Oncology — MCQs
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What is the percentage of patients with multiple myeloma that exhibit vertebral involvement?
What is the primary function of CA-125 in clinical practice?
Most common cancer to occur in organ transplant patients?
Which malignancy is most commonly associated with hypercalcemia?
Granulomatous lung disease is caused by?
In which of the following conditions is Bendamustine most commonly used for treatment?
Panitumumab is used for which cancer?
Which type of paraneoplastic syndrome is most commonly associated with lung carcinoma?
Carcinoembryonic antigen (CEA) is raised in which of the following conditions?
Screening is not useful in which carcinoma
Oncology Indian Medical PG Practice Questions and MCQs
Question 331: What is the percentage of patients with multiple myeloma that exhibit vertebral involvement?
- A. 66% of patients
- B. 22% of patients
- C. 44% of patients
- D. 88% of patients (Correct Answer)
Explanation: ***66%*** - Approximately **66% of patients** with multiple myeloma exhibit some degree of **vertebral involvement**, primarily due to osteolytic lesions. - These lesions lead to **vertebral compression fractures** and pain, making vertebrae a common site of affection in this condition [1]. *22%* - This figure is significantly lower than the established data indicating **higher vertebral involvement** in multiple myeloma patients. - Such a low percentage does not reflect the **typical clinical realities** associated with this disease. *88%* - While vertebral involvement is common, **88%** is an overestimation and not supported by clinical evidence. - The risk of **spinal lesions** generally peaks around **66%**, indicating a lower frequency than suggested here. *44%* - This percentage underrepresents the true prevalence of vertebral involvement in multiple myeloma, which is higher. - Clinical findings consistently show that most patients demonstrate at least **some level of vertebral affection**.
Question 332: What is the primary function of CA-125 in clinical practice?
- A. CA-125: Tumor marker specific only for ovarian cancer
- B. CA-125: A glycoprotein, tumor marker for ovarian cancer (Correct Answer)
- C. CA-125: Diagnostic marker that confirms ovarian cancer diagnosis
- D. CA-125: Used primarily for screening healthy women for ovarian cancer
Explanation: ***CA-125: A glycoprotein, tumor marker for ovarian cancer*** - **CA-125** is a **glycoprotein** that serves as a **tumor marker**, primarily recognized for its association with **ovarian cancer**. - While not exclusively specific to ovarian cancer, elevated levels are frequently observed in women with this malignancy, making it useful in diagnosis and monitoring [1]. *CA-125: Tumor marker specific only for ovarian cancer* - **CA-125** is **not specific only for ovarian cancer**; its levels can be elevated in various benign conditions [3]. - Conditions such as **endometriosis**, **pelvic inflammatory disease**, **uterine fibroids**, and even menstruation can cause elevated CA-125 levels. *CA-125: Diagnostic marker that confirms ovarian cancer diagnosis* - **CA-125** is **not a diagnostic marker that confirms ovarian cancer**; a definitive diagnosis requires a biopsy and histopathological examination [1]. - Its utility lies in aiding the **diagnosis**, monitoring **treatment response**, and detecting **recurrence**, but it cannot confirm the disease on its own [2]. *CA-125: Used primarily for screening healthy women for ovarian cancer* - **CA-125** is **not recommended for screening healthy women** due to its low specificity and sensitivity [1]. - Using CA-125 for general population screening would lead to a high rate of **false positives**, resulting in unnecessary invasive procedures.
Question 333: Most common cancer to occur in organ transplant patients?
- A. Squamous cell carcinoma (Correct Answer)
- B. Melanoma
- C. Lung cancer
- D. Colorectal cancer
Explanation: ***Squamous cell carcinoma*** - Organ transplant patients are on lifelong **immunosuppressive therapy**, which significantly increases the risk of **skin cancers**, especially squamous cell carcinoma (SCC) [1]. - The risk of SCC in transplant recipients is 65-250 times higher than in the general population, making it the most common malignancy in this group [1]. *Melanoma* - While the risk of **melanoma** is also increased in transplant patients due to immunosuppression, it is **less common** than squamous cell carcinoma [1]. - The increased risk for melanoma in transplant recipients is roughly 2-5 times higher than the general population, which is considerably lower than the increase for SCC. *Lung cancer* - The risk of **lung cancer** is elevated in transplant patients, particularly in those with a history of smoking, but it is **not the most common cancer** overall. - The incidence is influenced by the patient's age, smoking history, and the type of immunosuppression, but skin cancers consistently rank higher in frequency [2]. *Colorectal cancer* - There is a **modest increase** in the risk of **colorectal cancer** among organ transplant recipients, but it is not the most prevalent malignancy [2]. - The elevation in risk is generally much lower than for skin cancers and certain lymphomas linked to post-transplant immunosuppression [2].
Question 334: Which malignancy is most commonly associated with hypercalcemia?
- A. Breast cancer (Correct Answer)
- B. Prostate cancer
- C. Small cell lung cancer
- D. Multiple myeloma
Explanation: ***Breast cancer*** - While other malignancies can cause hypercalcemia, **breast cancer** is the most common solid tumor associated with **hypercalcemia of malignancy (HCM)** [1], [3]. - Hypercalcemia in breast cancer is commonly due to **bone metastases** causing osteolysis or the tumor secreting **parathyroid hormone-related protein (PTHrP)** [1]. *Small cell lung cancer* - **Small cell lung cancer** is more often associated with **syndrome of inappropriate antidiuretic hormone (SIADH)** leading to hyponatremia [1], [2]. - Although it can cause **HCM**, it is less frequent compared to breast cancer [2]. *Multiple myeloma* - **Multiple myeloma** is a hematologic malignancy that very commonly causes hypercalcemia due to **osteolytic bone lesions** and local cytokine release (e.g., IL-6) [2], [3]. - However, among all malignancies (both solid and hematologic), **breast cancer** remains the most prevalent cause of HCM overall. *Prostate cancer* - **Prostate cancer** often metastasizes to bone, leading to predominantly **osteoblastic** (bone-forming) lesions, which are less likely to cause hypercalcemia. - While osteolytic metastases can occur and lead to hypercalcemia, it's not the most common malignancy to do so.
Question 335: Granulomatous lung disease is caused by?
- A. Bronchogenic carcinoma
- B. Sarcoidosis (Correct Answer)
- C. Infection
- D. Hypersensitivity pneumonitis
Explanation: Hypersensitivity pneumonitis - This condition leads to an immune-mediated inflammatory response in the lungs, resulting in granuloma formation [1]. - Associated with exposure to organic antigens, such as mold spores or animal proteins, which trigger a hypersensitivity reaction [1]. Sarcoma - Sarcomas are malignant tumors arising from mesenchymal tissues, not typically associated with granulomatous inflammation in the lungs. - They present as mass lesions rather than diffuse lung disease with granuloma formation. Bronchogenic carcinoma - This type of cancer arises from the lung epithelium and typically presents with malignant cell proliferation, not granulomatous lesions. [1] - Symptoms are often more consistent with obstructive lung disease rather than the immune response seen in granulomatous conditions. Bronchogenic cyst - A bronchogenic cyst is a developmental anomaly that is a cystic lesion located in the mediastinum or lung but does not involve granulomatous lung disease. - It usually has no inflammatory reaction associated with it and is not caused by an immune response.
Question 336: In which of the following conditions is Bendamustine most commonly used for treatment?
- A. Colon carcinoma
- B. Breast carcinoma
- C. Chronic lymphocytic leukemia (CLL)
- D. Non-Hodgkin lymphoma (NHL) (Correct Answer)
Explanation: ***Non-Hodgkin lymphoma (NHL)*** - **Bendamustine** is an **alkylating agent** frequently used in the treatment of various subtypes of **Non-Hodgkin lymphoma (NHL)**, particularly in relapsed or refractory settings, or as first-line therapy [1]. - It is known for its efficacy with a relatively manageable toxicity profile compared to other alkylating agents in NHL [1]. *Colon carcinoma* - **Bendamustine** is **not a standard treatment** for **colon carcinoma**. - Treatment regimens for colon carcinoma commonly involve agents like **5-fluorouracil**, **oxaliplatin**, and **irinotecan**. *Breast carcinoma* - **Bendamustine** is **not a primary chemotherapy agent** for **breast carcinoma**. - Standard chemotherapy for breast cancer often includes **anthracyclines**, **taxanes**, and **cyclophosphamide**. *Chronic lymphocytic leukemia (CLL)* - While **Bendamustine** is also approved and used for **Chronic lymphocytic leukemia (CLL)**, especially in combination with rituximab, it is arguably **most commonly associated with NHL** due to its broader application across various NHL subtypes and different lines of therapy [1]. - For CLL, it is an important option, but its use in NHL is generally more encompassing [1].
Question 337: Panitumumab is used for which cancer?
- A. Metastatic colorectal cancer (associated with wild-type RAS). (Correct Answer)
- B. Non-small cell lung cancer (EGFR mutation-positive).
- C. HER2-positive breast cancer.
- D. Advanced osteosarcoma (chemotherapy-resistant).
Explanation: ***Metastatic colorectal cancer (associated with wild-type RAS)*** - **Panitumumab** is a **monoclonal antibody** that targets the **epidermal growth factor receptor (EGFR)**, whose overexpression is implicated in CRC. - It is specifically effective in patients with **wild-type RAS** (KRAS and NRAS) genes, as mutations in these genes can lead to **EGFR-independent signaling**, rendering EGFR inhibitors ineffective. *Non-small cell lung cancer (EGFR mutation-positive)* - While **EGFR inhibitors** are used in NSCLC, **Panitumumab** is not the primary agent; drugs like **Osimertinib** or **Erlotinib** are commonly used for EGFR-mutated NSCLC. - **Panitumumab**'s approval is specific to **colorectal cancer** and not NSCLC, despite both involving EGFR signaling. *HER2-positive breast cancer* - **HER2-positive breast cancer** is treated with **HER2-targeted therapies** such as **Trastuzumab** or **Pertuzumab**, which target the Human Epidermal Growth Factor Receptor 2. - **Panitumumab** targets EGFR (HER1) and is not indicated for HER2-positive breast cancer. *Advanced osteosarcoma (chemotherapy-resistant)* - **Osteosarcoma** is a bone cancer with treatment regimens typically involving **chemotherapy** and surgery, while targeted therapies for this specific cancer are still under active investigation. - **Panitumumab** has no established role or approval in the treatment of osteosarcoma.
Question 338: Which type of paraneoplastic syndrome is most commonly associated with lung carcinoma?
- A. SIADH (Correct Answer)
- B. Gynaecomastia
- C. Acanthosis nigricans
- D. Hypocalcaemia
Explanation: ***SIADH*** - Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is the **most common paraneoplastic syndrome** associated with **small cell lung carcinoma (SCLC)** due to ectopic **ADH production** [1], [2]. - It leads to **hyponatremia** and fluid retention, often being the presenting symptom for SCLC patients [3]. *Gynaecomastia* - While possible in some cancers, **gynaecomastia** is not a commonly recognized paraneoplastic syndrome for lung carcinoma. - It is more classically associated with conditions causing hormonal imbalances, such as **testicular tumors** or liver cirrhosis. *Acanthosis nigricans* - This is a cutaneous manifestation characterized by **dark, velvety patches** of skin, typically in body folds. - While it can be a paraneoplastic syndrome, it is more commonly associated with **gastrointestinal adenocarcinomas**, not lung carcinoma. *Hypocalcaemia* - **Hypocalcaemia** (low calcium) is a rare paraneoplastic syndrome of lung cancer. - **Hypercalcaemia** (high calcium) is more commonly associated with lung carcinoma, particularly squamous cell carcinoma, due to the production of PTH-related protein (PTHrP) [1].
Question 339: Carcinoembryonic antigen (CEA) is raised in which of the following conditions?
- A. Sickle cell anemia
- B. Inflammatory bowel disease (Correct Answer)
- C. Colorectal cancer
- D. Hepatitis
Explanation: Carcinoembryonic antigen (CEA) is raised in which of the following conditions? ***Inflammatory bowel disease*** - **Carcinoembryonic antigen (CEA)** levels can be elevated in various inflammatory conditions, including **inflammatory bowel disease (IBD)** [1], due to tissue inflammation and turnover, even in the absence of malignancy. - While primarily associated with malignancy, CEA is not specific and can be a non-specific marker of inflammation. *Sickle cell anemia* - **Sickle cell anemia** is a genetic **hemoglobinopathy** characterized by abnormal hemoglobin, leading to red blood cell sickling and hemolysis. - It does not typically cause an elevation in **CEA levels**, as it is not a direct inflammatory or cancerous condition linked to CEA production. *Colorectal cancer* - Although **colorectal cancer** [2] is the most well-known condition associated with significantly elevated **CEA levels**, particularly for monitoring recurrence, the question asks where CEA is "raised," implying conditions beyond just malignancy. - High CEA in colorectal cancer reflects the production of this **onco-fetal glycoprotein** [2] by cancerous cells. *Hepatitis* - **Hepatitis**, an inflammation of the liver, can cause a rise in liver enzymes and other inflammatory markers. - However, **CEA levels** are not typically elevated in hepatitis unless there is an underlying malignancy or severe liver cirrhosis, which is not directly implied by the term "hepatitis" alone.
Question 340: Screening is not useful in which carcinoma
- A. Testicular carcinoma (Correct Answer)
- B. Carcinoma prostate
- C. Carcinoma colon
- D. Carcinoma breast
Explanation: Testicular carcinoma - **Testicular cancer** typically presents as a painless mass, and **self-examination** is often emphasized for early detection rather than formal screening programs due to low incidence and variable benefits. - While early detection is important, population-wide screening for testicular cancer is **not recommended** due to its rarity and lack of evidence for improved outcomes compared to opportunistic detection. *Carcinoma prostate* - **Prostate cancer screening** using **PSA (prostate-specific antigen)** testing and digital rectal examinations is routinely performed, though its benefits and risks are debated [1]. - Early detection aims to identify potentially aggressive cancers, but also leads to **overdiagnosis and overtreatment** of indolent lesions [1]. *Carcinoma colon* - **Colorectal cancer screening** is highly effective and widely recommended through methods like **colonoscopy**, fecal occult blood testing, and sigmoisingoscopy. - Screening aims to detect **polyps** before they become cancerous or find cancer at an early, treatable stage, significantly reducing mortality. *Carcinoma breast* - **Breast cancer screening** using **mammography** is a well-established and highly effective method for early detection in women. - Early detection allows for timely treatment, significantly improving prognosis and reducing breast cancer mortality.
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Cancer Biology and Carcinogenesis
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Principles of Cancer Diagnosis and Staging
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Solid Tumor Management
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Hematological Malignancies
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Cancer Emergencies
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Principles of Chemotherapy, Immunotherapy and Targeted Therapy
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Radiation Oncology Basics
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Palliative Care in Oncology
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Cancer Screening and Prevention
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Paraneoplastic Syndromes
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