Oncology — MCQs
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Metastases from follicular carcinoma should be treated by:
Which one of the following is not a tumor marker for testicular tumors?
Which type of lung cancer is most commonly found in non-smokers?
Which type of lung tumor is most responsive to radiotherapy?
Which malignancy is characterized by a stepwise progression through lymph nodes, making staging an important prognostic factor?
Trousseau's syndrome is classically seen with:
A 52-year-old recent immigrant from Vietnam presents with abdominal swelling, weight loss, and upper abdominal pain of three weeks' duration. His past medical history includes malaria and infection with Clonorchis sinensis. On palpation, the liver is hard. An abdominal CT scan reveals a hypo-attenuated mass with lobulated margins in the liver, and a biopsy shows well-differentiated neoplastic glands embedded in a dense fibrous stroma. What is the most likely diagnosis?
Which of the following tumor markers is most specific for hepatocellular carcinoma (HCC)?
Most common malignancy in post-transplant individuals:
Oncology Indian Medical PG Practice Questions and MCQs
Question 391: Metastases from follicular carcinoma should be treated by:
- A. Radioiodine (Correct Answer)
- B. Surgery
- C. Thyroxine
- D. Observation
Explanation: ***Radioiodine*** - **Differentiated thyroid cancers**, including **follicular carcinoma**, retain the ability to uptake iodine, making **radioiodine (I-131) therapy** highly effective for treating metastases [1]. - This therapy targets and destroys thyroid cancer cells wherever they are located in the body, including distant metastatic sites. *Surgery* - While surgery (e.g., **thyroidectomy**) is the primary treatment for localized thyroid cancer and can be used to resect some metastases, it is **not always feasible** for all metastatic sites, especially widely disseminated disease. - Surgery for widespread metastases carries significant risks and may not be curative if all tumor burden cannot be removed. *Thyroxine* - **Thyroxine (T4)** replacement therapy is crucial after thyroidectomy to replace missing hormones and to **suppress TSH** production, which can stimulate residual cancer growth [1]. - However, thyroxine itself does **not directly destroy** existing metastases; it's a supportive and suppressive therapy, not a primary treatment for metastases. *Observation* - **Observation** is generally not appropriate for treating metastases from **follicular carcinoma**, as these metastases have the potential to grow and lead to significant morbidity and mortality if left untreated. - Active treatment is usually indicated to improve prognosis and quality of life.
Question 392: Which one of the following is not a tumor marker for testicular tumors?
- A. AFP
- B. LDH
- C. HCG
- D. CA-125 (Correct Answer)
Explanation: ***CEA*** - **Carcinoembryonic antigen (CEA)** is primarily used as a tumor marker for colorectal and other gastrointestinal cancers [1], not for testicular tumors [2]. - It lacks specificity for germ cell tumors, as the primary markers in testicular tumors are **HCG**, **AFP**, and **LDH** [2]. *HCG* - **Human chorionic gonadotropin (HCG)** is commonly elevated in the presence of germ cell tumors, especially teratomas and choriocarcinomas [2]. - It is a key marker for diagnosis and monitoring of testicular tumors. *AFP* - **Alpha-fetoprotein (AFP)** is often elevated in non-seminomatous germ cell tumors, particularly yolk sac tumors [2]. - It serves as an important marker for diagnosis and treatment response in these tumors. *LDH* - **Lactate dehydrogenase (LDH)** can be elevated in various tumors, including testicular cancer, but it is a non-specific marker. - It is used to assess tumor burden and monitor treatment response rather than for definitive diagnosis.
Question 393: Which type of lung cancer is most commonly found in non-smokers?
- A. Adenocarcinoma (Correct Answer)
- B. Squamous cell carcinoma (associated with smoking)
- C. Oat cell carcinoma (small cell lung cancer)
- D. None of the options
Explanation: ***Adenocarcinoma*** - It is the most common type of lung cancer among **non-smokers**, often associated with **lung scarring** and **asbestos exposure**. - Typically presents in the **peripheral** regions of the lungs and has a **glandular** pattern on histology. *Squamous cell carcinoma* - More commonly associated with **smoking** [1] and usually arises in the **central parts** of the lungs. - Known for cavitary lesions and often linked to chronic **lung disease** rather than non-smokers. *None of the above* - This oes not provide a definitive lung cancer type, which is **not relevant** when adenocarcinoma is the correct answer. - Fails to recognize the significant evidence linking adenocarcinoma as the predominant type in non-smokers. *Oat cell carcinoma* - This represents **small cell lung cancer**, which is strongly linked to **smoking** rather than being common in non-smokers [1]. - Often presents with **metastatic lesions** and is more aggressive, unlike adenocarcinoma.
Question 394: Which type of lung tumor is most responsive to radiotherapy?
- A. Squamous cell CA
- B. Adeno CA
- C. All types respond differently to treatment.
- D. Small cell lung cancer (SCLC) (Correct Answer)
Explanation: ***Small cell lung cancer (SCLC)*** - SCLC is **highly sensitive to chemotherapy and radiation therapy** [2] due to its rapid growth rate and proliferative nature. - While frequently presenting with metastatic disease, local control with **radiotherapy** combined with chemotherapy is crucial, especially in limited-stage disease, and leads to significant tumor shrinkage. *Squamous cell CA* - Squamous cell carcinoma (SCC) is generally **less sensitive** to radiation therapy compared to SCLC, though it is often included in treatment plans for local control. - It tends to grow slower than SCLC and is primarily associated with a **smoking history**. *Adeno CA* - Adenocarcinoma (Adeno CA) is the **most common type of non-small cell lung cancer (NSCLC)**, and its response to radiotherapy varies. - While radiation is used, particularly for **local control or palliation** [1], it is not as uniquely responsive as SCLC, and targeted therapies are often preferred for systemic treatment. *All types respond differently to treatment.* - While it is true that all tumors respond differently based on their histology and individual patient factors, this option does not identify the **most responsive type** as requested by the question. - This statement is a general truth but **lacks the specificity** needed to answer which specific type is most responsive to radiotherapy.
Question 395: Which malignancy is characterized by a stepwise progression through lymph nodes, making staging an important prognostic factor?
- A. Hodgkin's lymphoma (Correct Answer)
- B. Multiple myeloma
- C. Mature T cell NHL
- D. Mature B cell NHL
Explanation: ***Hodgkin's lymphoma*** - Characteristically spreads in a **stepwise fashion** through lymphatic pathways [1], making **staging critical** for prognosis [1]. - Its localized dissemination and the presence of **Reed-Sternberg cells** help define its distinct clinical behavior [1]. *Multiple myeloma* - Primarily characterized by **disseminated plasma cell proliferation** and typically does not follow a stepwise spread pattern. - Staging is based on **serum markers** rather than anatomical spread, focusing more on paraproteins and organ damage. *Mature T cell NHL* - Often exhibits an **aggressive** nature with various patterns of spread, but not characteristically in a stepwise manner [2]. - Staging relevance is less focused compared to Hodgkin's lymphoma, as many subtypes present differently. *Mature B cell NHL* - More variable in behavior and can disseminate **discontinuously** [2], lacking a uniform stepwise progression. - Staging exists but is often less straightforward compared to **Hodgkin's lymphoma**, which has a more predictable pattern [1][2].
Question 396: Trousseau's syndrome is classically seen with:
- A. Carcinoma of the stomach
- B. Multiple Endocrine Neoplasia type II
- C. Neuroendocrine tumors of the pancreas
- D. Pancreatic carcinoma (Correct Answer)
Explanation: ***Pancreatic carcinoma*** - **Trousseau's syndrome**, or migratory thrombophlebitis, is a paraneoplastic syndrome characterized by recurrent, migratory episodes of **venous thrombosis** in unusual sites. - It is often associated with adenocarcinomas, particularly those of the **pancreas**, lung, stomach, and prostate, due to the tumor's ability to activate clotting [1]. *Carcinoma of the stomach* - While stomach carcinoma can be associated with Trousseau's syndrome, it is **less common** than with pancreatic carcinoma. - Trousseau's syndrome in gastric cancer may also involve other paraneoplastic phenomena like **acanthosis nigricans**. *Multiple Endocrine Neoplasia type II* - This syndrome is associated with tumors such as **medullary thyroid carcinoma**, pheochromocytoma, and parathyroid adenomas. - It does not typically present with **Trousseau's syndrome** but instead has a distinct set of paraneoplastic manifestations related to hormone overexpression [1]. *Neuroendocrine tumors of the pancreas* - These tumors often manifest with symptoms related to hormone overproduction, such as **insulinomas** (hypoglycemia) or **gastrinomas** (Zollinger-Ellison syndrome) [2]. - While any malignancy can theoretically predispose to thrombosis, they are **not classically associated** with Trousseau's syndrome, which is more typical of exocrine pancreatic adenocarcinoma.
Question 397: A 52-year-old recent immigrant from Vietnam presents with abdominal swelling, weight loss, and upper abdominal pain of three weeks' duration. His past medical history includes malaria and infection with Clonorchis sinensis. On palpation, the liver is hard. An abdominal CT scan reveals a hypo-attenuated mass with lobulated margins in the liver, and a biopsy shows well-differentiated neoplastic glands embedded in a dense fibrous stroma. What is the most likely diagnosis?
- A. Cholangiocarcinoma (Correct Answer)
- B. Gallbladder carcinoma
- C. Angiosarcoma
- D. Hepatic adenoma
Explanation: ***Cholangiocarcinoma*** - The history of **Clonorchis sinensis** infection is a significant risk factor for the development of cholangiocarcinoma, a malignancy of the bile ducts [1]. - The presentation of a **hypo-attenuated mass** with well-differentiated glands in the biopsy is characteristic of cholangiocarcinoma, especially given the patient's background. [1] *Carcinoma of the gallbladder* - Typically presents with mass lesions, but would more likely show **gallbladder wall thickening** rather than a hypo-attenuated mass in the liver. - Associated with **gallstones** and chronic inflammation, which are not indicated in this patient's history. *Hemangiosarcoma* - More commonly found in the spleen or heart; liver involvement is rare. - Biopsy would show **vascular spaces** rather than well-differentiated neoplastic glands, making it less likely in this case. *Hepatocellular carcinoma* - Generally develops in patients with **chronic liver disease** and shows a more **vascular** appearance on imaging [2]. - The biopsy findings of well-differentiated glands and the absence of cirrhotic liver history point away from hepatocellular carcinoma.
Question 398: Which of the following tumor markers is most specific for hepatocellular carcinoma (HCC)?
- A. Alpha-fetoprotein (AFP)
- B. PIVKA-2 (Correct Answer)
- C. CA 19-9
- D. Neurotensin
Explanation: ***PIVKA-2*** - **PIVKA-2 (protein induced by vitamin K absence or antagonist-II)** is a tumor marker that is highly specific for **hepatocellular carcinoma (HCC)**, especially in differentiating it from other liver diseases. - Its levels can distinguish HCC from **cirrhosis** and **chronic hepatitis**, particularly when AFP levels are normal. - *Neurotensin* - **Neurotensin** is a neuropeptide that can be elevated in certain neuroendocrine tumors, such as **carcinoid tumors** or **pheochromocytomas**. - It is **not specific** for hepatocellular carcinoma and is not routinely used in its diagnosis. - *Alpha-fetoprotein (AFP)* - While **alpha-fetoprotein (AFP)** is a commonly used tumor marker for **HCC**, its specificity is limited as it can also be elevated in other conditions like **cirrhosis**, **chronic hepatitis**, and **germ cell tumors** [2]. - High AFP levels can also be seen in **pregnant women**, making it less specific than PIVKA-2 for HCC. - In HCC patients with elevated AFP levels, serial measurements can be a useful biomarker of disease progression/response to treatment [1]. - *CA 19-9* - **CA 19-9** is a tumor marker primarily associated with **pancreatic cancer** and can also be elevated in **biliary tract cancers**. - It is **not specific** for hepatocellular carcinoma and is not used in its primary diagnosis or monitoring.
Question 399: Most common malignancy in post-transplant individuals:
- A. Kaposi sarcoma
- B. PTLD
- C. CNS lymphoma
- D. Squamous cell carcinoma of skin (Correct Answer)
Explanation: Most common malignancy in post-transplant individuals: ***Squamous cell carcinoma of skin*** - **Squamous cell carcinoma (SCC) of the skin** is the most common malignancy in post-transplant individuals, largely due to **immunosuppression** which impairs immune surveillance against oncogenic viruses and sunlight-induced mutations [1]. - The risk of SCC is significantly increased (up to 65-fold) in transplant recipients, often presenting as **multiple tumors** and exhibiting a more aggressive course than in the general population [2]. *Kaposi sarcoma* - **Kaposi sarcoma (KS)** is associated with **human herpesvirus 8 (HHV-8)** infection and is more common in transplant recipients compared to the general population, but it is not the *most common* malignancy [1]. - While its incidence is increased, it remains less frequent than skin cancers like SCC. *PTLD* - **Post-transplant lymphoproliferative disorder (PTLD)** is a significant complication of organ transplantation, primarily driven by **Epstein-Barr virus (EBV)** infection in the setting of immunosuppression [1]. - PTLD is a serious malignancy, but its overall incidence is less than that of skin cancers. *CNS lymphoma* - **CNS lymphoma** can occur in post-transplant patients, often linked to **EBV infection** and immunosuppression [1]. - Although it is a severe complication, its incidence is considerably lower than that of skin cancers in this population.
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