Solid Tumor Management — MCQs
A 35-year-old female presents with a 5-cm tumor of the oral cavity and a single lymph node of 2 cm in diameter on the same side in the neck, and is staged as:
Radiotherapy is most useful in:
Radiotherapy has the most significant therapeutic role in:
Treatment of malignant hyperthermia is
Which of the following stages of lip carcinoma does not have nodal involvement?
A 49 year old female presents with a breast lump. Which of the following findings is in accordance with basal-like breast cancer?
Which histological type of lung cancer is most commonly associated with metastasis?
Which one of the following statements is true regarding brain tumors in childhood?
Which of the following malignancies is most sensitive to radiotherapy?
What is the appropriate management for a patient with a carcinoid tumor of the appendix larger than 2 cm?
Solid Tumor Management Indian Medical PG Practice Questions and MCQs
Question 1: A 35-year-old female presents with a 5-cm tumor of the oral cavity and a single lymph node of 2 cm in diameter on the same side in the neck, and is staged as:
- A. T2 N1 M0
- B. T3 N1 M0 (Correct Answer)
- C. T2 N2 M0
- D. T1 N1 M0
Explanation: ***T3 N1 M0*** - A 5-cm tumor in the oral cavity is classified as **T3** because T3 refers to a tumor larger than 4 cm. - A single lymph node of 2 cm on the same side is classified as **N1**, which indicates a single ipsilateral lymph node ≤ 3 cm. *T2 N1 M0* - A **T2** tumor would be between 2 and 4 cm in its greatest dimension, which is contrary to the 5-cm tumor described. - While **N1** is correctly assigned for the lymph node, the T-stage is incorrect. *T2 N2 M0* - A **T2** tumor classification is incorrect given the 5-cm size of the primary tumor. - **N2** would indicate multiple ipsilateral lymph nodes, a single ipsilateral lymph node > 3 cm but ≤ 6 cm, or bilateral/contralateral lymph nodes, which is not consistent with a single 2-cm lymph node. *T1 N1 M0* - A **T1** tumor would be 2 cm or smaller in its greatest dimension, which is incorrect for a 5-cm tumor. - While **N1** is correctly assigned for the lymph node, the T-stage is incorrect.
Question 2: Radiotherapy is most useful in:
- A. Melanoma
- B. Pancreatic carcinoma
- C. Osteosarcoma
- D. Seminoma (Correct Answer)
Explanation: ***Seminoma*** - **Seminoma** is a highly **radiosensitive** tumor, making radiotherapy a cornerstone of its treatment, especially for localized disease and in adjuvant settings. - Due to its chemosensitivity and radiosensitivity, even advanced seminoma often responds well to treatment, leading to **high cure rates**. *Melanoma* - **Melanoma** is generally considered **radioresistant**, meaning that it does not respond well to conventional doses of radiation. - Treatment primarily involves **surgical excision**, immunotherapy, and targeted therapies. *Pancreatic carcinoma* - **Pancreatic carcinoma** is notoriously **radioresistant** and has a poor prognosis, with limited effectiveness of standalone radiation therapy. - Treatment often involves a combination of **surgery**, chemotherapy, and sometimes concurrent chemoradiation, though outcomes remain challenging. *Osteosarcoma* - **Osteosarcoma** is primarily managed with **surgical resection** and **neoadjuvant/adjuvant chemotherapy**, as it is relatively radioresistant. - Radiotherapy is typically reserved for unresectable tumors, palliative care, or when surgery is contraindicated.
Question 3: Radiotherapy has the most significant therapeutic role in:
- A. Monoclonal gammopathy
- B. Tuberculosis
- C. Sarcomas (Correct Answer)
- D. Sarcoidosis
Explanation: ***Sarcomas*** - **Radiotherapy** plays a crucial therapeutic role in **sarcomas**, though typically as **adjuvant therapy** combined with surgical resection - Used for **local control** in soft tissue sarcomas, particularly when wide margins cannot be achieved - **Primary radiotherapy** is the treatment of choice for certain radiation-sensitive sarcomas like **Ewing's sarcoma** and in cases of **inoperable tumors** - Essential for reducing **local recurrence rates** in high-grade soft tissue sarcomas - Among the options listed, sarcomas have the **strongest and most established indication** for radiotherapy *Monoclonal gammopathy* - Generally **observation only** for MGUS (Monoclonal Gammopathy of Undetermined Significance) - Radiotherapy used only for **solitary plasmacytoma**, which is a specific localized manifestation - Multiple myeloma (if it progresses) is treated with **chemotherapy** and targeted agents, not radiotherapy as primary treatment *Tuberculosis* - An **infectious disease** caused by *Mycobacterium tuberculosis* - Treated exclusively with **anti-tubercular drug regimens** (RIPE: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) - Radiotherapy has **no role** in treating infections *Sarcoidosis* - A **systemic inflammatory condition** with non-caseating granulomas - Primary treatment is **corticosteroids** for symptomatic cases - Immunosuppressants used for refractory cases - Radiotherapy has **no role** in inflammatory/granulomatous diseases
Question 4: Treatment of malignant hyperthermia is
- A. Propranolol
- B. Dantrolene (Correct Answer)
- C. Halothane
- D. Nitrous oxide
Explanation: ***Dantrolene*** - **Dantrolene** is a **ryanodine receptor antagonist** that blocks calcium release from the sarcoplasmic reticulum in muscle cells, directly addressing the underlying pathophysiology of malignant hyperthermia. - Administration of dantrolene is the **first-line and specific treatment** for malignant hyperthermia, rapidly reversing its life-threatening symptoms. *Propranolol* - **Propranolol** is a **beta-blocker** primarily used to treat hypertension, angina, and arrhythmias, by reducing heart rate and contractility. - It does not have any direct action on the **ryanodine receptors** or the excessive calcium release responsible for the muscle rigidity and hypermetabolism seen in malignant hyperthermia. *Halothane* - **Halothane** is an **inhalational anesthetic** that is a well-known trigger of malignant hyperthermia, particularly in genetically susceptible individuals. - Administering halothane would **exacerbate** malignant hyperthermia due to its potent ability to induce uncontrolled calcium release from the sarcoplasmic reticulum. *Nitrous oxide* - **Nitrous oxide** is an **inhalational anesthetic** that is generally considered a weak trigger for malignant hyperthermia and is often used in combination with other agents. - While typically considered safe regarding malignant hyperthermia, it does not possess any therapeutic properties to treat the condition and would not be used once malignant hyperthermia is suspected.
Question 5: Which of the following stages of lip carcinoma does not have nodal involvement?
- A. T2N1
- B. T3N0 (Correct Answer)
- C. T2N2
- D. T1N1
Explanation: ***T3N0*** - The **'N' classification** in the TNM staging system refers to **nodal involvement**. A stage with **'N0' indicates no regional lymph node metastasis**. - A **T3 lesion** signifies a large primary tumor, but if it's accompanied by **N0**, it means there's no evidence of spread to the lymph nodes. *T2N1* - The **'N1' classification** indicates the presence of **regional lymph node metastasis**, specifically in a **single ipsilateral lymph node** that is 3 cm or less in its greatest dimension. - This stage therefore **does have nodal involvement**, contradicting the premise of the question. *T2N2* - The **'N2' classification** signifies more advanced regional lymph node metastasis, such as a **single ipsilateral lymph node** greater than 3 cm but not more than 6 cm. - It could also refer to **multiple ipsilateral lymph nodes**, none greater than 6 cm, or bilateral/contralateral lymph nodes, none greater than 6 cm. In all these cases, **nodal involvement is present**. *T1N1* - Similar to T2N1, the **'N1' component** in T1N1 indicates the presence of **regional lymph node metastasis** in a single ipsilateral lymph node of 3 cm or less. - Therefore, this stage **does involve nodal spread**, despite having a smaller primary tumor (T1).
Question 6: A 49 year old female presents with a breast lump. Which of the following findings is in accordance with basal-like breast cancer?
- A. ER-, PR-, HER2- (Correct Answer)
- B. ER+, PR-, HER2-
- C. ER-, PR-, HER2+
- D. ER+, PR+, HER2-
Explanation: ***ER-, PR-, HER2-*** - **Basal-like breast cancer** is characterized by its **triple-negative** status, meaning it does not express estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2) [1]. - This specific immunophenotype is crucial for diagnosis and influences treatment strategies, as these cancers do not respond to therapies targeting these receptors [1]. *ER+, PR-, HER2-* - This profile describes a **hormone-sensitive** cancer (ER positive) but without PR or HER2 expression. - While it responds to endocrine therapies, it is distinct from basal-like cancer due to its ER positivity. *ER-, PR-, HER2+* - This profile indicates a cancer that is **HER2-positive**, meaning it overexpresses HER2, and can be targeted with anti-HER2 therapies like trastuzumab. - This is a separate molecular subtype of breast cancer often referred to as HER2-enriched, which is distinct from basal-like [2]. *ER+, PR+, HER2-* - This is the most common subtype, known as **luminal A** or **luminal B** depending on grade and Ki-67 expression, characterized by sensitivity to endocrine therapy [2]. - This hormone receptor-positive and HER2-negative profile is very different from the triple-negative basal-like breast cancer. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1064-1066. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, p. 1060.
Question 7: Which histological type of lung cancer is most commonly associated with metastasis?
- A. Small cell carcinoma (Correct Answer)
- B. Squamous cell carcinoma
- C. Adenocarcinoma
- D. Large cell carcinoma
Explanation: ***Squamous cell CA*** - Known for its **aggressive nature** and propensity to metastasize, particularly in later stages. - Typically arises in the **central part of the lungs**, often associated with smoking and leads to local invasion and distant spread. *Alveolar-carcinoma* - Rarely found and tends to be **less aggressive** compared to squamous cell carcinoma. - Usually has a more localized effect without the same potential for widespread metastasis. *Small cell carcinoma* - Although it is **highly metastatic**, it is less common than squamous cell carcinoma in terms of overall lung cancer incidence. - Characterized by its rapid growth and early metastasis [1], but mostly associated with a specific subtype of lung cancer cases. *Adenocarcinoma* - Generally presents as a **peripheral lung lesion** and has **less propensity for early metastasis** compared to squamous cell carcinoma. - More common in non-smokers and tends to have a less aggressive metastatic pattern. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 337-338.
Question 8: Which one of the following statements is true regarding brain tumors in childhood?
- A. Most tumours are below the tentorium (Correct Answer)
- B. Papilloedema is infrequent
- C. Is a rare form of malignancy
- D. Hemiparesis is the most common presenting feature
Explanation: ***Most tumours are below the tentorium*** - In children, approximately 60% of primary brain tumors are **infratentorial**, located in the cerebellum, brainstem, and fourth ventricle. - This predominance of posterior fossa tumors in children contrasts with adults, where **supratentorial tumors** are more common. *Is a rare form of malignancy* - Brain tumors are the **most common solid tumors** in children and the second most common childhood malignancy overall, after leukemia. - While individually rare, as a group, they represent a significant proportion of childhood cancers. *Hemiparesis is the most common presenting feature* - **Hemiparesis** is NOT the most common presentation in pediatric brain tumors. - Most common presentations include **headaches, vomiting, ataxia, and cranial nerve palsies**, reflecting the predominance of **infratentorial tumors**. - Hemiparesis occurs more commonly with supratentorial lesions, which represent the minority of childhood brain tumors. *Papilloedema is infrequent* - **Papilledema**, or swelling of the optic disc due to increased intracranial pressure, is a **frequent finding** in children with brain tumors. - It often develops as a result of tumor mass effect, hydrocephalus, or obstruction of CSF flow.
Question 9: 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 10: What is the appropriate management for a patient with a carcinoid tumor of the appendix larger than 2 cm?
- A. Right hemicolectomy (Correct Answer)
- B. Appendicectomy
- C. Appendicectomy + abdominal CT scan
- D. Appendicectomy + 24 hrs urinary HIAA
Explanation: ***Right hemicolectomy*** - Carcinoid tumors of the appendix larger than **2 cm** are considered at high risk for **lymph node metastasis** and recurrence. - A **right hemicolectomy** provides adequate margins and allows for lymph node dissection, which is essential for staging and definitive treatment in such cases. *Appendicectomy* - An **appendicectomy** alone is typically sufficient for carcinoid tumors of the appendix that are **less than 1 cm** and localized to the tip. - For larger tumors, appendicectomy carries an unacceptably high risk of **incomplete resection** and metastatic disease. *Appendicectomy + abdominal CT scan* - While an **abdominal CT scan** is useful for assessing local spread and distant metastases, it does not address the need for a more extensive surgical resection for a **large primary tumor**. - A simple **appendicectomy** in this scenario would be inadequate as definitive treatment. *Appendicectomy + 24 hrs urinary HIAA* - **24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA)** is a biomarker used to detect and monitor **carcinoid syndrome**, which occurs in a minority of patients with carcinoid tumors. - Measuring 5-HIAA is primarily for assessing systemic symptoms rather than determining the primary surgical management of the **tumor size**.
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