Oncology Practice Questions

Q: What is the most common primary source of metastatic bone tumors in males?

Prostate. ***Prostate*** - **Prostate cancer** is the most common primary source of metastatic bone tumors in males due to its high propensity to **metastasize to bone** and its high prevalence in the male population [1]. - These metastases are typically **osteoblastic**, causing increased bone density visible on imaging. *Liver* - While the **liver** can be a site of metastasis for many cancers, it is not a common primary source for **bone metastases** [2]. - Liver cancer (hepatocellular carcinoma) can metastasize, but bone is not its most frequent distant site. *Bone* - **Bone** itself can be the site of primary bone tumors, such as osteosarcoma or Ewing's sarcoma, but these are **not metastatic bone tumors** in the sense of originating elsewhere [3]. - When cancer originates in the bone, it is a primary bone cancer, not a metastatic one. *Brain* - **Brain tumors** (primary intracranial malignancies) generally have a **low propensity to metastasize** outside of the central nervous system. - While rare cases of brain tumor metastasis to bone can occur, it is not a common event or primary source.

Q: What is the most common cause of brain metastasis?

Carcinoma lung. ***Carcinoma lung*** - Lung cancer is the most common source of **brain metastases**, accounting for a significant proportion of cases [1]. - Typically spreads via the **hematogenous route**, leading to multiple lesions in the brain [1]. *Prostate cancer* - While prostate cancer can metastasize to the brain, it is less common than lung cancer. - More frequently it spreads to **bone**, making it a relatively rare cause of brain metastases. *HCC* - Hepatocellular carcinoma (HCC) has a tendency to metastasize to the **lungs** and **bone**, but brain metastases are rare. - It typically performs worse in terms of brain involvement compared to lung carcinoma. *Seminoma* - Seminomas primarily spread to regional **lymph nodes** and can metastasize to other organs, but brain involvement is quite rare. - Common sites of metastasis include the **lungs** and **liver**, not the brain.

Q: A patient with a history of increased lethargy and significant loss of weight, found to have elevated carcinoembryonic antigens (CEA) in laboratory examination, may have all of the following conditions, except:

Osteogenic sarcoma. ***Osteogenic sarcoma*** - While osteogenic sarcoma is a serious malignancy, it is **not typically associated with elevated carcinoembryonic antigen (CEA)** levels. - CEA is primarily a marker for **adenocarcinomas** and does not usually rise in bone or soft tissue sarcomas. *Lung cancer* - **Elevated CEA** is a common finding in many types of lung cancer, particularly **adenocarcinoma of the lung**. - Lung cancer can cause symptoms like **lethargy** and **significant weight loss** due to systemic effects of the malignancy [1], [3]. *Breast cancer* - **CEA levels can be elevated** in a significant proportion of patients with breast cancer, especially in advanced or metastatic disease. - Like other advanced cancers, breast cancer can present with **lethargy** and **unexplained weight loss** [1], [3]. *Colon cancer* - **Elevated CEA** is a well-established and widely used tumor marker for **colon cancer**, both for diagnosis and monitoring of disease recurrence [2], [4]. - Colon cancer, particularly in later stages, often leads to systemic symptoms such as **lethargy**, fatigue, and **significant weight loss** [1].

Q: Most common symptom of lung carcinoma is

Cough. ***Cough*** - **Chronic cough** is the most frequently reported symptom in patients with lung carcinoma, often progressing in severity or character. [1] - It results from irritation of the **bronchial tree** by the tumor or associated inflammation. [1] *Dyspnoea* - While common, **shortness of breath** typically occurs when the tumor significantly obstructs airways, causes pleural effusion, or spreads to lymphatics. [1] - It usually presents later in the disease progression compared to cough. *Weight loss* - **Unexplained weight loss** is a common systemic symptom of malignancy, including lung cancer, but is often a sign of advanced disease. [1] - This symptom is non-specific and can be associated with many chronic illnesses. *Chest pain* - **Chest pain** in lung carcinoma often indicates involvement of the pleura, chest wall, or mediastinum by the tumor. - It is a common symptom but is less frequent than cough as the initial presenting complaint.

Q: Which type of tumor is most amenable to chemotherapy?

Choriocarcinoma. ***Choriocarcinoma*** - **Choriocarcinoma** is highly sensitive to chemotherapy, often achieving **cure rates greater than 90%** even in metastatic settings, especially when treated with combination regimens such as EMA-CO. - Its rapid growth rate and high mitotic index make it particularly susceptible to **cytotoxic agents** that target rapidly dividing cells. *Embryonal rhabdomyosarcoma* - While treatable with chemotherapy, **rhabdomyosarcoma**, especially the embryonal subtype, typically requires a combination of **surgery, chemotherapy, and radiation**, and its response to chemotherapy alone is not as uniformly curative as choriocarcinoma. - The efficacy of chemotherapy is often dependent on the tumor's stage, location, and the completeness of surgical resection. *Hepatocellular carcinoma* - **Hepatocellular carcinoma (HCC)** is notoriously resistant to traditional systemic chemotherapy, with limited response rates and often requiring targeted therapies like sorafenib or lenvatinib. - Its management is primarily based on **surgical resection, liver transplantation**, or locoregional therapies such as **transarterial chemoembolization (TACE)** or radiofrequency ablation (RFA). *Thyroid carcinoma* - Most types of thyroid carcinoma, especially **differentiated thyroid cancers (papillary and follicular)**, are managed primarily with **surgery and radioactive iodine (RAI)** therapy, showing limited responsiveness to conventional chemotherapy. - Anaplastic thyroid carcinoma, while aggressive, also typically responds poorly to standard chemotherapy regimens, often requiring multimodal treatment.

Q: Which of the following is typically not elevated in multiple myeloma?

Increase in alkaline phosphatase. ***Increase in alkaline phosphatase*** - While multiple myeloma leads to **bone destruction**, it primarily involves **osteoclast activation** and bone resorption, rather than osteoblast activity. - Therefore, markers of osteoblast activity, like **alkaline phosphatase**, are typically not elevated and may even be normal or low, unless there's an associated complication like fracture healing or hepatobiliary disease. *Lytic lesions in bone* - Multiple myeloma cells produce factors that enhance **osteoclast activity** and inhibit osteoblast function, leading to the characteristic **punch-out lytic lesions** visible on imaging [1]. - These lesions are a hallmark of the disease and are caused by the destruction of bone tissue, not new bone formation [1]. *Hypercalcemia* - The extensive **bone destruction** caused by lytic lesions leads to the release of calcium into the bloodstream, resulting in **hypercalcemia**. - This is a common and serious complication of multiple myeloma, contributing to symptoms like fatigue, confusion, and kidney problems. *Hypercalciuria* - The increased serum calcium from **bone breakdown** often leads to an excessive excretion of calcium in the urine, known as **hypercalciuria**. - This can contribute to kidney stone formation and further worsen kidney function in patients with multiple myeloma.

Q: A 65-year-old white male in previously good health starts to notice blood in his urine, develops pain with urination, and experiences a weakened urinary stream. He seeks medical attention from his family doctor due to these symptoms. Laboratory findings reveal anemia, and urinalysis is positive for red cells, white cells, and gram-negative rods. A cystogram shows a tumor, and a transurethral biopsy confirms a malignant bladder tumor. Which of the following is true about this patient's tumor?

Is likely to recur after treatment. ***Is likely to recur after treatment*** - Bladder cancers, especially **urothelial carcinomas**, have a high rate of recurrence, often requiring ongoing surveillance after initial treatment [1]. - Recurrence can occur in the bladder or other parts of the **urothelial tract**, even after successful primary tumor resection [1]. *It is unlikely to be an adenocarcinoma* - This statement is actually **false** because the most common type of bladder cancer is **urothelial carcinoma** (transitional cell carcinoma), making adenocarcinoma less common but still a possibility [1]. - The symptoms described (hematuria, dysuria, weakened stream) are general for bladder cancer and do not specifically rule out adenocarcinoma. *Typically does not present with a palpable abdominal mass* - While bladder tumors *can* present with a palpable mass in advanced stages, the initial symptoms of **hematuria** and **dysuria** are more common. - A palpable mass in the abdomen would indicate a significantly large or invasive tumor, which is not suggested as the primary presentation here. *Does not typically cause an elevated serum acid phosphatase* - **Elevated serum acid phosphatase** is commonly associated with advanced **prostate cancer**, especially with bone metastases. - Bladder cancer does not typically cause an elevation in this specific marker.

Q: In which of the following conditions is emergency radiotherapy indicated?

Superior vena cava syndrome. ### Superior vena cava syndrome - **Emergency radiotherapy** is indicated in SVC syndrome, especially if caused by radiation-sensitive tumors, to rapidly reduce tumor burden and relieve **venous compression**. [3] - Rapid intervention is crucial due to the potential for **life-threatening compromise** of venous return from the head and upper extremities. [2] *Neoplastic cardiac tamponade* - The primary emergency treatment for **cardiac tamponade** is **pericardiocentesis** to urgently relieve fluid pressure around the heart. - Radiotherapy is not the immediate intervention for acute tamponade, though it may be used later to manage the underlying malignancy. *Acute epidural spinal cord compression* - **Acute spinal cord compression** requires immediate intervention, often with **high-dose corticosteroids** to reduce edema and emergent surgical decompression to prevent permanent neurological damage. [1] - Radiotherapy may be used as an adjunct or for less acute cases, but surgery is usually prioritized for acute compression. [1] *Tumor lysis syndrome* - **Tumor lysis syndrome** is a metabolic emergency managed with aggressive **hydration**, **allopurinol**, or **rasburicase** to prevent renal failure and electrolyte abnormalities. - Radiotherapy is not a treatment for the acute metabolic derangements of tumor lysis syndrome.

Q: In which of the following conditions is neoadjuvant chemotherapy not typically used?

Thyroid cancer. ***Thyroid cancer*** - **Neoadjuvant chemotherapy** is generally **not used** for the treatment of thyroid cancer, as it is primarily managed with surgery, radioactive iodine, and thyroid hormone suppression [1]. - Most thyroid cancers, especially differentiated types like **papillary** and **follicular carcinoma**, are not highly sensitive to conventional chemotherapy [1]. *Breast cancer* - **Neoadjuvant chemotherapy** is a common approach in **locally advanced breast cancer** to downstage tumors, improve surgical outcomes, and assess treatment response. - It may also be used in cases of **inflammatory** or certain aggressive subtypes like **triple-negative** breast cancer. *Esophageal cancer* - **Neoadjuvant chemotherapy**, often combined with **radiation** (chemoradiotherapy), is a standard treatment for **locally advanced esophageal cancer**. - Its purpose is to **downstage** the tumor, reduce invasiveness, and improve surgical resectability and survival rates. *Lung cancer* - **Neoadjuvant chemotherapy** is frequently employed for **locally advanced non-small cell lung cancer** (NSCLC) to reduce tumor size and extent before surgical resection. - This approach aims to improve the likelihood of a complete surgical removal and overall prognosis.

Q: What is the percentage of testicular cancer cases that are associated with cryptorchidism?

30%. ***30%*** - While cryptorchidism is a significant risk factor for testicular cancer, it is associated with approximately **30%** of all testicular cancer cases. - The remaining 70% of testicular cancer cases occur in men with normally descended testes, indicating that other factors are also involved in its etiology. *10%* - This percentage is too low to represent the known association between cryptorchidism and testicular cancer. - Cryptorchidism is a well-established and more prominent risk factor than what 10% would suggest. *50%* - This percentage is higher than the generally accepted figure for the association between cryptorchidism and testicular cancer. - While cryptorchidism significantly increases the risk, it does not account for half of all cases. *70%* - This percentage is significantly higher than current epidemiological data suggest for the proportion of testicular cancer cases linked to cryptorchidism. - This would imply that cryptorchidism is almost the sole cause, which is not accurate.

Question 1

What is the most common primary source of metastatic bone tumors in males?

Accepted Answer

Prostate

Answer

Liver

Answer

Bone

Answer

Brain

Question 2

What is the most common cause of brain metastasis?

Accepted Answer

Carcinoma lung

Answer

Prostate cancer

Answer

HCC

Answer

Seminoma

Question 3

A patient with a history of increased lethargy and significant loss of weight, found to have elevated carcinoembryonic antigens (CEA) in laboratory examination, may have all of the following conditions, except:

Accepted Answer

Osteogenic sarcoma

Answer

Lung cancer

Answer

Breast cancer

Answer

Colon cancer

Question 4

Most common symptom of lung carcinoma is

Accepted Answer

Cough

Answer

Dyspnoea

Answer

Weight loss

Answer

Chest pain

Question 5

Which type of tumor is most amenable to chemotherapy?

Accepted Answer

Choriocarcinoma

Answer

Embryonal rhabdomyosarcoma

Answer

Hepatocellular carcinoma

Answer

Thyroid carcinoma

Question 6

Which of the following is typically not elevated in multiple myeloma?

Accepted Answer

Increase in alkaline phosphatase

Answer

Hypercalcemia

Answer

Hypercalciuria

Answer

Lytic lesions in bone

Question 7

A 65-year-old white male in previously good health starts to notice blood in his urine, develops pain with urination, and experiences a weakened urinary stream. He seeks medical attention from his family doctor due to these symptoms. Laboratory findings reveal anemia, and urinalysis is positive for red cells, white cells, and gram-negative rods. A cystogram shows a tumor, and a transurethral biopsy confirms a malignant bladder tumor. Which of the following is true about this patient's tumor?

Accepted Answer

Is likely to recur after treatment

Answer

It is unlikely to be an adenocarcinoma

Answer

Typically does not present with a palpable abdominal mass

Answer

Does not typically cause an elevated serum acid phosphatase

Question 8

In which of the following conditions is emergency radiotherapy indicated?

Accepted Answer

Superior vena cava syndrome

Answer

Neoplastic cardiac tamponade

Answer

Acute epidural spinal cord compression

Answer

Tumor lysis syndrome

Question 9

In which of the following conditions is neoadjuvant chemotherapy not typically used?

Accepted Answer

Thyroid cancer

Answer

Breast cancer

Answer

Esophageal cancer

Answer

Lung cancer

Question 10

What is the percentage of testicular cancer cases that are associated with cryptorchidism?

Accepted Answer

30%

Answer

50%

Answer

70%

Answer

10%

Oncology — MCQs

Oncology — MCQs

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