Oncology — MCQs
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Chemotherapeutic Agent of Choice for the treatment of CML?
What is true about HER2/neu overexpression in cancer?
Which type of cancer is most commonly associated with exposure to thorium?
All of the following are risk factors for carcinoma of the gallbladder, EXCEPT -
Tumor marker for medullary carcinoma of the thyroid is:
Which cancer most commonly metastasizes to the brain?
A 57-year-old man presents with hemoptysis and generalized weakness. His symptoms began with small-volume hemoptysis 4 weeks ago, followed by progressive weakness, fatigue, and weight loss over the past 2 weeks. He has a 45-pack-year history of cigarette smoking. Physical examination is unremarkable, and laboratory studies reveal mild anemia and hyponatremia. Chest x-ray shows a 5-cm left, mid-lung field mass with mediastinal lymphadenopathy. MR scan of the brain is normal. What is the most likely cause of his symptoms?
A patient with Hodgkin's lymphoma presents with isolated cervical lymphadenopathy, and biopsy from the lesion shows characteristic lacunar cells. The treatment of choice for this patient is:
Which of the following is used in the treatment of well-differentiated thyroid carcinoma?
A 50-year-old woman is discovered to have metastatic breast cancer and develops bacterial pneumonia one week after receiving her first dose of chemotherapy. Which of the following best explains this patient's susceptibility to bacterial infection?
Oncology Indian Medical PG Practice Questions and MCQs
Question 351: Chemotherapeutic Agent of Choice for the treatment of CML?
- A. Imatinib (Correct Answer)
- B. Vincristine
- C. Cyclophosphamide
- D. Methotrexate
Explanation: ***Imatinib*** - **Imatinib** is a **tyrosine kinase inhibitor** specifically targeting the **BCR-ABL fusion protein**, which is the hallmark of CML [1][2]. - It dramatically improved the prognosis of CML patients, making it the **first-line therapy** and agent of choice due to its high efficacy and relatively low toxicity compared to conventional chemotherapy [2]. *Vincristine* - **Vincristine** is a **vinca alkaloid** that inhibits microtubule formation, primarily used in acute leukemias and lymphomas. - It is not the agent of choice for CML due to its different mechanism of action and the availability of more targeted therapies for CML. *Cyclophosphamide* - **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, used in various cancers and autoimmune diseases. - While it can be used in some hematologic malignancies, it is not the preferred or most effective treatment for CML, especially given the success of targeted therapies. *Methotrexate* - **Methotrexate** is an **antimetabolite** that interferes with DNA synthesis, commonly used in acute leukemias, lymphomas, and autoimmune conditions. - It is not considered the chemotherapeutic agent of choice for CML, as its mechanism of action is not specific to the BCR-ABL anomaly characteristic of CML.
Question 352: What is true about HER2/neu overexpression in cancer?
- A. Good prognosis
- B. Responds well to taxanes
- C. Responds well to monoclonal antibodies (Correct Answer)
- D. Seen in various cancers, including breast cancer
Explanation: ***Responds well to monoclonal antibodies*** - HER2/neu overexpression is targeted by **monoclonal antibodies** like trastuzumab (Herceptin), improving treatment outcomes [1]. - These therapies are specifically designed to **inhibit HER2-positive** tumors, leading to better overall prognosis compared to those without such therapies [1]. *Good prognosis* - HER2/neu overexpression is generally associated with a **poor prognosis** due to increased aggressiveness of the cancer. - It correlates with **higher rates of recurrence** and metastasis compared to HER2-negative breast cancers. *Responds well to taxanes* - While taxanes are commonly used in breast cancer treatment, HER2/neu positivity does not specifically imply a good response. - Response rates may not significantly differ based on HER2 status for taxane-based therapies alone. *Seen only in breast cancer* - HER2/neu overexpression can also occur in other cancers, such as **gastric and gastroesophageal junction cancers**. - It is not exclusive to breast cancer, though it is most commonly studied in this context [1].
Question 353: Which type of cancer is most commonly associated with exposure to thorium?
- A. Angiosarcoma of liver (Correct Answer)
- B. Renal cell carcinoma
- C. Lymphoma
- D. Astrocytoma
Explanation: ***Angiosarcoma of liver*** - Thorium exposure is strongly associated with **angiosarcoma**, particularly in the liver, due to its carcinogenic properties. - Clinical findings often include **abdominal pain**, hepatomegaly, and elevated liver enzymes, indicative of liver involvement. *Renal cell carcinoma* - Commonly presents with **hematuria**, weight loss, and flank pain, and is not specifically linked to thorium exposure. - Typically arises from the **renal parenchyma**, not the liver, differentiating it from thorium-related tumors. *Astrocytoma* - Primarily a **central nervous system tumor**, often presenting with seizures, neurological deficits, and headaches. - Lacks an association with thorium exposure, focusing instead on genetic and environmental risk factors. *Lymphoma* - Usually presents with **lymphadenopathy**, fever, weight loss, and night sweats, without a clear link to thorium. - Associated more with **immune system** compromise and infections, differing significantly from thorium-induced cancers.
Question 354: All of the following are risk factors for carcinoma of the gallbladder, EXCEPT -
- A. Adenomatous gall bladder polyps
- B. Choledochal cysts
- C. Oral contraceptives (Correct Answer)
- D. Typhoid carriers
Explanation: ***Oral contraceptives*** - While **oral contraceptives** can increase the risk of **gallstones**, they are not directly recognized as a specific risk factor for **gallbladder carcinoma**. - The impact of oral contraceptives on gallbladder cancer risk is generally considered to be minor or non-existent compared to established risk factors. *Typhoid carriers* - **Chronic asymptomatic carriers of Salmonella Typhi** have a significantly increased risk of developing **gallbladder carcinoma**, likely due to chronic inflammation and cellular damage. - The bacteria can reside in the gallbladder for years, leading to a persistent inflammatory state and genetic mutations. *Adenomatous gall bladder polyps* - **Adenomatous polyps** in the gallbladder are considered **premalignant lesions**, especially if they are larger than 10 mm, and are associated with an increased risk of progression to adenocarcinoma. - Their presence indicates a need for careful monitoring and often surgical removal due to their malignant potential. *Choledochal cysts* - **Choledochal cysts**, congenital dilations of the bile ducts, are well-established risk factors for **cholangiocarcinoma** (bile duct cancer) and, less commonly, **gallbladder carcinoma**. - The stasis and reflux of bile within these cysts lead to chronic irritation and inflammation, increasing the risk of malignant transformation.
Question 355: Tumor marker for medullary carcinoma of the thyroid is:
- A. Albumin
- B. TSH
- C. Thyroglobulin
- D. Calcitonin (Correct Answer)
Explanation: Everything in the original explanation remains unchanged as none of the provided references [1, 2, 3, 4, 5] were relevant to Medullary Thyroid Carcinoma or Calcitonin. ***Calcitonin*** - **Calcitonin** is a hormone produced by the parafollicular C cells of the thyroid gland. Medullary thyroid carcinoma originates from these C cells. - Elevated serum calcitonin levels are a highly sensitive and specific **tumor marker** for both diagnosis and monitoring of medullary thyroid carcinoma. *Albumin* - **Albumin** is a protein primarily produced by the liver, essential for maintaining oncotic pressure and transporting various substances in the blood. - It is not a tumor marker for any specific thyroid cancer. *TSH* - **Thyroid-stimulating hormone (TSH)** is produced by the pituitary gland and regulates thyroid hormone production by follicular cells. - While TSH levels are crucial in evaluating other thyroid disorders, they are not a specific tumor marker for medullary thyroid carcinoma, which arises from C cells, not follicular cells. *Thyroglobulin* - **Thyroglobulin** is a protein produced by the follicular cells of the thyroid gland and is the precursor to thyroid hormones. - It serves as a tumor marker for **differentiated thyroid cancers** (papillary and follicular carcinoma), but not for medullary thyroid carcinoma.
Question 356: Which cancer most commonly metastasizes to the brain?
- A. Lung cancer (Correct Answer)
- B. Head and neck cancer
- C. Prostate cancer
- D. Breast cancer
Explanation: ***Lung cancer*** - Lung cancer is the most common source of **brain metastases**, accounting for approximately **40%** of cases. - It often leads to **multiple metastases** due to hematogenous spread to the brain, especially affecting the **cerebral hemispheres**. - The brain is a favored site of metastases for lung carcinomas, with approximately **20%** of cases involving brain metastases. *Prostate cancer* - While prostate cancer can metastasize to the brain, it is much less common than lung cancer, primarily spreading to **bones** and **lymph nodes**. - When it does metastasize, it usually manifests later in the disease course compared to lung cancer. *Breast cancer* - Although breast cancer is also a known cancer that can metastasize to the brain, it ranks below lung cancer in incidence of brain metastasis, typically seen in advanced cases. - It often leads to single or few lesions in the brain as compared to the **multiplicity** seen with lung cancer. *Head and neck cancer* - Head and neck cancers metastasize predominantly to regional lymph nodes more than the brain. - They are less associated with brain metastases compared to **lung**, **breast**, or **melanoma** cancers.
Question 357: A 57-year-old man presents with hemoptysis and generalized weakness. His symptoms began with small-volume hemoptysis 4 weeks ago, followed by progressive weakness, fatigue, and weight loss over the past 2 weeks. He has a 45-pack-year history of cigarette smoking. Physical examination is unremarkable, and laboratory studies reveal mild anemia and hyponatremia. Chest x-ray shows a 5-cm left, mid-lung field mass with mediastinal lymphadenopathy. MR scan of the brain is normal. What is the most likely cause of his symptoms?
- A. Bronchial carcinoid tumor
- B. Lung adenocarcinoma
- C. Small cell lung carcinoma (Correct Answer)
- D. Lung abscess
Explanation: ***Small cell lung carcinoma*** - This presentation, including **hemoptysis** [1], **progressive weakness**, **fatigue**, **weight loss** [2], and a **large lung mass with mediastinal lymphadenopathy** in a heavy smoker [3], is highly characteristic of **small cell lung carcinoma (SCLC)**. - The presence of **hyponatremia** suggests **syndrome of inappropriate antidiuretic hormone (SIADH)**, a common paraneoplastic syndrome associated with SCLC due to ectopic ADH production [2]. *Bronchial carcinoid tumor* - While carcinoid tumors can cause hemoptysis, they typically grow slowly and are characterized by **neuroendocrine symptoms** (e.g., flushing, diarrhea, wheezing) that are not mentioned here. - Malignant carcinoid tumors are less common and rarely present with such rapid progressive systemic symptoms and extensive lymphadenopathy. *Lung adenocarcinoma* - Adenocarcinoma often presents with a mass and can cause hemoptysis and systemic symptoms, but it is **less strongly associated with SIADH** and mediastinal lymphadenopathy in the initial presentation compared to SCLC. - While adenocarcinoma is common in smokers, the rapid progression and specific paraneoplastic finding point more towards SCLC. *Lung abscess* - A lung abscess typically presents with **fever**, **productive cough of purulent sputum**, and often pleuritic chest pain, which are absent in this case [4]. - While an abscess can cause hemoptysis and general malaise, the presence of **lymphadenopathy** and the rapid progression with hyponatremia are not typical features [4].
Question 358: A patient with Hodgkin's lymphoma presents with isolated cervical lymphadenopathy, and biopsy from the lesion shows characteristic lacunar cells. The treatment of choice for this patient is:
- A. Chemotherapy with Radiotherapy (Correct Answer)
- B. Chemotherapy alone
- C. Radiotherapy alone
- D. No treatment needed
Explanation: ### Chemotherapy with Radiotherapy - This combination is the standard of care for most stages of **Hodgkin's lymphoma**, including early-stage disease with localized **lymphadenopathy**. [1] - **Chemotherapy** targets systemic disease while **radiotherapy** delivers localized high-dose treatment to affected lymph nodes, improving local control and preventing recurrence. ### Chemotherapy alone - While chemotherapy is crucial for **systemic disease control** in Hodgkin's lymphoma, using it alone for localized disease might lead to a higher risk of local recurrence compared to combined modality therapy. - In certain very early stages or specific patient populations, this might be considered, but generally, local control with **radiotherapy** is preferred for isolated disease. ### Radiotherapy alone - **Radiotherapy alone** was historically used for early-stage Hodgkin's lymphoma but has been largely replaced by combined modality therapy due to better **overall survival** and disease control with the addition of chemotherapy. [1] - It might be considered in very specific, highly localized, and favorable presentations, but in the presence of **lacunar cells** and the aim for optimal outcome, combined modality therapy is preferred. ### No treatment needed - **Hodgkin's lymphoma** is a malignant neoplastic disease that requires active treatment to achieve remission and cure. - Untreated **Hodgkin's lymphoma** is a progressive and fatal disease, making "no treatment" an inappropriate option.
Question 359: Which of the following is used in the treatment of well-differentiated thyroid carcinoma?
- A. I131 (Correct Answer)
- B. 99m Tc
- C. 32p
- D. MIBG
Explanation: ***I131*** - **Radioactive iodine (I131)** is specifically absorbed by **well-differentiated thyroid cancer cells** because these cells retain the ability to uptake iodine, unlike other types of cancer cells. - Used for **ablating residual thyroid tissue** after surgery and for treating **metastatic well-differentiated thyroid carcinoma** [1]. *99m Tc* - **Technetium-99m (99m Tc)** is primarily used for **diagnostic imaging** (e.g., thyroid scans, bone scans), not for therapeutic treatment of thyroid cancer. - It has a short half-life and emits gamma rays, making it suitable for imaging but generally not for delivering sustained radiation for therapeutic effect. *32p* - **Phosphorus-32 (32p)** is a beta-emitting radionuclide used in the treatment of certain hematological malignancies, such as **polycythemia vera**, and for palliative treatment of bone metastases. - It is not selectively taken up by thyroid cancer cells and therefore is not used in the treatment of thyroid carcinoma. *MIBG* - **Metaiodobenzylguanidine (MIBG)**, often labeled with I123 (diagnostic) or I131 (therapeutic), is used in the diagnosis and treatment of **neuroendocrine tumors** like **pheochromocytoma** and **neuroblastoma**. - Its uptake mechanism targets cells of neuroectodermal origin, which is distinct from the iodine uptake mechanism of thyroid cells.
Question 360: A 50-year-old woman is discovered to have metastatic breast cancer and develops bacterial pneumonia one week after receiving her first dose of chemotherapy. Which of the following best explains this patient's susceptibility to bacterial infection?
- A. Depletion of serum complement
- B. Impaired neutrophil respiratory burst
- C. Inhibition of clotting factor activation
- D. Neutropenia (Correct Answer)
Explanation: ***Neutropenia*** - **Chemotherapy** often causes **bone marrow suppression**, leading to a decrease in the absolute number of **neutrophils**, a condition known as neutropenia. - Neutrophils are crucial for the primary defense against **bacterial and fungal infections**, and their depletion significantly increases susceptibility, especially to **bacterial pneumonia**. *Depletion of serum complement* - While complement deficiency can increase susceptibility to certain infections, it is not a direct or common side effect of typical **chemotherapy regimens**. - Complement deficiencies are often **genetic** or related to specific **autoimmune diseases**, which are not indicated as the primary cause here. *Impaired neutrophil respiratory burst* - Impaired **neutrophil respiratory burst** (e.g., in **chronic granulomatous disease**) leads to a reduced ability to kill ingested bacteria, resulting in recurrent infections. - While chemotherapy can affect neutrophil function, severe impairment of the respiratory burst is not the primary mechanism of increased infection risk one week post-treatment; **neutropenia** is more immediate and profound. *Inhibition of clotting factor activation* - **Inhibition of clotting factor activation** would primarily manifest as **bleeding disorders**, not increased susceptibility to bacterial infections. - Chemotherapy can affect platelet count and function, but this mechanism does not directly explain increased risk of **bacterial pneumonia**.
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