Oncology Practice Questions

Q: CAR-T cell therapy (Chimeric Antigen Receptor T-cell therapy) is being investigated for the treatment of which malignancy?

Acute Lymphoblastic Leukemia. ***Acute Lymphoblastic Leukemia*** - **CAR T-cell therapy** has shown remarkable success, particularly in treating refractory or relapsed **B-cell acute lymphoblastic leukemia (ALL)** in children and young adults. - The therapy targets the **CD19 antigen** found on malignant B-cells, leading to their destruction by engineered T-cells. *Renal Cell Carcinoma* - While immune therapies are used for **renal cell carcinoma (RCC)**, traditional CAR T-cell therapy targeting specific antigens has not yet achieved widespread clinical success for this solid tumor. - RCC often presents with a **heterogeneous antigenic landscape**, making it challenging for single-target CAR T-cells. *Pancreatic Cancer* - **Pancreatic cancer** is a challenging malignancy due to its dense stroma and immunosuppressive microenvironment, which limits T-cell infiltration and efficacy. - CAR T-cell therapy for pancreatic cancer is still largely in **early-stage clinical trials**, facing significant hurdles in solid tumor treatment. *Glioblastoma Multiforme* - **Glioblastoma multiforme (GBM)** is an aggressive brain tumor with unique challenges for CAR T-cell therapy, including the **blood-brain barrier** and tumor heterogeneity. - Research is ongoing to develop CAR T-cells that can effectively target GBM, often using **regional delivery methods** or targeting multiple antigens.

Q: Which is the most common tumor leading to death in adults?

Lung cancer. ***Lung cancer*** - **Lung cancer** is the most common cause of cancer-related death in both men and women worldwide [1], [2]. - Its high mortality is attributed to its aggressive nature, late diagnosis, and limited treatment options for advanced stages [3]. *Prostate cancer* - While **prostate cancer** is very common in men, it typically has a slower progression and a relatively high survival rate compared to lung cancer. - Early detection through screening often leads to successful treatment and a good prognosis. *Colorectal cancer* - **Colorectal cancer** is a significant cause of cancer mortality but ranks behind lung cancer in overall deaths [2]. - Improved screening methods like colonoscopies allow for early detection and removal of precancerous polyps, reducing mortality. *Leukemia* - **Leukemia** refers to cancers of the blood and bone marrow, and while serious, they are less common causes of cancer death than solid tumors like lung, colorectal, or prostate cancer [2]. - Advances in chemotherapy, stem cell transplantation, and targeted therapies have significantly improved survival rates for many types of leukemia.

Q: All of the following are paraneoplastic syndromes for renal cell carcinoma except which of the following?

Acanthosis Nigricans. Acanthosis Nigricans - Acanthosis nigricans is primarily associated with **insulin resistance** and is not a known paraneoplastic syndrome related to renal cell carcinoma. - Paraneoplastic syndromes typically involve **systemic effects** of tumors rather than dermatological manifestations like acanthosis nigricans. *Fever* - Fever can occur as a result of the body's response to tumors, including renal cell carcinoma, and is classified as a **paraneoplastic syndrome**. - It reflects the **systemic inflammatory response** often seen with malignancies. *Anaemia* - Anaemia is a common paraneoplastic syndrome associated with renal cell carcinoma due to the production of **erythropoietin** or as a result of **chronic disease** [1]. - It can lead to **fatigue** and pallor in affected individuals, making it relevant to renal cancers [1]. *Amyloidosis* - Amyloidosis can occur as a paraneoplastic syndrome in various malignancies, including renal cell carcinoma, due to **protein misfolding** states. - It can lead to complications affecting **kidney function** and other organs, aligning it with renal cell carcinoma, though kidney tumors also frequently present with hypercalcemia [1].

Q: What is the most common cause of death in patients with advanced cancer?

Infection. ***Infection*** - **Immunosuppression** from cancer itself and its treatments (e.g., chemotherapy, radiation) significantly increases susceptibility to infections. - Many patients with advanced cancer die from **sepsis** or opportunistic infections due to their weakened immune systems [1]. *Bleeding* - While bleeding can be a significant complication in advanced cancer (e.g., from tumor erosion, thrombocytopenia), it is less common as a direct cause of death compared to infection. - Life-threatening hemorrhages are typically managed, and other factors often contribute to mortality. *Respiratory failure* - **Respiratory failure** can occur due to **lung metastases**, direct tumor invasion, or complications like pneumonia in advanced cancer patients. - However, the underlying cause of such pneumonia or decline is often infectious or a result of systemic weakness. *Renal failure* - **Renal failure** can be caused by tumor obstruction of the urinary tract, **nephrotoxic chemotherapy**, or paraneoplastic syndromes. - Although serious, it is not the most frequent immediate cause of death in the broad population of advanced cancer patients.

Q: Which of the following is not associated with Carney's triad?

Atrial myxoma. ***Atrial myxoma*** - Atriomyxoma is not part of **Carney's triad**, which primarily includes **paraganglioma**, **chondroma**, and **gastrointestinal stromal tumors (GIST)**. - Carney's triad is a rare genetic condition associated with **multiple neoplasms**, and atrial myxomas are cardiac tumors, not part of this triad. *Paraganglioma* - Paragangliomas are tumors derived from **neuroendocrine cells**, and they are one of the key components of **Carney's triad**. - They typically arise in **chromaffin tissue**, which is involved in catecholamine secretion. *Chondroma* - Chondromas are benign tumors of **cartilage**, also recognized as a component of **Carney's triad**. - They are often found in the **bones** or soft tissues, but they are part of the neoplasms associated with this condition. *GIST* - Gastrointestinal stromal tumors (GISTs) are significant neoplasms linked to **Carney's triad**, arising from **interstitial cells of Cajal** in the GI tract. - They are characterized by specific mutations and can be a source of gastrointestinal symptoms in affected individuals.

Q: Classic triad in Renal cell carcinoma includes all of the following, Except:

Hypertension. ***Hypertension*** - While hypertension can occur in patients with renal cell carcinoma due to **renin secretion** or other mechanisms, it is **not considered one of the classic triad symptoms**. - The classic triad represents symptoms that historically led to diagnosis, though most RCCs are now discovered incidentally. *Hematuria* - **Gross or microscopic hematuria** is a common symptom of renal cell carcinoma [1], resulting from tumor invasion into the collecting system. - It is one of the **three classic symptoms** associated with advanced disease. *Flank mass* - A palpable **flank mass** indicates a sizable tumor infiltrating the renal parenchyma and is a classic sign of renal cell carcinoma [1]. - This symptom is often associated with later-stage disease. *Abdominal Pain* - **Flank pain** or abdominal pain is a frequent symptom of renal cell carcinoma, which may be caused by tumor growth, hemorrhage, or obstruction. - This symptom, along with hematuria and a flank mass, constitutes the **classic diagnostic triad**.

Q: Which of the following is true regarding carcinoid tumor?

Neuroendocrine tumor. ### Most common site is lung - Carcinoid tumors are more commonly found in the **gastrointestinal tract**, specifically the appendix and ileum, rather than the lungs [1]. - This statement is false as they can occur in the lungs but are not the most common site overall. ### Potentially malignant tumor - Carcinoid tumors can be classified as **malignant,** especially if they show aggressive behavior or metastasis. - Many carcinoid tumors, particularly those in the gastrointestinal tract, can be **non-functional** and less aggressive [1]. ### Neuroendocrine tumor - Carcinoid tumors are indeed a type of **neuroendocrine tumor**, arising from **neuroendocrine cells**. - This classification emphasizes their origin and potential for secretion of hormones like **serotonin**. ### Associated with serotonin production - Many carcinoid tumors produce **serotonin**, leading to symptoms like **carcinoid syndrome** when they metastasize, particularly to the liver [1]. - This statement is true, indicating their involvement in neuroendocrine secretions.

Q: Major contribution to cachexia with advanced cancer?

Tumor-necrosis-factor (TNF). ***Tumor-necrosis-factor (TNF)*** - **Tumor necrosis factor (TNF-α)** is a prominent cytokine involved in the pathogenesis of cancer cachexia, leading to muscle wasting and weight loss [1]. - It induces inflammation, increases **catabolism**, and reduces anabolism, contributing significantly to the metabolic dysfunction seen in cancer patients [1]. *Histamine* - **Histamine** is primarily known for its role in allergic reactions and inflammatory responses, but it is not a major direct driver of cachexia. - While it can be released in various inflammatory conditions, its direct contribution to the severe muscle wasting and metabolic changes of cachexia is limited compared to other cytokines. *Interferon* - **Interferons (IFNs)** are cytokines typically associated with antiviral responses and immune modulation, which can have diverse effects on metabolism. - While some interferons can indirectly contribute to systemic inflammation and fatigue, they are not considered a primary or major direct mediator of muscle catabolism and fat loss characteristic of cancer cachexia. *Clathrin* - **Clathrin** is a protein involved in the formation of clathrin-coated vesicles, essential for **endocytosis** and intracellular trafficking. - It has no direct role in the systemic metabolic dysregulation or muscle wasting associated with cancer cachexia.

Q: All are common sites of primary cancer for bone metastasis except:

Brain. ***Brain*** - The **brain** is not a common site for primary bone metastasis, as bone metastases typically originate from organs like the **breast**, **lung**, and **prostate**. - While brain tumors can metastasize to bone, the reverse (primary bone cancer) occurring here is rare. *Breast* - Breast cancer is one of the **most prevalent sources** of bone metastases, commonly affecting the spine and pelvis. - Symptoms often include **bone pain** and potential fractures due to metastasis. *Brain* - Similar to , while brain tumors can metastasize, **primary cancers** do not commonly originate in the bone. - The **metastatic spread** to the brain from other primary sites is common, but not the other way around. *Breast* - Again, breast cancer commonly leads to **bone metastasis**, accounting for a significant percentage of these cases. - It is important to identify busy metastasis to **manage** symptoms and improve patient outcomes.

Q: Which of the following is a feature of tumor lysis syndrome?

Hypocalcemia (a decrease in blood calcium levels). ***Hypocalcemia (a decrease in blood calcium levels)*** - **Hypocalcemia** in tumor lysis syndrome results from the precipitation of calcium with excessive phosphate released from lysed tumor cells. - The elevated phosphate levels bind to calcium, forming **calcium phosphate crystals** that can deposit in tissues, further lowering serum calcium. *Metabolic alkalosis (a rise in blood pH)* - Tumor lysis syndrome typically leads to **metabolic acidosis**, not alkalosis, due to the release of acidic intracellular metabolites like uric acid and phosphate. - The accumulation of these acidic compounds overwhelms the body's buffering systems, decreasing blood pH. *Hypokalemia (a decrease in blood potassium levels)* - Tumor lysis syndrome is characterized by **hyperkalemia**, an increase in blood potassium, as potassium is a major intracellular cation released during cell lysis. - The rapid breakdown of numerous tumor cells dumps vast amounts of intracellular potassium into the bloodstream. *Hypophosphatemia (a decrease in blood phosphate levels)* - Tumor lysis syndrome causes **hyperphosphatemia**, an elevation in blood phosphate levels, because phosphate is abundantly present within tumor cells and is released upon their destruction. - This excessive release of intracellular phosphate is a hallmark biochemical feature of the syndrome.

Question 1

CAR-T cell therapy (Chimeric Antigen Receptor T-cell therapy) is being investigated for the treatment of which malignancy?

Accepted Answer

Acute Lymphoblastic Leukemia

Answer

Renal Cell Carcinoma

Answer

Pancreatic Cancer

Answer

Glioblastoma Multiforme

Question 2

Which is the most common tumor leading to death in adults?

Accepted Answer

Lung cancer

Answer

Prostate cancer

Answer

Colorectal cancer

Answer

Leukemia

Question 3

All of the following are paraneoplastic syndromes for renal cell carcinoma except which of the following?

Accepted Answer

Acanthosis Nigricans

Answer

Fever

Answer

Amyloidosis

Answer

Anaemia

Question 4

What is the most common cause of death in patients with advanced cancer?

Accepted Answer

Infection

Answer

Bleeding

Answer

Respiratory failure

Answer

Renal failure

Question 5

Which of the following is not associated with Carney's triad?

Accepted Answer

Atrial myxoma

Answer

GIST

Answer

Chondroma

Answer

Paraganglioma

Question 6

Classic triad in Renal cell carcinoma includes all of the following, Except:

Accepted Answer

Hypertension

Answer

Hematuria

Answer

Flank mass

Answer

Abdominal Pain

Question 7

Which of the following is true regarding carcinoid tumor?

Accepted Answer

Neuroendocrine tumor

Answer

Associated with serotonin production

Answer

Potentially malignant tumor

Answer

Most common site is lung

Question 8

Major contribution to cachexia with advanced cancer?

Accepted Answer

Tumor-necrosis-factor (TNF)

Answer

Histamine

Answer

Interferon

Answer

Clathrin

Question 9

All are common sites of primary cancer for bone metastasis except:

Accepted Answer

Brain

Answer

Prostate

Answer

Lung

Answer

Thyroid

Question 10

Which of the following is a feature of tumor lysis syndrome?

Accepted Answer

Hypocalcemia (a decrease in blood calcium levels)

Answer

Metabolic alkalosis (a rise in blood pH)

Answer

Hypokalemia (a decrease in blood potassium levels)

Answer

Hypophosphatemia (a decrease in blood phosphate levels)

Oncology — MCQs

Oncology — MCQs

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