Oncological Surgery Practice Questions

Q: Which is the most common type of thyroid carcinoma with the least hematogenous spread?

Papillary. ### Explanation **Correct Option: B. Papillary Thyroid Carcinoma (PTC)** Papillary carcinoma is the **most common** type of thyroid malignancy (accounting for ~80–85% of cases). The hallmark of PTC is its mode of metastasis: it spreads primarily via the **lymphatics** to the cervical lymph nodes. It has the **least tendency for hematogenous (blood-borne) spread** among all thyroid cancers. This localized spread and slow growth contribute to its excellent prognosis. **Incorrect Options:** * **A. Follicular Thyroid Carcinoma (FTC):** This is the second most common type. Unlike PTC, its hallmark is **hematogenous spread** (to bone and lungs) because it tends to invade blood vessels rather than lymphatics. * **C. Anaplastic Carcinoma:** This is the most aggressive and undifferentiated form. It spreads rapidly via both direct local invasion and hematogenous routes, carrying the worst prognosis. * **D. Medullary Thyroid Carcinoma (MTC):** Arising from parafollicular C-cells, it spreads via both lymphatics and blood. While it can involve lymph nodes early, it has a higher rate of distant hematogenous metastasis compared to PTC. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factor:** Prior exposure to ionizing radiation is the most significant risk factor for PTC. * **Microscopic Features:** Look for **Orphan Annie eye nuclei** (empty-appearing nuclei), **Psammoma bodies** (laminated calcifications), and **Nuclear grooves**. * **Prognosis:** Excellent; the 10-year survival rate is >90%. * **Management:** Usually involves total thyroidectomy or hemithyroidectomy followed by Radioiodine (RAI) ablation if indicated. Lymph node dissection is performed only if nodes are clinically involved (unlike MTC, where prophylactic dissection is common).

Q: Thyroglossal cyst may occasionally give rise to which type of carcinoma?

Papillary. **Explanation:** A thyroglossal cyst is a congenital anomaly resulting from the failure of the thyroglossal duct to obliterate. While most cysts are benign, malignancy occurs in approximately **1%** of cases. **Why Papillary Carcinoma is correct:** The thyroglossal duct is lined by respiratory or squamous epithelium, but it frequently contains **ectopic thyroid tissue** within its wall. Because this tissue is embryologically derived from the thyroid primordium, it is susceptible to the same neoplastic transformations as the thyroid gland itself. **Papillary carcinoma** is the most common type (occurring in >80% of malignant cases) because the ectopic tissue is most prone to this specific transformation. Diagnosis is often made incidentally after a Sistrunk operation. **Why other options are incorrect:** * **Medullary Carcinoma:** This arises from parafollicular C-cells, which are derived from the **ultimobranchial body** (not the thyroglossal duct). Therefore, medullary carcinoma is almost never found in a thyroglossal cyst. * **Anaplastic Carcinoma:** This is an undifferentiated, highly aggressive tumor of the elderly. It is extremely rare in the ectopic tissue of a thyroglossal duct. * **Follicular Carcinoma:** While possible, it is significantly less common than the papillary variety in this location. **High-Yield Clinical Pearls for NEET-PG:** * **Sistrunk Operation:** The definitive treatment for a thyroglossal cyst; it involves excision of the cyst, the entire duct, and the **central part of the hyoid bone** to prevent recurrence. * **Movement:** A thyroglossal cyst is unique because it moves upward on **protrusion of the tongue** (due to its attachment to the foramen caecum via the hyoid). * **Location:** Most commonly found in the **subhyoid** position.

Q: What is the treatment of choice for anaplastic carcinoma of the thyroid that infiltrates the trachea and sternum?

Palliative/Symptomatic treatment. **Explanation:** Anaplastic Thyroid Carcinoma (ATC) is one of the most aggressive solid tumors in humans, characterized by rapid growth and early local invasion. By the time of diagnosis, most patients present with Stage IV disease. **1. Why Palliative/Symptomatic treatment is correct:** In this clinical scenario, the tumor has already infiltrated vital structures like the **trachea and sternum**, rendering it **unresectable**. The primary goal of management for advanced ATC is not curative, but to maintain the airway and improve quality of life. Palliative measures include tracheostomy (to prevent asphyxiation), gastrostomy (for nutrition), and palliative radiotherapy/chemotherapy to reduce tumor bulk. **2. Why the other options are incorrect:** * **Radical Excision:** Surgery is only indicated if the tumor is small and localized (rare). Once there is extensive infiltration of the trachea and sternum, radical surgery is morbid and does not improve survival. * **Chemotherapy & Radiotherapy:** While these are used in ATC, they are rarely curative. In the context of extensive infiltration, they are used as **adjuncts to palliative care** rather than the primary "treatment of choice" for cure. ATC is notoriously resistant to standard chemotherapy. **Clinical Pearls for NEET-PG:** * **Demographics:** Typically affects elderly patients (6th–7th decade). * **Presentation:** Rapidly enlarging neck mass, dysphagia, and hoarseness (vocal cord palsy). * **Histology:** Shows spindle, polygonal, or giant cells; p53 mutations are common. * **Prognosis:** Extremely poor; median survival is 3–6 months. * **Management Priority:** Always secure the airway first (Tracheostomy is often required).

Q: A 60-year-old man is suspected of having endobronchial carcinoma. What is the best investigation?

Bronchoscopy and biopsy. **Explanation:** The diagnosis of lung cancer depends on the location of the lesion. For **endobronchial carcinoma** (centrally located tumors arising within the large airways), **Bronchoscopy and biopsy** is the investigation of choice. It allows for direct visualization of the tumor, assessment of its proximity to the carina (crucial for operability), and the collection of tissue for histopathological confirmation, which is essential for staging and treatment planning. **Analysis of Options:** * **A. CT-guided FNAC:** This is the investigation of choice for **peripheral lung lesions** that are inaccessible by a bronchoscope. In endobronchial cases, it carries a higher risk of pneumothorax and may not yield enough tissue for architectural grading. * **C. Sputum cytology:** While non-invasive and useful for screening central squamous cell carcinomas, it has low sensitivity and cannot provide the precise anatomical localization required for surgical planning. * **D. X-ray chest:** This is usually the initial screening tool. While it may show a mass, collapse, or obstructive pneumonitis, it is not diagnostic and cannot differentiate between malignancy and other pathologies. **Clinical Pearls for NEET-PG:** * **Central Tumors:** Squamous cell carcinoma and Small cell carcinoma (Best investigated via Bronchoscopy). * **Peripheral Tumors:** Adenocarcinoma and Large cell carcinoma (Best investigated via CT-guided FNAC). * **Staging:** Contrast-Enhanced CT (CECT) of the chest and upper abdomen is the standard for radiological staging, while PET-CT is used for detecting distant metastasis. * **Gold Standard for Mediastinal Nodes:** Endobronchial Ultrasound (EBUS) guided TBNA.

Q: What is the recommended treatment for stage 2 anal canal cancer?

Chemoradiation. **Explanation:** The primary treatment for squamous cell carcinoma (SCC) of the anal canal (Stages I, II, and III) is **definitive chemoradiation**, commonly known as the **Nigro Protocol**. 1. **Why Chemoradiation is Correct:** Unlike most gastrointestinal cancers where surgery is the mainstay, anal canal cancer is highly radiosensitive and chemosensitive. The Nigro Protocol (consisting of 5-Fluorouracil, Mitomycin-C, and external beam radiation) achieves high cure rates while **preserving the anal sphincter**, thereby avoiding a permanent colostomy and maintaining the patient's quality of life. 2. **Why Other Options are Incorrect:** * **Abdominoperineal Resection (APR):** Historically the gold standard, it is now reserved only for **salvage therapy** (persistent or recurrent disease) or for patients who cannot tolerate radiation. * **Chemotherapy and Surgery:** Surgery is not part of the initial multimodal management for Stage 2 disease. * **Radiotherapy only:** While radiation is effective, the addition of chemotherapy (Mitomycin-C) has been proven in clinical trials to significantly reduce local recurrence rates compared to radiation alone. **High-Yield Clinical Pearls for NEET-PG:** * **Most common histology:** Squamous Cell Carcinoma (associated with HPV 16 and 18). * **Nigro Protocol components:** 5-FU + Mitomycin-C + Radiation. * **Anal Margin vs. Anal Canal:** Small (<2cm), well-differentiated tumors of the **anal margin** (not canal) can be treated with wide local excision. * **Follow-up:** Response to chemoradiation can be slow; clinical assessment of "cure" is usually done at 12–26 weeks post-treatment. * **Salvage Surgery:** APR is the treatment of choice for biopsy-proven residual disease after chemoradiation.

Q: What is the standard treatment for verrucous carcinoma of the lip?

Surgical excision. **Explanation:** Verrucous carcinoma (Ackerman’s tumor) is a distinct, well-differentiated variant of squamous cell carcinoma characterized by a slow-growing, "wart-like" exophytic appearance. **Why Surgical Excision is the Correct Answer:** The gold standard treatment is **wide local surgical excision**. Verrucous carcinoma is locally aggressive but rarely metastasizes to regional lymph nodes. Therefore, complete surgical removal with clear margins is usually curative. Unlike typical squamous cell carcinoma, routine neck dissection is not indicated unless there is clinical evidence of lymphadenopathy or a hybrid tumor component. **Analysis of Incorrect Options:** * **A. Surgery and Radiotherapy:** Radiotherapy is generally **contraindicated** as a primary or adjuvant treatment. Exposure to radiation can trigger "anaplastic transformation," turning a low-grade verrucous lesion into a highly aggressive, rapidly metastasizing spindle cell carcinoma. * **C. Laser Therapy:** While used for some superficial premalignant lesions, laser therapy is inadequate for verrucous carcinoma because it does not allow for precise margin assessment and may lead to incomplete removal of the deep "pushing" borders. * **D. Interferon:** Medical therapies like interferon or chemotherapy are not primary treatment modalities for localized verrucous carcinoma, which is primarily a surgical disease. **Clinical Pearls for NEET-PG:** * **Histology:** Characterized by a "pushing" rather than an "infiltrating" margin and minimal cellular atypia. * **Common Sites:** Most common in the oral cavity (buccal mucosa) and associated with smokeless tobacco (Snuff dipper’s cancer). * **Key Contraindication:** Avoid Radiotherapy due to the risk of **anaplastic transformation**. * **Prognosis:** Excellent if completely excised, as distant metastasis is extremely rare.

Question 1

All of the following are treatment modalities in malignant mesothelioma except?

Accepted Answer

Exclusive Radiotherapy

Answer

Talc Pleurodesis

Answer

Extrapleural pneumonectomy

Answer

Combination therapy with surgery, chemotherapy and radiotherapy

Question 2

Which is the most common type of thyroid carcinoma with the least hematogenous spread?

Accepted Answer

Papillary

Answer

Follicular

Answer

Anaplastic

Answer

Medullary

Question 3

What is the primary treatment for lower lip carcinoma?

Accepted Answer

Excision

Answer

Radiation

Answer

Chemotherapy

Answer

Radiation and chemotherapy

Question 4

Thyroglossal cyst may occasionally give rise to which type of carcinoma?

Accepted Answer

Papillary

Answer

Medullary

Answer

Anaplastic

Answer

Follicular

Question 5

What is the treatment of choice for anaplastic carcinoma of the thyroid that infiltrates the trachea and sternum?

Accepted Answer

Palliative/Symptomatic treatment

Answer

Radical excision

Answer

Chemotherapy

Answer

Radiotherapy

Question 6

A 60-year-old man is suspected of having endobronchial carcinoma. What is the best investigation?

Accepted Answer

Bronchoscopy and biopsy

Answer

CT guided FNAC

Answer

Sputum cytology

Answer

X-ray chest

Question 7

Sarcoma Botryoides is also known as:

Accepted Answer

Embryonal rhabdomyosarcoma

Answer

Alveolar rhabdomyosarcoma

Answer

Leiomyosarcoma

Answer

Lipoblastomatosis

Question 8

What is the recommended treatment for stage 2 anal canal cancer?

Accepted Answer

Chemoradiation

Answer

Abdominoperineal resection

Answer

Chemotherapy and surgery

Answer

Radiotherapy only

Question 9

What is a sentinel lymph node?

Accepted Answer

The first lymph node along the lymphatic drainage pathway from a tumor

Answer

A group of lymph nodes

Answer

A lymph node that is bypassed during distant metastasis

Answer

A lymph node that has metastasized distantly

Question 10

What is the standard treatment for verrucous carcinoma of the lip?

Accepted Answer

Surgical excision

Answer

Surgery and radiotherapy

Answer

Laser therapy

Answer

Interferon

Oncological Surgery — MCQs

Oncological Surgery — MCQs

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