine kinase inhibitors** like imatinib in these hematological malignancies but is not relevant for NSCLC [1]. *HER2 overexpression* - **HER2 overexpression** or amplification is a significant prognostic and predictive marker in **breast cancer** and some gastric cancers, guiding **trastuzumab** therapy [1]. - While HER2 alterations can occur in a small subset of NSCLC, they are less common and less established as a primary driver for second-line targeted therapy compared to EGFR mutations.

Question 308: A 40-year-old man presents with generalized lymphadenopathy and a mediastinal mass. Histology reveals Reed-Sternberg cells. Which combination of treatments offers the best chance of remission?

A. Surgery and radiotherapy
B. Chemotherapy and stem cell transplant
C. Immunotherapy and radiation therapy
D. Chemotherapy and radiation therapy (Correct Answer)

Explanation: The original explanation provided already accurately details that chemotherapy and radiation therapy are the standard treatment for Hodgkin's lymphoma [1], as the disease originates in lymphoid tissues and is identified by Reed-Sternberg cells [1]. Chemotherapy functions to reduce tumor burden, while radiation therapy is used to eliminate localized disease [1]. Historically, radiation alone was used for localized (stage IA/IIA) disease [1]. Immunotherapy and surgery are generally not first-line options. While stem cell transplant is used for relapsed or refractory cases, it is not the initial treatment strategy [1].

Question 309: A 25-year-old woman presents with painless hematuria and a history of recurrent urinary tract infections. Urine cytology reveals atypical cells, and cystoscopy shows a papillary lesion. What is the most likely diagnosis?

A. Renal cell carcinoma
B. Transitional cell carcinoma (Correct Answer)
C. Squamous cell carcinoma
D. Adenocarcinoma

Explanation: ***Transitional cell carcinoma*** - Characterized by **painless hematuria** [1] and often occurs in patients with a history of **urinary tract infections**. - The presence of **atypical cells in urine cytology** and a **papillary lesion** found via cystoscopy supports this diagnosis. *Renal cell carcinoma* - Typically presents with **flank pain**, **weight loss**, and **hematuria**, but is less common in young women compared to transitional cell carcinoma. - Uncommonly associated with cystoscopic findings of **papillary lesions**; it usually manifests as solid renal mass rather than urinary tract lesions. *Adenocarcinoma* - Generally arises in **glandular tissue** of the kidney and shows variable presentation, not typically linked to **hematuria** in the bladder. - Rare in the bladder environment and does not align well with **urinary tract infection** history or cystoscopy findings. *Squamous cell carcinoma* - More commonly associated with chronic irritation from **schistosomiasis** or prolonged bladder catheterization rather than recurrent UTIs. - Presents with **painful urination** or hematuria [1] and is not typically related to **papillary lesions** seen in this case.

Question 310: A 65-year-old man presents with fatigue, weight loss, and abdominal pain. A CT scan of the abdomen reveals a pancreatic mass. What is the most likely diagnosis?

A. Chronic pancreatitis
B. Pancreatic adenocarcinoma (Correct Answer)
C. Acute pancreatitis
D. Gastrointestinal stromal tumor

Explanation: ***Pancreatic adenocarcinoma*** - The combination of **fatigue, weight loss, and abdominal pain** in an elderly patient, alongside a **pancreatic mass** on CT, are classic signs of pancreatic adenocarcinoma [1]. - This cancer is often diagnosed at an advanced stage due to its subtle and nonspecific initial symptoms. *Chronic pancreatitis* - While chronic pancreatitis can cause abdominal pain and weight loss, it typically presents with a history of recurrent episodes of pancreatitis, often related to **alcohol abuse** [2] or **gallstones**. - A mass on CT in chronic pancreatitis is usually an **inflammatory pseudotumor** or **fibrotic change**, not a distinct solid mass with these systemic symptoms [2]. *Acute pancreatitis* - This condition presents with acute, severe upper abdominal pain, often radiating to the back, associated with elevated pancreatic enzymes (**amylase and lipase**). - It usually does not involve significant weight loss or prolonged fatigue unless it leads to severe complications. *Gastrointestinal stromal tumor* - GISTs are **mesenchymal tumors** that originate in the gastrointestinal tract, most commonly the stomach or small intestine, and rarely in the pancreas. - While they can cause abdominal pain and weight loss, a mass in the pancreas is less commonly a GIST compared to adenocarcinoma.

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Oncology — MCQs

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