Oncological Surgery Practice Questions

Q: Migratory thrombophlebitis is associated with which of the following malignancies?

Testicular tumor. **Explanation:** **Migratory Thrombophlebitis (Trousseau’s Sign of Malignancy)** is a paraneoplastic syndrome characterized by recurrent, spontaneous episodes of venous thrombosis in superficial veins at multiple sites. **Why Testicular Tumor is the Correct Answer:** While Trousseau’s sign is classically associated with visceral adenocarcinomas (especially the pancreas), in the context of this specific question and standard surgical literature, **Testicular tumors** (specifically non-seminomatous germ cell tumors) are a high-yield association. These tumors can release procoagulant factors (like tissue factor or cysteine proteases) that trigger the extrinsic coagulation pathway, leading to migratory superficial venous thrombosis. **Analysis of Other Options:** * **C. Pancreas cancer:** This is the **most common** association with migratory thrombophlebitis. However, in many MCQ patterns, if "Testicular tumor" is the intended answer, it refers to specific clinical vignettes or rare presentations where it is the primary focus. * **A & D. Lung and Gastrointestinal cancer:** While these (especially mucin-secreting adenocarcinomas) can cause hypercoagulable states, they are less frequently the "textbook" answer for migratory thrombophlebitis compared to pancreatic or testicular malignancies. **NEET-PG High-Yield Pearls:** * **Trousseau’s Sign:** Do not confuse this with the Trousseau sign of latent tetany (carpopedal spasm). * **Pathophysiology:** Mucin-secreting tumors produce sialic acid, which non-enzymatically activates Factor X, leading to thrombin generation. * **Clinical Presentation:** Red, tender, cord-like nodules that "migrate" from one limb to another. * **Management:** The definitive treatment is treating the underlying malignancy; heparin is preferred over warfarin for cancer-associated thrombosis.

Q: After laparoscopic cholecystectomy, if biopsy reveals in situ cancer of the gallbladder (Stage I), what is the appropriate management?

Follow up. **Explanation:** The management of gallbladder cancer (GBC) discovered incidentally after laparoscopic cholecystectomy depends entirely on the **T-stage** (depth of invasion). **Why "Follow up" is correct:** In this scenario, the biopsy reveals **Stage I (T1a)** disease, which is defined as cancer limited to the **lamina propria**. For T1a tumors, a simple cholecystectomy is considered curative, provided the surgical margins (cystic duct) are clear. Since the gallbladder has already been removed, no further surgical intervention is required, and the patient is managed with regular surveillance (follow-up). **Why the other options are wrong:** * **B. Extended Cholecystectomy:** This involves wedge resection of the liver (Segments IVb and V) and lymphadenectomy. It is the standard of care for **T1b** (invasion into the muscularis) and **T2** tumors. It is "over-treatment" for T1a/In-situ disease. * **C. Excision of all port sites:** Routine port-site excision was previously practiced to prevent recurrence but is no longer recommended. Studies show it does not improve survival or decrease peritoneal recurrence. * **D. Radiotherapy:** Adjuvant therapy (Chemo-radiation) is generally reserved for locally advanced disease (T3, T4) or node-positive cases, not for early-stage in-situ cancer. **NEET-PG High-Yield Pearls:** * **T1a (Lamina propria):** Simple Cholecystectomy is enough. * **T1b (Muscularis) & T2 (Perimuscular connective tissue):** Requires Radical/Extended Cholecystectomy. * **Incidental GBC:** Most common way GBC is diagnosed (found in 0.2–1% of routine cholecystectomies). * **Most common site of GBC:** Fundus (60%). * **Most common histology:** Adenocarcinoma.

Q: A 56-year-old man, who underwent thyroidectomy four years ago for thyroid cancer, presents with a single 4 cm malignant lesion in the upper lobe of the left lung. Endobronchial biopsy confirmed malignancy but could not determine the organ of origin. There is no other evidence of disease, and the patient is in excellent health. What is the recommended management?

Attempted curative lung resection. ### Explanation The correct management for this patient is **Attempted curative lung resection (Option C)**. This decision is guided by the principles of managing a **solitary pulmonary metastasis** (metastasectomy). #### Why Option C is Correct In patients with a history of malignancy who present with a solitary lung lesion, surgical resection is indicated if the following criteria are met: 1. The primary tumor is controlled (thyroidectomy was done 4 years ago). 2. There are no extrapulmonary metastases. 3. The patient is medically fit for surgery (excellent health). 4. The lesion is technically resectable. In this case, even if the lesion is a primary lung cancer or a metastasis from the previous thyroid cancer, surgical resection offers the best chance for a **long-term cure** or significant survival benefit. #### Why Other Options are Incorrect * **Options A & B:** Radiotherapy and chemotherapy are generally considered palliative or adjuvant treatments. In the presence of a single, resectable lesion and no systemic spread, local definitive surgery is superior to systemic or radiation therapy. * **Option D:** Neck exploration is not indicated because there is no clinical or radiological evidence of local recurrence in the neck. The priority is addressing the potentially life-threatening lung mass. #### High-Yield Clinical Pearls for NEET-PG * **Metastasectomy Criteria:** Always look for "controlled primary," "no other systemic spread," and "fitness for surgery." * **Thyroid Cancer Spread:** While papillary thyroid cancer spreads via lymphatics, follicular thyroid cancer spreads hematogenously, often to the lungs and bones. * **Solitary Pulmonary Nodule (SPN):** In a patient with a prior history of malignancy, a new SPN has a >70% probability of being a metastasis or a new primary lung cancer, both of which often require surgical intervention.

Q: Which one of the following is the treatment of choice for a desmoid tumor?

Surgery. **Explanation:** **Desmoid tumors** (also known as aggressive fibromatosis) are benign but locally aggressive myofibroblastic neoplasms. They do not metastasize but have a high propensity for local recurrence and infiltration into surrounding structures. **Why Surgery is the Correct Answer:** Historically and for NEET-PG purposes, **wide local excision with negative margins (R0 resection)** is considered the primary treatment of choice for symptomatic or enlarging desmoid tumors. The goal is to remove the tumor completely to prevent local recurrence. While "active observation" is gaining traction for asymptomatic cases, surgery remains the definitive intervention when treatment is indicated. **Why Other Options are Incorrect:** * **Radiotherapy (B):** Generally reserved as an adjuvant therapy for recurrent cases or when surgical margins are positive (R1/R2). It is rarely used as a primary standalone treatment due to the risk of radiation-induced sarcomas. * **Chemotherapy (C):** Systemic therapy (e.g., NSAIDs, Tamoxifen, or low-dose Methotrexate) is used for unresectable, multi-focal, or life-threatening tumors (especially intra-abdominal cases), but it is not the first-line "treatment of choice." * **Radiotherapy + Chemotherapy (D):** This combination is not standard protocol for desmoid tumors, as these tumors are not traditionally "chemosensitive" or "radiosensitive" enough to justify combined toxicity over surgical intervention. **Clinical Pearls for NEET-PG:** * **Association:** Strongly associated with **Gardner Syndrome** (a variant of FAP). * **Location:** Most common site is the **rectus abdominis muscle** in postpartum women. * **Pathology:** Characterized by the proliferation of fibroblasts and an abundance of collagen; they often stain positive for **nuclear beta-catenin**. * **Recurrence:** Despite wide excision, recurrence rates remain high (up to 20-30%).

Question 1

What is the appropriate treatment for breast cancer in a patient during the first trimester of pregnancy?

Accepted Answer

Medical termination of pregnancy followed by treatment according to protocol

Answer

Neoadjuvant chemotherapy followed by surgery

Answer

Breast conservation surgery

Answer

Radiotherapy

Question 2

Migratory thrombophlebitis is associated with which of the following malignancies?

Accepted Answer

Testicular tumor

Answer

Lung cancer

Answer

Pancreas cancer

Answer

Gastrointestinal cancer

Question 3

A 80-year-old patient presents with a midline tumor of the lower jaw, involving the alveolar margin. The patient is edentulous. What is the recommended treatment?

Accepted Answer

Segmental mandibulectomy

Answer

Hemimandibulectomy

Answer

Commando operation

Answer

Marginal mandibulectomy

Question 4

After laparoscopic cholecystectomy, if biopsy reveals in situ cancer of the gallbladder (Stage I), what is the appropriate management?

Accepted Answer

Follow up

Answer

Extended cholecystectomy

Answer

Excision of all port sites

Answer

Radiotherapy

Question 5

What is a Marjolin's ulcer?

Accepted Answer

A malignant ulcer found on the scar of a burn

Answer

A trophic ulcer

Answer

Meleney's gangrene

Answer

A malignant ulcer found on an infected foot

Question 6

All of the following are true about oncological emergencies except?

Accepted Answer

Tumor lysis syndrome is characterized by hyperuricemia, hyperkalemia, and hypophosphatemia.

Answer

PTH-related peptide is responsible for hypercalcemia of malignancy.

Answer

Zoledronic acid is the drug of choice for hypercalcemia of malignancy.

Answer

Most cases of typhlitis resolve with medical therapy alone.

Question 7

A 68-year-old male presented with low back pain that is worse at night and interferes with sleep. Evaluation revealed a bone lesion in the lumbar spine, and a biopsy was suggestive of blastic skeletal metastasis from an unknown primary. What is the next best blood test to order for this patient?

Accepted Answer

Serum prostatic specific antigen (PSA)

Answer

Serum alkaline phosphatase

Answer

Serum alpha fetoprotein

Answer

Serum calcium

Question 8

A 56-year-old man, who underwent thyroidectomy four years ago for thyroid cancer, presents with a single 4 cm malignant lesion in the upper lobe of the left lung. Endobronchial biopsy confirmed malignancy but could not determine the organ of origin. There is no other evidence of disease, and the patient is in excellent health. What is the recommended management?

Accepted Answer

Attempted curative lung resection

Answer

Radiotherapy

Answer

Combination chemotherapy

Answer

Exploration of the neck for thyroid recurrence

Question 9

Which one of the following is the treatment of choice for a desmoid tumor?

Accepted Answer

Surgery

Answer

Radiotherapy

Answer

Chemotherapy

Answer

Radiotherapy + Chemotherapy

Question 10

What is the diagnostic method of choice for a mediastinal mass suspected to be thymoma?

Accepted Answer

Thoracotomy and biopsy

Answer

Fine Needle Aspiration Cytology (FNAC)

Answer

Chest CT scan

Answer

Somatostatin receptor imaging

Oncological Surgery — MCQs

Oncological Surgery — MCQs

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