Cancer Staging — MCQs
What is the T stage of a 2.5cm lung carcinoma, not involving the pleura?
Staging of ovarian cancer when the rectum is involved.
International prognostic index for lymphomas includes the following prognostic factors, EXCEPT:
Which malignancy is characterized by a stepwise progression through lymph nodes, making staging an important prognostic factor?
Classification system of bone tumors is -
Which of the following stages of lip carcinoma does not have nodal involvement?
Radiotherapy has the most significant therapeutic role in:
Which of the following treatment options best represents the standard management approach for stage IB cervical cancer?
A colonic carcinoma involving muscularis propria, with one or two nodes involved with a solitary metastasis in the liver, the TNM stage would be:
A patient has carcinoid tumour of appendix of size more than 2.5 cm. The management of choice is:
Cancer Staging Indian Medical PG Practice Questions and MCQs
Question 1: What is the T stage of a 2.5cm lung carcinoma, not involving the pleura?
- A. T1a
- B. T2
- C. T1b
- D. T1c (Correct Answer)
Explanation: ***T1c*** - A **2.5 cm lung carcinoma** without pleural involvement falls into the T1 category [1]. - According to the **TNM staging system (8th edition)** for lung cancer, a tumor between **2-3 cm is classified as T1c** [1]. *T1a* - This classification is reserved for tumors that are **1 cm or less** in greatest dimension. - The given tumor size of **2.5 cm is larger** than the T1a criteria. *T2* - A T2 tumor is generally defined by a size greater than **3 cm but less than or equal to 5 cm**, or has specific features like visceral pleural invasion or involvement of the main bronchus regardless of distance from the carina [1]. - Our tumor is **only 2.5 cm** and does not involve the pleura, excluding T2. *T1b* - This category applies to tumors that are **greater than 1 cm but equal to or less than 2 cm** in greatest dimension. - The 2.5 cm tumor size exceeds the criteria for **T1b**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 721-725.
Question 2: Staging of ovarian cancer when the rectum is involved.
- A. Stage I
- B. Stage 2 (Correct Answer)
- C. Stage 4
- D. Stage 3
Explanation: ***Stage 2*** - **Rectal involvement** in ovarian cancer represents direct extension to other **pelvic structures**, which defines **Stage II disease** according to FIGO staging. - **Stage IIB** specifically includes extension to other pelvic intraperitoneal tissues, including the rectum, sigmoid colon, bladder, and uterus. - The rectum is a **pelvic organ**, and its involvement represents local spread within the pelvis, not distant metastasis. *Stage I* - **Stage I** ovarian cancer is confined to the **ovaries or fallopian tubes** only. - There is no extension beyond the ovaries or fallopian tubes, making rectal involvement inconsistent with this stage. *Stage 3* - **Stage III** involves tumor **outside the pelvis** with peritoneal implants beyond the pelvis or positive retroperitoneal lymph nodes. - This represents intra-abdominal spread but still within the peritoneal cavity, not limited to pelvic organ involvement like the rectum. *Stage 4* - **Stage IV** is defined by **distant metastasis outside the peritoneal cavity**, including parenchymal liver or spleen metastasis, pleural effusion with positive cytology, or metastasis to extra-abdominal organs. - Direct rectal involvement does not constitute distant metastasis and therefore is not Stage IV.
Question 3: International prognostic index for lymphomas includes the following prognostic factors, EXCEPT:
- A. LDH
- B. Number of extralymphatic sites involved
- C. Hemoglobin and albumin (Correct Answer)
- D. Stage of disease
Explanation: ***Hemoglobin and albumin*** - While hemoglobin and albumin can be indicators of overall health and nutritional status, they are **not part of the standard International Prognostic Index (IPI)** for lymphomas. - The IPI specifically focuses on factors directly related to tumor burden and patient vitality, not general systemic markers like these. *LDH* - **Lactate dehydrogenase (LDH)** is a crucial component of the IPI, reflecting tumor burden and aggressiveness [1]. - Elevated LDH levels indicate a higher risk and are associated with a poorer prognosis [1]. *Number of extralymphatic sites involved* - The **number of extralymphatic sites involved** is a key prognostic factor in the IPI. - Involvement of more than one extralymphatic site indicates more widespread disease and a worse prognosis. *Stage of disease* - The **stage of disease**, as defined by the Ann Arbor staging system, is an essential element of the IPI [1]. - Advanced stages (III or IV) are associated with a poorer prognosis compared to early stages [1].
Question 4: 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 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: 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 7: 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 8: Which of the following treatment options best represents the standard management approach for stage IB cervical cancer?
- A. Surgery and Radiotherapy
- B. Surgery (Correct Answer)
- C. Chemotherapy and Radiotherapy
- D. Surgery and Chemotherapy
Explanation: ***Surgery*** - For **stage IB cervical cancer**, **radical hysterectomy with pelvic lymphadenectomy** is the primary standard surgical treatment option. - Surgery alone is appropriate for cases without high-risk features on final pathology. - This represents the cornerstone primary management approach for early-stage cervical cancer. - Alternative primary treatment is definitive **concurrent chemoradiation**, which is considered equivalent to surgery. *Surgery and Radiotherapy* - **Adjuvant radiotherapy** (or chemoradiation) is added only if **high-risk pathologic features** are found post-surgery, such as positive margins, parametrial involvement, or positive lymph nodes. - This is not the standard primary approach but rather selective adjuvant therapy based on surgical pathology findings. - Not all stage IB cases require adjuvant radiotherapy. *Surgery and Chemotherapy* - **Adjuvant chemotherapy alone** is NOT standard management for cervical cancer. - When adjuvant therapy is needed, it is **concurrent chemoradiation** (radiation with chemotherapy as a radiosensitizer), not chemotherapy alone. - Chemotherapy alone does not provide adequate locoregional control for cervical cancer. *Chemotherapy and Radiotherapy* - **Concurrent chemoradiation** is the primary treatment for **locally advanced cervical cancer** (stages IB3 with certain features, IIB-IVA). - It is also an alternative to surgery for primary treatment of stage IB, but the question asks for standard management, which traditionally refers to the surgical approach for early-stage disease. - This is definitive treatment without surgery for larger or locally advanced tumors.
Question 9: A colonic carcinoma involving muscularis propria, with one or two nodes involved with a solitary metastasis in the liver, the TNM stage would be:
- A. T2 N1 M1 (Correct Answer)
- B. T1 N2 M1
- C. T1 N1 M1
- D. T2 N2 M1
Explanation: ***T2 N1 M1*** **(Correct Answer)** - **T2** indicates the tumor invades the **muscularis propria** in the TNM classification for colorectal cancer. - **N1** signifies involvement of **one to three regional lymph nodes**, which corresponds to "one or two nodes involved" in the question. - **M1** denotes the presence of **distant metastasis**, specifically a "solitary metastasis in the liver" as described. *T1 N2 M1* - **T1** describes a tumor that invades the **submucosa** but not the muscularis propria, which is less advanced than the scenario described. - **N2** would imply involvement of **four or more regional lymph nodes**, contradicting the "one or two nodes involved" stated in the question. *T1 N1 M1* - **T1** indicates invasion into the **submucosa**, not reaching the muscularis propria as specified in the case description. - The **N1** and **M1** components are consistent with the nodal involvement and distant metastasis, but the **T stage** is incorrect. *T2 N2 M1* - While **T2** is correct for invasion into the muscularis propria, **N2** incorrectly implies involvement of **four or more regional lymph nodes**. - The question states "one or two nodes involved," making **N1** the appropriate nodal classification.
Question 10: A patient has carcinoid tumour of appendix of size more than 2.5 cm. The management of choice is:
- A. Appendectomy
- B. Right hemicolectomy (Correct Answer)
- C. Appendectomy and 24 hour urinary HIAA
- D. Appendectomy and abdominal CT scan
Explanation: **Right hemicolectomy** - For **carcinoid tumors of the appendix** larger than **2.0 cm (or 2.5 cm by some guidelines)**, a right hemicolectomy is the recommended management due to the increased risk of **lymph node metastasis** and distant spread. - This procedure ensures adequate tumor clearance and regional lymphadenectomy, which is crucial for staging and preventing recurrence in larger tumors. *Appendectomy* - An appendectomy alone is usually sufficient for **small carcinoid tumors (<1-2 cm)** that are **confined to the appendix**, without evidence of mesoappendiceal invasion or lymph node involvement. - For tumors exceeding 2.5 cm, the risk of metastasis is considerably higher, making appendectomy alone inadequate for complete oncological control. *Appendectomy and 24 hour urinary HIAA* - While a **24-hour urinary 5-hydroxyindoleacetic acid (5-HIAA)** measurement is useful for diagnosing and monitoring **carcinoid syndrome**, it does not influence the primary surgical management decision for an appendiceal tumor of this size. - The surgical approach is dictated by **tumor size** and the risk of metastasis, not by biochemical markers alone, unless the patient presents with symptoms of carcinoid syndrome. *Appendectomy and abdominal CT scan* - An abdominal **CT scan** is valuable for **staging** and detecting distant metastases or nodal involvement, especially in larger tumors, but it is a diagnostic tool, not a treatment itself. - While a CT scan would likely be performed as part of the work-up, an appendectomy alone is insufficient as the definitive surgical management for a tumor of this size without addressing the high risk of regional spread.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free