Surgical Oncology Principles Practice Questions

Q: What is true about gastric stump carcinoma?

Enterogastric reflex is the cause.. **Explanation:** Gastric stump carcinoma (GSC) is a malignancy arising in the gastric remnant at least 5 years after a primary surgery for benign disease (most commonly for peptic ulcer disease). **1. Why Option A is correct:** The primary pathophysiology involves the **enterogastric reflux** of bile acids and pancreatic enzymes into the gastric remnant. Chronic exposure to alkaline duodenal contents leads to chronic atrophic gastritis, intestinal metaplasia, and eventually dysplasia. This risk is significantly higher in **Billroth II** reconstructions compared to Billroth I due to the direct and constant bathing of the stoma with bile. **2. Why other options are incorrect:** * **Option B:** The prognosis is generally **poor**. GSC is often diagnosed at an advanced stage because symptoms (weight loss, anemia) are frequently attributed to post-gastrectomy syndromes. It also has a high propensity for lymphatic spread and involvement of adjacent organs. * **Option C:** While **adenocarcinoma** is the most common histological type (approx. 95%), it is not "always" the case. Rare instances of squamous cell carcinoma or primary gastric lymphoma in the stump have been reported. * **Option D:** Both **Lauren’s intestinal and diffuse types** can occur. While some studies suggest a higher prevalence of the diffuse type in the stump, the intestinal type is also frequently observed. **High-Yield Clinical Pearls for NEET-PG:** * **Latency Period:** Typically occurs **15–20 years** after the initial surgery. * **Risk Factor:** The risk is higher after surgery for **gastric ulcers** than for duodenal ulcers. * **Hypochlorhydria:** Post-gastrectomy achlorhydria allows for the colonization of nitrate-reducing bacteria, which produce carcinogenic **N-nitroso compounds**, further contributing to carcinogenesis. * **Screening:** Endoscopic surveillance is often recommended starting 10–15 years post-surgery.

Q: Sentinel lymph node biopsy is indicated in all of the following conditions except?

Carcinoma of the colon. **Explanation:** The concept of **Sentinel Lymph Node Biopsy (SLNB)** is based on the principle that lymphatic drainage from a primary tumor follows a predictable orderly pattern to a specific "first" node (the sentinel node). If this node is negative for metastasis, the remaining nodes in that basin are likely negative, sparing the patient from the morbidity of a radical lymph node dissection. **Why Carcinoma of the Colon is the Correct Answer:** In colon cancer, the lymphatic drainage is often unpredictable and "skip metastasis" can occur. More importantly, the standard surgical treatment for colon cancer is a **formal colectomy**, which inherently includes the wide excision of the associated mesentery and its regional lymph nodes (to ensure adequate oncological margins and staging). Therefore, identifying a single sentinel node does not change the extent of the surgery, making SLNB clinically redundant. **Why the other options are incorrect:** * **Carcinoma of the Breast:** SLNB is the standard of care for clinically node-negative (cN0) patients to avoid the complications of Axillary Lymph Node Dissection (ALND) like lymphedema. * **Malignant Melanoma:** SLNB is indicated for tumors with a thickness >0.75 mm or those with high-risk features to determine the need for therapeutic lymphadenectomy. * **Carcinoma of the Penis:** SLNB (or Dynamic Sentinel Node Biopsy) is indicated in patients with non-palpable inguinal nodes (cN0) but high-risk primary tumors (T1G2 or higher). **High-Yield Clinical Pearls for NEET-PG:** * **Tracer used:** Technetium-99m labeled sulfur colloid and/or isosulfan/methylene blue dye. * **Most common site for SLNB:** Breast cancer and Melanoma. * **Other indications:** Early-stage vulvar cancer and certain oral cavity cancers. * **Contraindication in Breast Cancer:** Inflammatory breast cancer and clinically positive (palpable) axillary nodes.

Q: Which tumor marker is used for the follow-up of colorectal cancer?

CEA. **Explanation:** **CEA (Carcinoembryonic Antigen)** is the correct answer because it is the gold-standard tumor marker for the surveillance and follow-up of **Colorectal Cancer (CRC)**. It is a glycoprotein normally produced during fetal development; in adults, elevated levels are associated with adenocarcinomas, particularly of the colon. * **Clinical Utility:** CEA is **not** used for screening due to low sensitivity and specificity (it can be elevated in smokers, COPD, and inflammatory bowel disease). Its primary role is in **monitoring recurrence** after surgical resection. A postoperative rise in CEA levels often precedes clinical or radiological evidence of metastasis by months. **Analysis of Incorrect Options:** * **CA 125:** Primarily used for **Ovarian Cancer** (specifically epithelial types). It can also be elevated in endometriosis or pelvic inflammatory disease. * **CA 19-9:** The primary marker for **Pancreatic Cancer** and Cholangiocarcinoma. While it can be elevated in CRC, it is not the preferred marker for follow-up. * **AFP (Alpha-Fetoprotein):** Used for **Hepatocellular Carcinoma (HCC)** and non-seminomatous germ cell tumors (like Yolk Sac tumors). **High-Yield Pearls for NEET-PG:** 1. **Most common site of CRC metastasis:** Liver (spread via the portal venous system). 2. **CEA and Prognosis:** Pre-operative CEA levels correlate with the stage of the disease; failure of CEA to return to normal after surgery suggests residual tumor. 3. **Surveillance Schedule:** ASCO guidelines recommend checking CEA every 3–6 months for the first 5 years after curative resection for Stage II and III disease.

Q: What is the most common malignancy affecting the spleen?

Lymphoma. **Explanation:** The spleen is the largest lymphoid organ in the body, making it a frequent site for involvement by hematological malignancies. **Correct Answer: D. Lymphoma** Lymphoma is the most common malignancy affecting the spleen. It can involve the spleen either as a **primary** site (Primary Splenic Lymphoma) or, more commonly, as part of **systemic** involvement (Secondary). Among these, Non-Hodgkin Lymphoma (NHL) is more frequent than Hodgkin Lymphoma. Splenic involvement is seen in approximately 30-40% of systemic lymphoma cases. **Analysis of Incorrect Options:** * **A. Angiosarcoma:** This is the most common **primary non-lymphoid malignant tumor** of the spleen. While highly aggressive with a poor prognosis, it is much rarer than lymphoma. * **B. Hemangioma:** This is the most common **benign** tumor of the spleen. It is usually an incidental finding and does not represent a malignancy. * **C. Metastases:** While the spleen is highly vascular, splenic metastases from solid tumors (e.g., breast, lung, melanoma) are relatively **uncommon** compared to other organs like the liver or lungs. This is attributed to the spleen’s high concentration of immune cells and the rhythmic contractions of its capsule. **High-Yield Clinical Pearls for NEET-PG:** * **Most common benign tumor:** Hemangioma. * **Most common primary malignancy:** Lymphoma (specifically Splenic Marginal Zone Lymphoma in primary cases). * **Most common primary non-lymphoid malignancy:** Angiosarcoma (associated with a high risk of spontaneous rupture). * **Indication for Splenectomy:** In lymphoma, splenectomy is usually reserved for diagnosis, staging, or management of symptomatic splenomegaly/hypersplenism.

Q: A Poly A base sequence would most likely be found at which location?

3' end of a eukaryotic mRNA. **Explanation:** The correct answer is **D. 3' end of a eukaryotic mRNA.** In eukaryotic cells, the maturation of pre-mRNA into functional messenger RNA (mRNA) involves a post-transcriptional modification known as **polyadenylation**. This process involves the addition of a "tail" consisting of 50 to 250 adenine nucleotides (the **Poly-A tail**) specifically to the **3' end** of the RNA molecule. **Why it is correct:** The Poly-A tail serves three critical functions: 1. **Stability:** It protects the mRNA from enzymatic degradation by exonucleases. 2. **Nuclear Export:** It facilitates the transport of the mRNA from the nucleus to the cytoplasm. 3. **Translation:** It enhances the recognition of the mRNA by ribosomes for protein synthesis. **Analysis of Incorrect Options:** * **A & B (Prokaryotic mRNA):** Prokaryotic mRNAs generally do not undergo polyadenylation. When polyadenylation does occur in bacteria, it ironically acts as a signal for *degradation* rather than stability. * **C (5' end of eukaryotic mRNA):** The 5' end of eukaryotic mRNA undergoes a different modification called **"Capping"** (addition of a 7-methylguanosine cap), which is essential for ribosome binding and protection from 5' exonucleases. **High-Yield Clinical Pearls for NEET-PG:** * **Sequence Signal:** The polyadenylation signal sequence is typically **AAUAAA**, located upstream of the poly-A site. * **Enzyme:** The addition of the tail is catalyzed by the enzyme **Poly(A) Polymerase**, which does *not* require a DNA template. * **Surgical Oncology Link:** Dysregulation of mRNA stability and polyadenylation patterns is often implicated in the overexpression of oncogenes and the progression of various solid tumors, making it a target for emerging molecular therapies.

Q: Antoni A and Antoni B patterns are seen in which of the following?

Schwannoma. **Explanation:** **Schwannoma** (also known as Neurilemmoma) is a benign nerve sheath tumor derived from Schwann cells. Histologically, it is characterized by a distinct biphasic pattern consisting of **Antoni A** and **Antoni B** areas: * **Antoni A:** Highly cellular areas with spindle cells arranged in fascicles. A hallmark feature here is the **Verocay body**, which consists of two compact rows of well-aligned nuclei separated by an acellular zone. * **Antoni B:** Hypocellular, loosely arranged myxoid stroma with fewer cells and cystic changes. **Why other options are incorrect:** * **Neurofibroma:** Unlike Schwannomas, these are unencapsulated and contain a mixture of cell types (Schwann cells, fibroblasts, and perineural cells) in a "shredded carrot" collagenous background. They do not exhibit the Antoni A/B biphasic pattern. * **Meningioma:** Characterized histologically by whorled patterns and **Psammoma bodies** (laminated calcifications), not Antoni patterns. * **Teratoma:** A germ cell tumor containing tissues from all three germ layers (ectoderm, endoderm, mesoderm). Its histology shows a disorganized mixture of various tissues like hair, muscle, and epithelium. **High-Yield Clinical Pearls for NEET-PG:** * **S-100 Protein:** Schwannomas show strong and diffuse positivity for S-100 (immunohistochemistry). * **Nerve Relationship:** Schwannomas usually arise from the side of the nerve and are **encapsulated**, making them surgically separable from the nerve (unlike neurofibromas). * **Acoustic Neuroma:** The most common location is the Vestibulocochlear nerve (CN VIII) at the cerebellopontine angle. Bilateral acoustic neuromas are pathognomonic for **Neurofibromatosis Type 2 (NF2)**.

Q: Blood-stained sputum may be the only presenting symptom in which of the following conditions?

Adenoma of the bronchus. **Explanation:** The correct answer is **Adenoma of the bronchus** (specifically Bronchial Carcinoid). **Why it is correct:** Bronchial adenomas (most commonly **Carcinoid tumors**) are highly vascular, slow-growing epithelial tumors that arise from the bronchial mucosa. Because they are centrally located and extremely vascular, they often present with recurrent, painless hemoptysis (blood-stained sputum) as the **sole or earliest symptom**. Unlike malignant tumors, they do not typically cause rapid constitutional symptoms (weight loss, cachexia) or significant parenchymal destruction in the early stages, making hemoptysis the primary clinical feature. **Why the other options are incorrect:** * **Bronchiectasis:** While hemoptysis occurs, the hallmark presentation is a chronic, productive cough with **copious, foul-smelling purulent sputum**, often associated with finger clubbing. * **Carcinoma of the bronchus:** Hemoptysis is common, but it is rarely the *only* symptom. Patients usually present with a constellation of symptoms including persistent cough, chest pain, dyspnea, and significant systemic features like weight loss and anorexia. * **Pulmonary tuberculosis:** This is a systemic infection. While blood-stained sputum is a classic sign, it is almost always accompanied by constitutional symptoms such as low-grade evening fever, night sweats, and chronic productive cough. **NEET-PG High-Yield Pearls:** * **Bronchial Carcinoid** is the most common "adenoma" (80-90%). * They are characterized by **extreme vascularity**; biopsy during bronchoscopy carries a high risk of significant bleeding. * **Clinical Triad (rare):** Hemoptysis, localized wheeze (due to obstruction), and recurrent pneumonia in the same lobe. * On imaging, they may show the **"Iceberg sign"** (a small endobronchial component with a large extrabronchial mass).

Question 1

What is true about gastric stump carcinoma?

Accepted Answer

Enterogastric reflex is the cause.

Answer

Prognosis is good after surgery.

Answer

It is always adenocarcinoma in nature.

Answer

The diffuse type is the only variety.

Question 2

Sentinel lymph node biopsy is indicated in all of the following conditions except?

Accepted Answer

Carcinoma of the colon

Answer

Carcinoma of the breast

Answer

Carcinoma of the penis

Answer

Malignant melanoma

Question 3

Which of the following statements is FALSE regarding Gastric lymphoma?

Accepted Answer

Total gastrectomy with adjuvant chemotherapy is the treatment of choice.

Answer

Stomach is the most common site.

Answer

It is associated with H. pylori infection.

Answer

The 5-year survival rate after treatment is 60%.

Question 4

What is the treatment of choice for desmoid tumors?

Accepted Answer

Surgery + Radiotherapy

Answer

Surgery

Answer

Chemotherapy

Answer

Radiotherapy

Question 5

Which tumor marker is used for the follow-up of colorectal cancer?

Accepted Answer

CEA

Answer

CA 125

Answer

CA 19-9

Answer

AFP

Question 6

Which is the most common tumor associated with superior vena cava syndrome?

Accepted Answer

Lung cancer

Answer

Lymphoma

Answer

Metastasis

Answer

Thyroid cancer

Question 7

What is the most common malignancy affecting the spleen?

Accepted Answer

Lymphoma

Answer

Angiosarcoma

Answer

Hemangioma

Answer

Metastases

Question 8

A Poly A base sequence would most likely be found at which location?

Accepted Answer

3' end of a eukaryotic mRNA

Answer

5' end of a prokaryotic messenger RNA (mRNA)

Answer

3' end of a prokaryotic mRNA

Answer

5' end of a eukaryotic mRNA

Question 9

Antoni A and Antoni B patterns are seen in which of the following?

Accepted Answer

Schwannoma

Answer

Neurofibroma

Answer

Meningioma

Answer

Teratoma

Question 10

Blood-stained sputum may be the only presenting symptom in which of the following conditions?

Accepted Answer

Adenoma of the bronchus

Answer

Bronchiectasis

Answer

Carcinoma of the bronchus

Answer

Pulmonary tuberculosis

Surgical Oncology Principles — MCQs

Surgical Oncology Principles — MCQs

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