Oncology — MCQs
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Which of the following malignancies is most sensitive to radiotherapy?
All of the following statements about nasopharyngeal carcinoma are true, except:
Birt-Hogg-Dubé syndrome is associated with:
For which malignancy is intensity-modulated radiotherapy (IMRT) the most suitable?
What is the most significant factor associated with the causation of head and neck carcinoma?
A 70-year-old woman with a history of ovarian cancer presents with diarrhea, having completed radiation therapy for her cancer 3 months prior. Physical examination reveals cachexia, hyperactive bowel sounds, and generalized pallor. The stools contain blood, and a complete blood count shows decreased hemoglobin (7.8 g/dL) and decreased mean corpuscular volume (70 fL). Which of the following is the most likely cause of gastrointestinal bleeding in this patient?
Which of the following statements about hepatocellular carcinoma (HCC) is true?
Which type of breast cancer is most commonly bilateral?
Which of the following statements about esophageal cancer is true?
Age for regular mammography screening in average-risk women is
Oncology Indian Medical PG Practice Questions and MCQs
Question 361: Which of the following malignancies is most sensitive to radiotherapy?
- A. Dysgerminoma (Correct Answer)
- B. Teratoma
- C. Hodgkin lymphoma
- D. Seminoma
Explanation: ***Dysgerminoma*** - **Dysgerminomas** are highly sensitive to **radiotherapy** due to their undifferentiated, rapidly proliferating nature, making radiation an effective primary or adjuvant treatment. - This sensitivity allows for effective **local tumor control** and can contribute to excellent prognosis, even in advanced stages. *Seminoma* - While **seminomas** are radiosensitive, **dysgerminomas** (which are the ovarian equivalent of seminomas) are generally considered *more* radiosensitive among germ cell tumors. - Radiation is often considered for seminomas, but its efficacy is also high with combination chemotherapy. *Hodgkin lymphoma* - **Hodgkin lymphoma** is highly curable with **radiotherapy**, especially in early stages, as lymph nodes are often targeted effectively [1]. - However, the definition of "most sensitive" often refers to tumors that respond to relatively lower doses of radiation for local control, for which germ cell tumors like dysgerminoma are prime examples. *Teratoma* - **Teratomas**, particularly mature teratomas, are generally **radioresistant** due to their differentiated histological components. - While immature teratomas may show some response, chemotherapy is the primary treatment for malignant forms, and radiation plays a minor role.
Question 362: All of the following statements about nasopharyngeal carcinoma are true, except:
- A. IgA antibody to EBV is observed
- B. Squamous cell carcinoma is the most common histological subtype
- C. Bimodal age distribution
- D. Nasopharyngectomy with radical neck dissection is the treatment of choice (Correct Answer)
Explanation: ***Nasopharyngectomy with radical neck dissection is the treatment of choice*** - This statement is incorrect because **radiation therapy** (often with chemotherapy) is the primary treatment for nasopharyngeal carcinoma due to its location and radiosensitivity. - **Surgical resection** (nasopharyngectomy) is rarely performed as the initial treatment for nasopharyngeal carcinoma, even for early stages, due to the complex anatomy and high morbidity of the region. *Bimodal age distribution* - This statement is true; nasopharyngeal carcinoma shows a **bimodal age distribution**, with peaks in adolescence/young adulthood and again in older individuals (50-60 years old). - This pattern is particularly evident in endemic regions and is often linked to **Epstein-Barr virus (EBV)** infection. *IgA antibody to EBV is observed* - This statement is true; elevated levels of **IgA antibodies to EBV viral capsid antigen (VCA)** and other EBV-related proteins are commonly observed in patients with nasopharyngeal carcinoma. - These antibodies are useful biomarkers for **screening, diagnosis, and monitoring disease recurrence**, especially in endemic areas. *Squamous cell carcinoma is the most common histological subtype* - This statement is true; **undifferentiated nasopharyngeal carcinoma (WHO type III)**, which is a subtype of squamous cell carcinoma, is the most common histological type, especially in endemic regions. - This subtype is strongly associated with **Epstein-Barr virus (EBV)** infection and has a relatively good prognosis compared to other head and neck squamous cell carcinomas due to its radiosensitivity.
Question 363: Birt-Hogg-Dubé syndrome is associated with:
- A. Renal cell carcinoma (RCC) (Correct Answer)
- B. Lung cancer
- C. Stomach cancer
- D. Ovarian cancer
Explanation: ***Renal cell carcinoma (RCC)*** - Birt-Hogg-Dubé syndrome is an **autosomal dominant disorder** characterized by an increased risk of developing **renal cell carcinoma**, particularly **chromophobe** and **oncocytic hybrid tumors**. - It results from mutations in the **FLCN gene**, which encodes the protein folliculin. *Lung cancer* - While Birt-Hogg-Dubé syndrome is associated with **pulmonary cysts** and an increased risk of **spontaneous pneumothorax**, it is not directly linked to an increased risk of **primary lung cancer**. - The cystic lung changes are distinct from cancerous lesions. *Stomach cancer* - There is **no established association** between Birt-Hogg-Dubé syndrome and an increased risk of developing **stomach cancer**. - The syndrome primarily affects the skin, lungs, and kidneys. *Ovarian cancer* - Birt-Hogg-Dubé syndrome has **no known association** with an increased incidence of **ovarian cancer**. - The clinical manifestations are generally limited to specific organs mentioned earlier.
Question 364: For which malignancy is intensity-modulated radiotherapy (IMRT) the most suitable?
- A. Lung
- B. Prostate (Correct Answer)
- C. Leukemias
- D. Stomach
Explanation: ***Prostate*** - **IMRT** is highly suitable for prostate cancer due to the prostate's proximity to critical organs like the **rectum and bladder**. - Its ability to conform the **radiation dose tightly** to the tumor while sparing adjacent healthy tissue significantly reduces side effects like **rectal bleeding** or **urinary dysfunction** [1]. *Lung* - While IMRT is used in lung cancer, especially for complex tumors near vital structures, **stereotactic body radiation therapy (SBRT)** is often preferred for early-stage lung cancer due to its high dose delivery over fewer fractions. - The **motion of the lung** during respiration can make precise IMRT delivery challenging without specialized techniques like **gating or tracking**. *Leukemias* - **Leukemias** are systemic diseases involving blood and bone marrow, making localized radiation therapies like IMRT generally unsuitable as a primary treatment. - Treatment for leukemias primarily involves **chemotherapy, targeted therapy, or stem cell transplant**. *Stomach* - **Stomach cancer** often requires larger radiation fields due to tumor spread and nodal involvement, making the precise dose sculpting of IMRT less advantageous compared to its benefits in smaller, well-defined tumors. - The **mobility of the stomach** and surrounding organs can also present challenges for highly conformal radiation delivery.
Question 365: What is the most significant factor associated with the causation of head and neck carcinoma?
- A. Intravenous drug abuse
- B. Exposure to nickel
- C. History of syphilis
- D. Tobacco use (Correct Answer)
Explanation: ***Tobacco use*** [1] - Tobacco use is the most significant risk factor for head and neck carcinomas, with strong evidence linking it to both oral and pharyngeal cancers. [1] - It promotes carcinogenic changes in the mucosal lining of the head and neck, significantly increasing the risk of malignancy. [1] *History of syphilis* - While syphilis has been linked to oropharyngeal squamous cell carcinoma, its role is less significant than tobacco. - Other factors, such as HPV infection, are more clinically relevant for head and neck cancers associated with syphilis. [1] *Exposure to nickel* - Nickel exposure is primarily associated with respiratory cancers, particularly lung cancer, rather than head and neck cancers. - The connection to head and neck carcinoma is not well established, making it a minor risk factor compared to tobacco. *Intravenous drug abuse* - Although intravenous drug abuse may lead to other health complications, it is not a direct significant risk factor for head and neck carcinoma. - Other lifestyle choices and exposures, particularly tobacco, play a much larger role in the development of these cancers.
Question 366: A 70-year-old woman with a history of ovarian cancer presents with diarrhea, having completed radiation therapy for her cancer 3 months prior. Physical examination reveals cachexia, hyperactive bowel sounds, and generalized pallor. The stools contain blood, and a complete blood count shows decreased hemoglobin (7.8 g/dL) and decreased mean corpuscular volume (70 fL). Which of the following is the most likely cause of gastrointestinal bleeding in this patient?
- A. Angiodysplasia
- B. Hemorrhoids
- C. Ischemic colitis
- D. Radiation enterocolitis (Correct Answer)
Explanation: ***Radiation enterocolitis*** - Following radiation therapy, patients can develop inflammation and damage to the **intestinal lining**, leading to symptoms such as diarrhea and gastrointestinal bleeding [1]. - The presence of **cachexia** and **decreased hemoglobin** indicates significant pathology, aligning with this diagnosis following her recent treatment for ovarian cancer. *Ischemic colitis* - Often presents with **abdominal pain** and is usually associated with risk factors like **vascular disease**, which is not described here [2]. - Symptoms typically include **bloody diarrhea**, but the link with recent radiation therapy makes this diagnosis less likely. *Hemorrhoids* - Generally cause **bright red blood per rectum** and are more associated with changes in bowel habits rather than diarrhea and cachexia. - The absence of a **history of straining** or other typical risk factors suggests that hemorrhoids are unlikely in this scenario. *Angiodysplasia* - Typically presents during older age and can cause gastrointestinal bleeding, but is usually associated with **chronic anemia** rather than the acute symptoms seen here [3]. - Without a significant previous history of bleeding or vascular anomalies, this condition is an unlikely cause for her symptoms.
Question 367: Which of the following statements about hepatocellular carcinoma (HCC) is true?
- A. It is resectable in early stages, depending on size, location, and liver function.
- B. More than 70% of cases show increased AFP levels.
- C. It is the most common primary liver tumor, though metastatic tumors are more common overall.
- D. All of the options. (Correct Answer)
Explanation: ***All of the options.*** - This option is correct because HCC is indeed resectable in early stages under specific conditions, AFP levels are elevated in a significant portion of cases, and it is the most common primary liver tumor. [1] - Each individual statement provides an accurate insight into the characteristics and clinical aspects of hepatocellular carcinoma. [2] *It is resectable in early stages, depending on size, location, and liver function.* - **Early-stage HCC** can be potentially cured with **surgical resection** or liver transplantation, provided the tumor is small, solitary, and the patient has good liver function. [2] - The decision for resectability is complex and depends on factors such as **tumor size, location**, and the patient's **Child-Pugh score** or MELD score for liver function. *More than 70% of cases show increased AFP levels.* - **Alpha-fetoprotein (AFP)** is a widely used **tumor marker** for HCC, and elevated levels are observed in 60-80% of patients, particularly those with larger tumors. [1] - While helpful for screening and monitoring, AFP is not specific enough for diagnosis on its own, as it can also be elevated in other liver conditions and germ cell tumors. *It is the most common primary liver tumor, though metastatic tumors are more common overall.* - **Hepatocellular carcinoma (HCC)** accounts for about 80-90% of **primary liver cancers**, making it the most prevalent type originating in the liver. - However, **metastatic liver cancer**, meaning cancer that has spread to the liver from another primary site (e.g., colon, lung, breast), is significantly more common in the general population than primary liver cancers.
Question 368: Which type of breast cancer is most commonly bilateral?
- A. Lobular (Correct Answer)
- B. Medullary
- C. None of the options
- D. Paget's disease
Explanation: ***Lobular*** - **Invasive lobular carcinoma (ILC)** is the breast cancer type most frequently associated with **bilateral disease**, occurring in about 5-28% of cases. - This tendency is attributed to its infiltrative growth pattern and potential for multifocal involvement, making bilateral involvement more likely. *Paget's disease* - **Paget's disease of the breast** is a rare form of breast cancer that primarily affects the skin of the **nipple and areola**. - It is almost exclusively **unilateral**, and its presentation with eczematous changes is distinct from bilateral parenchymal involvement. *Medullary* - **Medullary carcinoma** is a rare subtype of invasive ductal carcinoma known for its often **well-circumscribed appearance** and better prognosis. - While it can be multifocal, it does not have a strong propensity for **bilateral occurrence** like lobular carcinoma. *None of the options* - This option is incorrect because **lobular carcinoma** is well-established in medical literature as having the highest incidence of bilateral presentation among breast cancer types.
Question 369: Which of the following statements about esophageal cancer is true?
- A. Small lesions generally have a better prognosis.
- B. Esophageal cancer is more lethal than colorectal cancer. (Correct Answer)
- C. Asymptomatic benign esophageal lesions are usually monitored.
- D. Squamous cell carcinoma is declining globally and is now less common than adenocarcinoma worldwide.
Explanation: Esophageal cancer is more lethal than colorectal cancer. - Esophageal cancer generally has a poorer prognosis and a lower 5-year survival rate compared to colorectal cancer, making it more lethal. - This is often due to its aggressive nature and tendency to be diagnosed at advanced stages. Small lesions generally have a better prognosis. - While true for some cancers, this statement is misleading in the context of esophageal cancer because even small esophageal lesions can be highly aggressive and already involve deeper layers or lymph nodes. - Early detection of seemingly "small" lesions does improve outcomes, but the overall prognosis remains challenging due to the disease's inherent aggressiveness, even at early stages. Asymptomatic benign esophageal lesions are usually monitored. - The question is about esophageal cancer, not benign lesions. Asymptomatic benign lesions are typically managed based on their specific type and risk of progression, but this statement does not address esophageal cancer. [1] - This option introduces a different diagnostic and management consideration, shifting focus from the malignancy. Squamous cell carcinoma is declining globally and is now less common than adenocarcinoma worldwide. - While the incidence of adenocarcinoma has been rising in Western countries, squamous cell carcinoma (SCC) still accounts for the majority of esophageal cancers worldwide, especially in undeveloped nations. - The global shift where adenocarcinoma supersedes SCC is not universally true, especially when considering the global burden of the disease. [2]
Question 370: Age for regular mammography screening in average-risk women is
- A. 40 (Correct Answer)
- B. 55
- C. 25
- D. 35
Explanation: ***40*** - Current guidelines from organizations like the **American Cancer Society (ACS)** recommend that women at **average risk** begin regular annual mammography screening at **age 40**. - While other organizations have slightly different recommendations, **age 40** is a commonly cited starting point to maximize benefits for average-risk women. *55* - **Age 55** is typically when some guidelines suggest transitioning to **biennial** (every other year) mammography screening, rather than initiating it. - Delaying initial screening until 55 would miss potential early detection opportunities for many women. *25* - **Age 25** is generally considered too young for routine mammography screening in **average-risk women**, as breast tissue is denser and cancer incidence is very low. - Screening this early is reserved for high-risk individuals with specific genetic mutations or strong family histories. *35* - While **age 35** is closer to the recommended starting age, it is generally earlier than the standard guidelines for **average-risk women**. - Some high-risk individuals might begin screening around this age, but it's not the universal recommendation for the general population.
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