Cancer Survivorship — MCQs
At what age is the first dose of Measles vaccination given under the Universal Immunization Programme (UIP)?
Risk of malignancy in BIRADS score 2 is
What is triage for?
All of the following are true about long-term sequelae of craniospinal radiotherapy for children with CNS tumors except:
What is the primary basis for the Working Formulation in the classification of non-Hodgkin's lymphoma?
Bleomycin toxicity affects which organ predominantly?
Which of the following cancers is least associated with BRCA2 mutations?
A 45 year old underwent surgery for rectal prolapse. At present, he complains of sexual dysfunction which is probably due to the injury of:
What is the definition of a sentinel lymph node?
What is the definition of neoadjuvant chemotherapy?
Cancer Survivorship Indian Medical PG Practice Questions and MCQs
Question 1: At what age is the first dose of Measles vaccination given under the Universal Immunization Programme (UIP)?
- A. 10 weeks
- B. 9 months (Correct Answer)
- C. 14 weeks
- D. 6 months
Explanation: ***9 months*** - The first dose of the **Measles-Rubella (MR) vaccine** is given at **9 months of age** as per India's Universal Immunization Programme (UIP). - This timing is chosen because **maternal antibodies** against measles, which can interfere with vaccine effectiveness, generally wane by this age. - A second dose is given at **16-24 months** to ensure adequate protection (Note: Some countries use MMR vaccine which includes mumps component as well). *10 weeks* - This age is associated with the administration of other routine vaccinations like **Pentavalent vaccine (DPT-HepB-Hib)** and **OPV/IPV**, not measles. - Administering the measles vaccine too early, when **maternal antibodies** are still high, leads to suboptimal immune response. *14 weeks* - This is when the **third dose of Pentavalent vaccine and OPV/IPV** are given as part of the routine immunization schedule. - This age is not the standard recommendation for initial measles vaccination. *6 months* - While specific high-risk situations (e.g., outbreaks or travel to endemic areas) might warrant an additional measles vaccine dose at 6 months, it is **not the routine recommended age** for the first dose. - At 6 months, there may still be sufficient **maternal antibodies** to interfere with vaccine efficacy, leading to poorer immune response compared to vaccination at 9 months. - If given at 6 months during outbreaks, the child still receives routine doses at 9 months and 16-24 months.
Question 2: Risk of malignancy in BIRADS score 2 is
- A. 0% (Correct Answer)
- B. 2-4%
- C. 10%
- D. 50%
Explanation: ***0%*** - A **BIRADS score of 2** indicates a **definitively benign finding**, meaning there is **essentially 0% risk of malignancy**. - BIRADS 2 is assigned to findings that are clearly benign such as **simple cysts, intramammary lymph nodes, calcified fibroadenomas**, and other characteristically benign lesions. - **No follow-up or intervention is required** for BIRADS 2 findings. *2-4%* - This risk range is typically associated with **BIRADS 4A** lesions (low suspicion for malignancy), which require **tissue diagnosis/biopsy**. - BIRADS 2 findings are definitively benign and have no measurable risk of malignancy. *10%* - A 10% risk of malignancy is aligned with **BIRADS 4A-4B** lesions (low to moderate suspicion), which require **biopsy**. - This percentage indicates a suspicious finding, which is completely different from a definitively benign BIRADS 2 finding. *50%* - A 50% risk of malignancy corresponds to a highly suspicious finding, typically **BIRADS 4C**, demanding **immediate biopsy**. - This level of risk is far too high for a benign finding like BIRADS 2, which carries no risk of malignancy.
Question 3: What is triage for?
- A. To rehabilitate following a disaster
- B. To prepare for a disaster
- C. To classify the priority of treatment (Correct Answer)
- D. To assess the impact of a disaster
Explanation: ***To classify the priority of treatment*** - **Triage** is the process of sorting patients to determine the **priority** of their treatment based on the **severity** of their condition and the likelihood of recovery, especially when resources are limited. - This system ensures that those who need immediate care most urgently receive it first, maximizing the number of lives saved. *To rehabilitate following a disaster* - **Rehabilitation** focuses on restoring health and functional abilities after an injury or illness, which occurs **post-treatment**, not as the initial classification of need. - This phase of care happens *after* triage has been completed and immediate medical needs have been addressed. *To prepare for a disaster* - **Disaster preparedness** involves planning and training *before* a disaster strikes to mitigate its effects and ensure an effective response. - Triage is a **response mechanism** utilized *during* or *immediately after* a disaster, not a preparatory measure. *To assess the impact of a disaster* - **Impact assessment** involves evaluating the damage, casualties, and overall consequences of a disaster. - While disaster impact assessment helps guide overall response, triage is specifically about **individual patient assessment** and prioritization for medical care.
Question 4: All of the following are true about long-term sequelae of craniospinal radiotherapy for children with CNS tumors except:
- A. Musculoskeletal hypoplasia
- B. Neurocognitive dysfunction
- C. Endocrinologic dysfunction
- D. Neuropsychological sequelae are independent of radiation dose (Correct Answer)
Explanation: ***Neuropsychological sequelae are independent of radiation dose*** - This statement is incorrect; **neuropsychological sequelae** are **highly dependent on the radiation dose** received by the brain, with higher doses generally leading to more severe and frequent cognitive impairments. - The impact of radiation on developing neural tissue is dose-related, affecting **myelination**, **synaptogenesis**, and **neurogenesis**, leading to dose-dependent cognitive deficits. *Musculoskeletal hypoplasia* - **Craniospinal irradiation (CSI)** can lead to musculoskeletal hypoplasia, particularly affecting the **vertebrae** and **long bones**, resulting in **short stature** and **scoliosis**. - Radiation can damage growth plates and bone-forming cells, impairing normal bone development and leading to growth deficiencies. *Neurocognitive dysfunction* - **Radiation to the brain** in children, especially at a young age, can cause significant **neurocognitive dysfunction**, including deficits in **memory**, **attention**, **processing speed**, and **executive functions**. - Damage to **white matter**, particularly secondary to demyelination and vasculopathy, plays a significant role in these cognitive impairments. *Endocrinologic dysfunction* - **CSI** frequently affects the **hypothalamic-pituitary axis**, leading to various **endocrinologic dysfunctions** such as **growth hormone deficiency**, **thyroid dysfunction**, and **gonadal dysfunction**. - The developing endocrine glands and their regulatory centers are particularly sensitive to radiation, impacting hormonal production and regulation.
Question 5: What is the primary basis for the Working Formulation in the classification of non-Hodgkin's lymphoma?
- A. Morphology of cells (Correct Answer)
- B. Cell surface markers
- C. Survival characteristic of cells
- D. Cellular genetics
Explanation: ***Morphology of cells*** - The **Working Formulation** primarily classified non-Hodgkin's lymphomas based on the **histological appearance** of the malignant cells, such as cell size, nuclear features, and growth patterns. - This classification aimed to group lymphomas with similar prognoses, broadly categorizing them into low, intermediate, and high-grade based on their **cytological features**. *Cell surface markers* - While cell surface markers (immunophenotyping) are crucial in modern lymphoma classification (e.g., WHO classification), they were not the **primary basis** for the Working Formulation. - Immunophenotyping identifies the lineage and differentiation stage of lymphoid cells (e.g., B-cell, T-cell) but became widely integrated into lymphoma classification later. *Survival characteristic of cells* - The Working Formulation did indirectly consider survival by grouping lymphomas with similar prognoses, but **survival characteristics** themselves were not the primary *basis* for classifying each specific lymphoma type. - Prognosis was an outcome derived from the morphological classification, not the initial classifying factor. *Cellular genetics* - **Cellular genetics**, including chromosomal translocations and gene mutations, are fundamental to current World Health Organization (WHO) classifications of lymphoma. - However, comprehensive genetic analysis was not readily available or the primary method for classifying lymphomas when the Working Formulation was developed.
Question 6: Bleomycin toxicity affects which organ predominantly?
- A. Bone marrow
- B. Lungs (Correct Answer)
- C. Liver
- D. RBC
Explanation: ***Lungs*** - **Bleomycin** is well-known for causing **pulmonary fibrosis**, an irreversible scarring of the lungs, as its most significant and dose-limiting toxicity. - This toxicity is thought to be due to an inability of the lungs to adequately inactivate bleomycin, leading to oxidative damage. *Bone marrow* - While many chemotherapeutic agents cause **bone marrow suppression**, bleomycin is notable for causing **minimal myelosuppression** compared to other cytotoxic drugs. - Therefore, bone marrow is not the predominantly affected organ for toxicity with bleomycin. *Liver* - **Hepatotoxicity** (liver damage) can occur with some chemotherapy agents, but it is **not a primary or prominent toxicity associated with bleomycin**. - Other drugs are much more frequently associated with liver damage. *RBC* - Bleomycin does not directly target **red blood cells (RBCs)** for toxicity. - While severe bone marrow suppression from other drugs can lead to anemia, bleomycin's effect on RBCs is indirect and not its predominant toxicity profile.
Question 7: Which of the following cancers is least associated with BRCA2 mutations?
- A. Breast cancer
- B. Prostate cancer
- C. Ovarian cancer
- D. Vulval cancer (Correct Answer)
Explanation: ***Vulval cancer*** - While there may be some rare, sporadic cases, **vulval cancer** is generally not considered a primary cancer with a strong, well-established association with **BRCA2 mutations**. - Its etiology is more commonly linked to **HPV infection** and other risk factors not directly related to hereditary breast and ovarian cancer syndromes. *Breast cancer* - **BRCA2 mutations** are strongly associated with an increased lifetime risk of developing **breast cancer**, particularly for **male breast cancer**. - These mutations impair DNA repair mechanisms, leading to genomic instability that can result in cancerous transformation of breast tissue. *Prostate cancer* - Men with **BRCA2 mutations** have a significantly elevated risk of developing **prostate cancer**, often at an earlier age and with a more aggressive phenotype. - This association is well-documented, making BRCA2 testing relevant in high-risk prostate cancer populations. *Ovarian cancer* - **BRCA2 mutations** are a significant risk factor for **ovarian cancer**, particularly **high-grade serous ovarian cancer**. - The risk is substantial, though generally lower than that conferred by BRCA1 mutations for ovarian cancer in particular.
Question 8: A 45 year old underwent surgery for rectal prolapse. At present, he complains of sexual dysfunction which is probably due to the injury of:
- A. Pelvic autonomic nerves (Correct Answer)
- B. Urinary bladder
- C. Rectum
- D. Inferior mesenteric artery
Explanation: ***Pelvic autonomic nerves*** - Surgical procedures in the **pelvic region**, such as for rectal prolapse, carry a risk of damaging the **pelvic autonomic nerves**, which are crucial for sexual function. - Injury to these nerves can lead to various forms of **sexual dysfunction**, including erectile dysfunction in men, due to impaired nerve signaling to the genital organs. *Urinary bladder* - While the urinary bladder is anatomically close to the rectum, direct injury to the bladder itself during rectal prolapse surgery typically leads to **urinary symptoms** (e.g., incontinence, retention), not primarily sexual dysfunction. - Though bladder dysfunction can indirectly impact sexual activity, it's not the direct cause of primary sexual dysfunction following injury in this context. *Rectum* - The surgery is performed on the rectum, and while complications can occur, direct injury to the rectal wall itself primarily results in issues such as **fecal incontinence, bleeding, or infection**. - The rectum's primary role is in digestion and defecation, and its injury does not directly cause sexual dysfunction unrelated to nerve damage. *Inferior mesenteric artery* - The **inferior mesenteric artery (IMA)** supplies blood to the distal colon and rectum, and its injury during surgery would primarily lead to **ischemia or necrosis** of the supplied bowel segments. - While a severely compromised blood supply could have systemic effects, direct injury to the IMA is not a direct or common cause of sexual dysfunction.
Question 9: What is the definition of a sentinel lymph node?
- A. The primary lymph node draining the tumor. (Correct Answer)
- B. The first lymph node excised during a modified radical mastectomy.
- C. The lymph node located nearest to the tumor.
- D. None of the above.
Explanation: ### Explanation **Concept Overview** The **Sentinel Lymph Node (SLN)** is defined as the first lymph node (or group of nodes) in a regional lymphatic basin that receives direct lymphatic drainage from a primary tumor. The underlying physiological principle is that lymphatic metastasis occurs in an orderly, step-wise fashion. If the sentinel node is negative for malignancy, there is a high probability (usually >95%) that the remaining nodes in that basin are also free of disease. **Analysis of Options** * **Option A (Correct):** This aligns with the physiological definition. It is the "gatekeeper" node. If the tumor spreads via lymphatics, this node is the first site of metastasis. * **Option B (Incorrect):** A Modified Radical Mastectomy (MRM) involves a formal axillary lymph node dissection (Levels I and II). The nodes removed are based on anatomical boundaries, not necessarily the specific drainage pattern of the tumor. * **Option C (Incorrect):** Proximity does not always equal drainage. Due to the complexity of lymphatic channels, the sentinel node may sometimes be anatomically distant from the tumor while still being the first node to receive its drainage. **Clinical Pearls for NEET-PG** * **Identification:** SLN is identified using **Isosulfan blue/Methylene blue dye** (visualized) and/or **Technetium-99m labeled sulfur colloid** (detected via a gamma probe). * **Most Common Indications:** Breast cancer (T1/T2 lesions) and Malignant Melanoma. * **Skip Metastasis:** This refers to a phenomenon where the SLN is negative, but higher-level nodes are positive. While rare, it is a limitation of SLN biopsy. * **Contraindications in Breast Cancer:** Inflammatory breast cancer, multicentric tumors (relative), and clinically palpable axillary nodes (N1/N2).
Question 10: What is the definition of neoadjuvant chemotherapy?
- A. Chemotherapy administered concurrently with surgery
- B. Chemotherapy administered prior to surgery (Correct Answer)
- C. Chemotherapy administered following surgery
- D. Chemotherapy administered in conjunction with radiation therapy
Explanation: **Explanation:** **Neoadjuvant chemotherapy** refers to the administration of systemic cytotoxic agents **prior to the primary definitive treatment** (usually surgery). The primary goal is to downstage the tumor, increase the likelihood of a complete (R0) resection, and treat micrometastatic disease early. * **Why Option B is Correct:** The prefix "neo-" (new/before) and "adjuvant" (assisting) signifies therapy given before the main intervention. By shrinking the primary tumor, it can convert an inoperable case into an operable one or allow for breast-conserving surgery instead of a mastectomy. * **Why Options A, C, and D are Incorrect:** * **Option A:** Chemotherapy is rarely given *during* the surgical procedure itself (except for specialized techniques like HIPEC). * **Option C:** This describes **Adjuvant Chemotherapy**, which is given *after* surgery to eliminate residual microscopic disease and reduce recurrence risk. * **Option D:** This describes **Concurrent Chemoradiotherapy (CCRT)**, often used as definitive treatment in cancers like Carcinoma Cervix or Esophagus. **NEET-PG High-Yield Pearls:** 1. **Pathological Complete Response (pCR):** The gold standard for measuring the effectiveness of neoadjuvant therapy; it implies no viable tumor cells remain in the surgical specimen. 2. **Common Indications:** Locally advanced breast cancer (LABC), esophageal cancer, and rectal cancer (often as neoadjuvant chemoradiation). 3. **Window of Opportunity:** It provides an *in vivo* assessment of how sensitive the tumor is to a specific chemotherapy regimen.
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