Surgical Oncology Principles — MCQs
What is the standard excision margin for thick melanomas (>2 mm Breslow thickness)?
Prostate cancer that is limited to the capsule and not the urethra would be staged as -
Gold standard investigation for breast carcinoma screening in a patient with silicone breast implants
RPLND and Chemotherapy may be used in management of?
Classification system of bone tumors is -
What finding during surgery can change the staging of a tumor from Stage I to Stage II in a patient with a history of lung cancer?
Which of the following is an inappropriate indication for concomitant chemotherapy in cases of head and neck cancer?
A 10 cm tumor is found on the anterior surface of the thigh. What is the most appropriate procedure to obtain a diagnosis?
A patient with head and neck cancer has a contralateral lymph node of 3 cm size. What is the N staging?
In a female with appendicitis in pregnancy the treatment of choice is:
Surgical Oncology Principles Indian Medical PG Practice Questions and MCQs
Question 1: What is the standard excision margin for thick melanomas (>2 mm Breslow thickness)?
- A. 2 cm (Correct Answer)
- B. 5 cm
- C. 7 cm
- D. 10 cm
Explanation: **2 cm** - For **thick melanomas** with a Breslow thickness greater than 2 mm, a **2 cm excision margin** is recommended to minimize local recurrence risk. - This margin ensures adequate removal of microscopic disease, balancing complete tumor excision with cosmetic and functional outcomes. *5 cm* - A **5 cm excision margin** is not standard for melanoma regardless of thickness and would result in excessive tissue removal. - Such large margins are generally reserved for very rare, extremely aggressive soft tissue sarcomas or other extensive skin malignancies. *7 cm* - A **7 cm excision margin** is significantly wider than current recommendations for any melanoma thickness. - This would lead to unnecessary morbidity, including large wound defects that might require complex reconstructive surgery. *10 cm* - A **10 cm excision margin** is exceptionally wide and not medically indicated for melanoma management. - Applying such a large margin would result in substantial tissue loss and functional impairment without offering additional survival benefit.
Question 2: Prostate cancer that is limited to the capsule and not the urethra would be staged as -
- A. T1
- B. T2 (Correct Answer)
- C. T3
- D. T0
Explanation: ***T2*** - A T2 stage indicates that the prostate cancer is **confined within the prostate capsule**, meaning it has not spread beyond the outer layer of the prostate gland. - While it is not limited to the urethra, the key defining characteristic of T2 is **capsular confinement**, which is described in the question. *T1* - T1 stage prostate cancer is typically **non-palpable** on digital rectal exam (DRE) and not visible on imaging. - It is often found incidentally, for example, during a **transurethral resection of the prostate (TURP)** for benign prostatic hyperplasia. *T3* - A T3 stage indicates that the prostate cancer has **extended beyond the prostate capsule**, but has not metastasized to distant sites. - This typically involves invasion into the **seminal vesicles** or other periprostatic tissues. *T0* - T0 means there is **no evidence of primary tumor**, which is not consistent with a diagnosed prostate cancer. - This staging is used when there is no measurable tumor.
Question 3: Gold standard investigation for breast carcinoma screening in a patient with silicone breast implants
- A. Mammography
- B. CT scan
- C. USG
- D. MRI (Correct Answer)
Explanation: ***MRI*** - **MRI** is considered the **gold standard** for breast cancer screening in patients with silicone breast implants due to its superior ability to visualize breast tissue through the implant and detect subtle lesions. - It offers **high sensitivity** in detecting both implant rupture and early malignancies, often providing better clarity than mammography in augmented breasts where implants can obscure tissue. *Mammography* - While a standard screening tool, **mammography** can be limited in patients with silicone implants because the implants can **obscure adjacent breast tissue**, making detection of small masses challenging. - Special views (e.g., **Eklund views**) can be used, but sensitivity is still reduced compared to MRI in augmented breasts. *CT scan* - **CT scans** are not routinely used for primary breast cancer screening due to their use of **ionizing radiation** and lower sensitivity for detecting early breast lesions compared to MRI. - CT is more commonly used for **staging** advanced cancers or evaluating complex masses detected by other modalities. *USG* - **Ultrasound (USG)** is a valuable complementary tool, especially for evaluating palpable lumps or clarifying findings from mammography, but it is **operator-dependent** and has a lower overall sensitivity for general screening compared to MRI. - It is particularly useful for differentiating between **cystic and solid masses** and detecting implant ruptures but is not the gold standard for comprehensive screening in augmented breasts.
Question 4: RPLND and Chemotherapy may be used in management of?
- A. Non-seminomatous germ cell tumors of the testis (Correct Answer)
- B. Non-germ cell tumors
- C. Seminomatous germ cell tumors
- D. Lymphoma of the testis
Explanation: ***Non-seminomatous germ cell tumors of the testis*** - **Retroperitoneal lymph node dissection (RPLND)** and **chemotherapy** are key components in the management of non-seminomatous germ cell tumors (NSGCTs), especially for metastatic disease or after initial orchidectomy. - The combination therapy addresses both local nodal involvement (RPLND) and widespread micrometastases (chemotherapy), which are common in NSGCTs. *Non-germ cell tumors* - This is a broad category, and while some non-germ cell testicular tumors may require surgery or chemotherapy, **RPLND** is not a standard part of their management in the same way it is for germ cell tumors. - The specific treatment depends on the tumor type (e.g., Leydig cell tumor, Sertoli cell tumor), stage, and histology, and often involves less aggressive approaches. *Seminomatous germ cell tumors* - **Seminomas** are highly radiosensitive and often respond well to **radiation therapy**, particularly for localized disease or retroperitoneal nodal involvement. - While chemotherapy is used for metastatic seminoma, **RPLND** is generally not indicated for seminomas due to their radiosensitivity and different metastatic patterns compared to NSGCTs. *Lymphoma of the testis* - Testicular lymphoma is a type of **non-Hodgkin lymphoma** and is primarily managed with systemic **chemotherapy** (e.g., R-CHOP) and sometimes radiation therapy. - **RPLND** is not a standard treatment modality for testicular lymphoma, as it is a systemic disease requiring systemic treatment, not local surgical excision of retroperitoneal nodes.
Question 5: Classification system of bone tumors is -
- A. Enneking (Correct Answer)
- B. Edmonton
- C. TNM
- D. Manchester
Explanation: ***Enneking*** - The **Enneking staging system** is widely used for primary **bone tumors**, particularly sarcomas. - It classifies tumors based on their histological grade, local extension, and presence of metastases, which guides surgical planning and prognosis. *Edmonton* - The **Edmonton classification** is primarily used for **periprosthetic fractures** around hip and knee replacements. - It does not classify primary bone tumors but rather describes fracture patterns related to prosthetic implants. *TNM* - The **TNM (Tumor, Node, Metastasis)** classification is a general staging system used for many types of cancer, but it's not the primary system for bone tumors. - While applicable for some bone cancers, the **Enneking system** provides a more specific functional and anatomical assessment for limb-sparing surgery in bone sarcomas. *Manchester* - The **Manchester staging system** is primarily used for **lymphoma**, particularly Hodgkin lymphoma. - It describes the extent of lymph node involvement and extralymphatic disease, completely unrelated to bone tumors.
Question 6: What finding during surgery can change the staging of a tumor from Stage I to Stage II in a patient with a history of lung cancer?
- A. Involvement of the chest wall
- B. Small cell histology
- C. Tumor at the carina
- D. Positive hilar/peribronchial lymph nodes (Correct Answer)
Explanation: ***Positive bronchial lymph nodes*** - The presence of **positive bronchial lymph nodes** (N1) indicates regional lymph node involvement, necessitating an upgrade to Stage II from Stage I [1]. - This finding is significant in lung cancer staging, suggesting metastasis beyond the primary tumor. *Tumor at the carina* - A tumor at the **carina** may imply local invasion but does not specifically relate to lymph node involvement for upgrading the stage. - This would indicate a more advanced tumor stage only if it invaded adjacent structures directly. *Involvement of the chest wall* - Chest wall involvement typically refers to **direct extension of the tumor** and might upgrade the stage to III, not II. - The initial staging focused on **nodal involvement**, which is not indicated in this case. *Small cell histology* - Small cell carcinoma, while aggressive and often systemic, does not correspond with this staging system based on **N classification**. - It also usually presents with different clinical features and patterns compared to non-small cell lung cancers. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, p. 725.
Question 7: Which of the following is an inappropriate indication for concomitant chemotherapy in cases of head and neck cancer?
- A. Metastatic advanced head and neck cancer (Correct Answer)
- B. As an organ-preserving method of treatment
- C. Primary treatment for patients with unresectable disease
- D. Postoperative case of intermediate stage resectable tumor
Explanation: ***Metastatic advanced head and neck cancer*** - While chemotherapy is used in metastatic head and neck cancer, the term "concomitant chemotherapy" implies simultaneous administration with radiation therapy. For **metastatic disease**, the primary treatment strategy is usually **systemic chemotherapy** or targeted therapy, not necessarily concomitant with radiation to a local site with curative intent. - Concomitant chemoradiation is primarily used for **locally advanced, non-metastatic disease** to improve local control and survival, not typically for systemic metastatic disease where the goal is palliation or systemic control. *As an organ-preserving method of treatment* - Concomitant chemoradiation is a well-established strategy for organ preservation, particularly in advanced laryngeal and pharyngeal cancers, allowing patients to avoid **laryngectomy** or extensive surgical resections while achieving similar oncologic outcomes. - This approach aims to maintain **swallowing and speech function** by reducing tumor burden and eradicating microscopic disease. *Primary treatment for patients with unresectable disease* - For **unresectable locally advanced head and neck cancers**, concomitant chemoradiation is often considered the **definitive primary treatment** to achieve local control and improve survival outcomes. - Surgery is not feasible in these cases due to tumor extent or involvement of critical structures, making chemoradiation the best curative option. *Postoperative case of intermediate stage resectable tumor* - **Adjuvant concomitant chemoradiation** is indicated postoperatively for resected tumors with high-risk features such as **extracapsular extension (ECE)** or positive surgical margins, even in intermediate stages. - This is done to eradicate microscopic residual disease and reduce the risk of **local-regional recurrence**.
Question 8: A 10 cm tumor is found on the anterior surface of the thigh. What is the most appropriate procedure to obtain a diagnosis?
- A. Incision biopsy (Correct Answer)
- B. Excision biopsy
- C. FNAC
- D. USG
Explanation: ***Incision biopsy*** - An **incision biopsy** is most appropriate for a large tumor (10 cm) to obtain a tissue diagnosis without performing a potentially morbid or disfiguring complete excision upfront. - It involves removing a representative section of the tumor for histopathological analysis, providing adequate tissue for diagnosis, grading, and subtyping. - This allows definitive treatment planning based on confirmed histopathology. *Excision biopsy* - **Excision biopsy** is generally reserved for smaller tumors (typically <3-5 cm) that can be completely resected with acceptable cosmetic and functional outcomes. - Excision of a 10 cm tumor on the thigh would be a significant surgical procedure, potentially causing substantial morbidity, without a prior definitive diagnosis. - Could compromise subsequent definitive surgery if margins are inadequate. *FNAC* - **FNAC (Fine Needle Aspiration Cytology)** provides only cytological diagnosis, which is insufficient for definitive diagnosis, grading, and subtyping of soft tissue tumors, especially sarcomas. - It misses crucial architectural features and tissue patterns needed for accurate classification. - May yield inadequate or non-diagnostic samples from large heterogeneous tumors. *USG* - **USG (Ultrasound)** is an imaging modality, not a tissue diagnosis procedure. - While useful for characterizing mass features (size, location, vascularity, solid vs cystic), it cannot provide histopathological diagnosis. - The question specifically asks for a procedure to "obtain a diagnosis," which requires tissue sampling for microscopic examination.
Question 9: A patient with head and neck cancer has a contralateral lymph node of 3 cm size. What is the N staging?
- A. N2a Single Ipsilateral 3 to 6 cm
- B. N1 Single Ipsilateral Equal to or <3 cm
- C. N3 Single or Multiple Ipsilateral, Bilateral or Contralateral Any node >6 cm
- D. N2c Single or Multiple Bilateral or Contralateral None > 6 cm (Correct Answer)
Explanation: ***N2c (Single or Multiple, Bilateral or Contralateral, None > 6 cm)*** - A 3 cm **contralateral** lymph node falls under the **N2c** category according to the AJCC staging system for head and neck cancers. - **N2c** indicates involvement of **contralateral** or **bilateral lymph nodes**, with the largest node being **no greater than 6 cm**. - This is the correct staging for the described clinical scenario. *N2a (Single, Ipsilateral, 3 to 6 cm)* - This option incorrectly describes an **ipsilateral** lymph node, whereas the question specifies a **contralateral** node. - **N2a** is defined by a single **ipsilateral** lymph node between **3 and 6 cm** in greatest dimension. - The key differentiator is **laterality** (ipsilateral vs contralateral). *N1 (Single, Ipsilateral, Equal to or <3 cm)* - This option refers to an **ipsilateral** lymph node that is **3 cm or smaller**, which does not match the contralateral location provided in the question. - **N1** describes a single **ipsilateral** lymph node that is **≤ 3 cm** in greatest dimension. - This fails on both **laterality** (ipsilateral vs contralateral) and **size criteria** (the node is exactly 3 cm, at the boundary). *N3 (Single or Multiple, Ipsilateral/Bilateral/Contralateral, Any node >6 cm)* - While it includes contralateral involvement, **N3** is specifically for a lymph node **greater than 6 cm**, which is not the case for a 3 cm node. - A **N3** classification applies when **any** regional lymph node (ipsilateral, bilateral, or contralateral) exceeds **6 cm** in greatest dimension. - The described 3 cm node does not meet the **size threshold** for N3 staging.
Question 10: In a female with appendicitis in pregnancy the treatment of choice is:
- A. Continue pregnancy with medical Rx
- B. Surgery after delivery
- C. Surgery at earliest (Correct Answer)
- D. Abortion with appendectomy
Explanation: ***Surgery at earliest*** - **Prompt surgical intervention** is crucial for appendicitis in pregnancy to prevent complications such as perforation, peritonitis, and maternal or fetal morbidity and mortality. - Delaying surgery increases the risk of rupture, which can be devastating for both the mother and the fetus. *Continue pregnancy with medical Rx* - **Medical management (antibiotics alone)** is generally ineffective for acute appendicitis in pregnant women and carries a high risk of progression to perforation. - This approach would expose the mother and fetus to serious complications, including sepsis and preterm labor, without addressing the underlying surgical pathology. *Surgery after delivery* - Delaying surgery until after delivery is unsafe and potentially fatal, as **appendiceal rupture could occur at any time** during pregnancy. - The risk of **perforation, peritonitis, and subsequent complications** is too high to justify waiting. *Abortion with appendectomy* - **Therapeutic abortion** is not indicated for uncomplicated appendicitis in pregnancy and does not improve the maternal prognosis for the appendicitis itself. - The focus is on treating the underlying medical condition (appendicitis) while preserving the pregnancy, if possible.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free