Oncology — MCQs

Oncology Indian Medical PG Practice Questions and MCQs

Question 311: A 70-year-old woman presents with fatigue, weight loss, and anorexia. Physical examination reveals hepatomegaly and jaundice. Laboratory results show elevated alpha-fetoprotein. What is the most likely diagnosis?

A. Pancreatic cancer
B. Hepatocellular carcinoma (Correct Answer)
C. Gallbladder cancer
D. Cholangiocarcinoma

Explanation: ***Hepatocellular carcinoma*** - The constellation of **fatigue, weight loss, anorexia, hepatomegaly, jaundice**, and elevated **alpha-fetoprotein** strongly points to hepatocellular carcinoma (HCC) [1]. - **Alpha-fetoprotein (AFP)** is a well-established tumor marker for HCC, often elevated in a significant proportion of cases [3]. *Pancreatic cancer* - While it can cause weight loss, fatigue, and jaundice, **hepatomegaly** is less common, and **elevated alpha-fetoprotein** is not a characteristic marker for pancreatic cancer [1]. - Typical markers include **CA 19-9**, and jaundice is often due to **biliary obstruction**. *Gallbladder cancer* - This cancer can present with weight loss and jaundice due to biliary obstruction, but **hepatomegaly** is not a primary feature unless there's extensive metastasis [2]. - **Elevated alpha-fetoprotein** is not typically associated with gallbladder cancer. *Cholangiocarcinoma* - Similar to gallbladder cancer, cholangiocarcinoma can cause **jaundice and weight loss** due to involvement of the bile ducts [2]. - However, **alpha-fetoprotein** is not a typical tumor marker for cholangiocarcinoma; **CEA and CA 19-9** are more commonly elevated.

Question 312: A 25-year-old male presents with a painless swelling in the scrotum. An ultrasound shows a heterogeneous mass in the testis. Which marker is most likely to be elevated in this patient?

A. Prostate-specific antigen
B. Carcinoembryonic antigen
C. Alpha-fetoprotein (Correct Answer)
D. Beta-human chorionic gonadotropin

Explanation: ***Beta-human chorionic gonadotropin*** - A **heterogeneous mass** in the testis along with painless swelling raises suspicion of **germ cell tumors**, particularly **choriocarcinoma**, which is known to elevate this marker [1]. - It is commonly associated with testicular **tumors** in young males and can help in diagnosis and monitoring treatment response [1]. Syncytiotrophoblast cells scattered within germ cell tumors also cause moderate elevation of serum hCG, and approximately 15% of seminomas contain syncytiotrophoblasts that elevate HCG levels. *Alpha-fetoprotein* - Typically elevated in **non-seminomatous germ cell tumors** like **yolk sac tumors** and **mixed germ cell tumors** [1], but not specifically for the mass described. - Less relevant in cases primarily associated with **choriocarcinoma** or **seminomas**, which are more common in this age group. *Prostate-specific antigen* - Mainly used as a marker for **prostate cancer** and conditions related to the **prostate**, not applicable to testicular masses [1]. - Elevated in older males and has no significance in the context of a **scrotal mass** in young men. *Carcinoembryonic antigen* - Generally associated with **colorectal and certain other cancers**, not typically relevant in testicular masses [1]. - Does not provide information about the type of tumor present in the **testis**, making it an inappropriate marker in this case.

Question 313: A 40-year-old man presents with a persistent cough and hemoptysis. Imaging shows a mass in the right upper lobe, and a biopsy reveals squamous cell carcinoma. What is the most likely etiological factor?

A. Asbestos exposure
B. Cigarette smoking (Correct Answer)
C. Radon exposure
D. Viral infection

Explanation: ***Cigarette smoking*** [1] - Cigarette smoking is the **most significant risk factor** for the development of squamous cell carcinoma of the lung [1]. - It accounts for nearly **85% of lung cancer cases**, primarily due to the carcinogens present in tobacco smoke. *Radon exposure* - Radon exposure is a known risk factor for **lung cancer**, but it is more strongly associated with **adenocarcinoma** than with squamous cell carcinoma. - The risk from radon is generally lower than that posed by **cigarette smoking**, making it less likely in this scenario. [1] *Asbestos exposure* - Asbestos exposure is primarily associated with **mesothelioma** and lung cancer, but primarily the **adenocarcinoma** type, rather than squamous cell carcinoma. - It typically requires prolonged exposure and is not as directly linked to the risk seen with **cigarette smoking**. *Viral infection* - While viral infections like **HPV** can contribute to certain cancers, they are not a common etiology for **squamous cell carcinoma of the lung**. - Other environmental and lifestyle factors, especially **tobacco**, play a much more prominent role in lung cancer development. [1]

Question 314: A 65-year-old female presents with progressive dysphagia. A barium swallow shows multiple areas of narrowing with proximal dilatation. What is the most likely diagnosis?

A. Achalasia
B. Esophageal cancer (Correct Answer)
C. Peptic stricture
D. Esophageal varices

Explanation: ***Esophageal cancer*** - Progressive dysphagia, especially in an elderly patient, along with narrowing and proximal dilation seen on barium swallow, is highly concerning for **esophageal cancer**. - This presentation often signifies an **obstructive lesion** that is gradually worsening [1]. *Achalasia* - Achalasia is characterized by dysphagia for both solids and liquids due to **failure of lower esophageal sphincter (LES) relaxation** and aperistalsis [2]. - While it causes proximal dilation, the classic barium swallow finding is a **bird's beak appearance**, with smooth narrowing at the LES, not multiple areas of narrowing [2]. *Peptic stricture* - A peptic stricture typically causes **intermittent or progressive dysphagia** for solids due to chronic acid reflux leading to inflammation and scarring [1]. - While it presents with narrowing and upstream dilation, the history usually includes **heartburn** and **regurgitation**, and there's often *a single, shorter stricture* rather than multiple areas of narrowing. *Esophageal varices* - Esophageal varices are **dilated veins** in the lower esophagus, usually a complication of **portal hypertension**. - They typically present with **hematemesis** or melena due to rupture and bleeding, not progressive dysphagia as the primary symptom.

Question 315: A 70-year-old woman presents with recurrent urinary tract infections and a palpable pelvic mass. An ultrasound shows a large, irregular mass on the anterior wall of the bladder. What is the most likely diagnosis?

A. Bladder cancer (Correct Answer)
B. Uterine fibroids
C. Cystocele
D. Bladder diverticulum

Explanation: ***Bladder cancer*** - The combination of **recurrent UTIs**, a **palpable pelvic mass**, and an **irregular mass on the anterior bladder wall** on ultrasound is highly suggestive of bladder cancer, which can present with these non-specific symptoms. - Bladder cancer is more common in older individuals and can lead to symptoms like recurrent infections due to compromised bladder integrity or obstruction. *Uterine fibroids* - While uterine fibroids can present as a **pelvic mass**, they typically arise from the **uterus**, not the bladder wall. - They are less likely to cause recurrent UTIs unless they are very large and compress the bladder or ureters. *Cystocele* - A cystocele is a **prolapse of the bladder** into the vagina, manifesting as a bulge or pressure, not typically an irregular mass *on* the bladder wall seen on ultrasound. - While it can cause recurrent UTIs due to incomplete bladder emptying, the description of an "irregular mass" points away from this condition. *Bladder diverticulum* - A bladder diverticulum is an **outpouching of the bladder wall**, which can be congenital or acquired. - While it can be associated with recurrent UTIs due to urinary stasis, it is generally a **smooth-walled pouch** and not typically described as a large, "irregular mass" on the anterior bladder wall, which suggests a solid or infiltrative lesion.

Question 316: Which of the following is the first-line treatment for a patient diagnosed with Hodgkin's lymphoma?

A. Surgical resection
B. Chemotherapy with ABVD regimen (Correct Answer)
C. Radiation therapy alone
D. Immunotherapy with checkpoint inhibitors

Explanation: **Chemotherapy with ABVD regimen** - The **ABVD regimen (Adriamycin, Bleomycin, Vinblastine, Dacarbazine)** is a standard first-line chemotherapy protocol for both early and advanced stages of **Hodgkin's lymphoma**. - It is highly effective in inducing remission and has a well-established safety profile, making it the preferred initial treatment approach. *Surgical resection* - **Surgical resection** is generally not a primary treatment for Hodgkin's lymphoma, as it is a systemic disease. [1] - It may be used for **diagnostic biopsy** or to address complications, but not as definitive first-line therapy. [1] *Radiation therapy alone* - While **radiation therapy** is crucial in Hodgkin's lymphoma management, it is typically used in conjunction with chemotherapy, especially for localized disease. - **Radiation therapy alone** is usually reserved for very early-stage disease with favorable prognostic features in specific clinical settings. [1] *Immunotherapy with checkpoint inhibitors* - **Immunotherapy with checkpoint inhibitors** (e.g., nivolumab, pembrolizumab) is primarily reserved for **relapsed or refractory Hodgkin's lymphoma** after failure of initial chemotherapy. - It is not considered a first-line treatment option, especially given the high efficacy of ABVD in newly diagnosed cases.

Question 317: A 70-year-old man presents with weight loss, night sweats, and an abdominal mass. A CT scan reveals a large mesenteric mass, and a biopsy shows sheets of large lymphoid cells. What is the likely diagnosis?

A. Non-Hodgkin lymphoma (Correct Answer)
B. Multiple myeloma
C. Chronic lymphocytic leukemia
D. Hodgkin lymphoma

Explanation: ***Non-Hodgkin lymphoma*** - The presence of a **large mesenteric mass** with sheets of **large lymphoid cells** on biopsy is characteristic of non-Hodgkin lymphoma, especially in older adults [1]. - Symptoms such as **weight loss** and **night sweats** align with the clinical presentation of aggressive non-Hodgkin lymphoma [1]. [2] *Multiple myeloma* - Typically presents with **bone pain**, **anemia**, and high levels of **monoclonal proteins**, not primarily with a mesenteric mass [3]. - Characterized by **punched-out** lytic lesions on imaging rather than large lymphoid masses. *Hodgkin lymphoma* - Often presents with **lymphadenopathy** and **Reed-Sternberg cells**, and less commonly with mesenteric masses [1]. - Frequently associated with **B symptoms**, but the predominant presentation here suggests a different diagnosis [2]. *Chronic lymphocytic leukemia* - Generally results in **lymphocytosis** and may involve lymph nodes but does not typically present with a large abdominal mass. - Usually presents insidiously and may show **splenomegaly**, but is not associated with sheets of large lymphoid cells seen in this case.

Question 318: A 60-year-old man presents with progressive fatigue. Laboratory results reveal microcytic anemia, and a colonoscopy shows a mass. Which type of colon cancer is most commonly associated with this presentation?

A. Sigmoid colon carcinoma
B. Rectal carcinoma
C. Ascending colon carcinoma (Correct Answer)
D. Descending colon carcinoma

Explanation: ***Ascending colon carcinoma*** - Carcinomas in the **right (ascending) colon** often present with **occult bleeding** leading to **iron deficiency anemia** (microcytic anemia), and subtle symptoms like fatigue, making them harder to detect until advanced [1]. - The wider lumen and more liquid stool in the ascending colon allow tumors to grow larger before causing obstructive symptoms [1]. *Sigmoid colon carcinoma* - **Sigmoid colon cancers** are distal and typically present with symptoms related to **obstruction**, changes in bowel habits, or more overt rectal bleeding due to the narrower lumen and more formed stool [1]. - While they can cause anemia, it's less commonly the sole or primary presenting symptom compared to right-sided lesions [1]. *Rectal carcinoma* - **Rectal cancers** commonly present with symptoms such as **hematochezia** (bright red blood per rectum), tenesmus, or changes in stool caliber [1]. - While they can also lead to anemia, their proximity to the anus often causes more immediate and noticeable bleeding symptoms [1]. *Descending colon carcinoma* - Similar to sigmoid colon cancers, **descending colon carcinomas** tend to cause symptoms related to **partial obstruction**, such as changes in bowel habits, abdominal pain, or tenesmus. - They are less frequently associated with occult bleeding and microcytic anemia as the primary presentation compared to right-sided lesions.

Question 319: A 60-year-old woman with a history of breast cancer presents with new-onset back pain and difficulty walking. An MRI shows spinal cord compression. What is the next best step?

A. Chemotherapy
B. Radiation therapy
C. Surgery
D. Corticosteroids (Correct Answer)

Explanation: ***Corticosteroids*** - **Corticosteroids** are the immediate next step in managing **spinal cord compression** [1] to reduce **edema** around the cord and alleviate pressure, preventing further neurological damage. - This provides temporary relief and time for definitive treatment planning. *Chemotherapy* - **Chemotherapy** is a systemic treatment for cancer and is typically not the initial emergent therapy for acute **spinal cord compression**, though it may be part of the long-term management after stabilization [2]. - Its effects are often delayed, and it doesn't provide the rapid anti-inflammatory action needed to protect the spinal cord. *Radiation therapy* - **Radiation therapy** is a crucial definitive treatment for malignant spinal cord compression but usually follows initial stabilization with corticosteroids and a thorough evaluation [1]. - While effective, it takes time to administer and has a slower onset of action in reducing tumor bulk and edema compared to corticosteroids [2]. *Surgery* - **Surgery** (decompression) is an option for certain cases of spinal cord compression, particularly when there is bony compression, neurological deficit progression despite steroids, or an unknown primary tumor [1]. - However, in many cases, especially with an immediate need to reduce swelling and improve symptoms, **corticosteroids** are administered first to stabilize the patient before considering surgical intervention [1].

Question 320: A 40-year-old man with a history of chronic alcohol use presents with epigastric pain and weight loss. Imaging reveals a pancreatic mass. What is the most likely diagnosis?

A. Pancreatitis
B. Pancreatic adenocarcinoma (Correct Answer)
C. Gastric ulcer
D. Liver metastasis

Explanation: ***Pancreatic adenocarcinoma*** - The combination of **epigastric pain**, **weight loss**, and a **pancreatic mass** in a 40-year-old, especially with a history of chronic alcohol use (which is a risk factor), is highly suspicious for pancreatic adenocarcinoma. - This cancer often presents late with non-specific symptoms, leading to advanced disease at diagnosis. *Pancreatitis* - While chronic alcohol use is a major cause of **pancreatitis** [1], the presence of a distinct **pancreatic mass** along with significant **weight loss** makes malignancy more likely than simple inflammation, especially in this age group. - Pancreatitis typically causes acute, severe pain, and while chronic pancreatitis can lead to pain and weight loss, a mass points towards a neoplastic process [1]. *Gastric ulcer* - A **gastric ulcer** would typically present with epigastric pain, but it is less likely to cause a **pancreatic mass** or significant, unexplained **weight loss** specific to pancreatic involvement. - The imaging specificity for a pancreatic mass rules out a primary gastric ulcer as the sole diagnosis. *Liver metastasis* - **Liver metastasis** implies a primary cancer elsewhere that has spread to the liver, not originating as a primary pancreatic mass. - While pancreatic cancer can metastasize to the liver, the initial finding of a "pancreatic mass" points to the pancreas as the primary site of concern.

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Oncology — MCQs

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