Surgical Oncology Principles Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Surgical Oncology Principles. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Surgical Oncology Principles Indian Medical PG Question 1: 65 year old man with carcinoma of tongue of > 4 cm size and multiple lymph nodes of > 6 cm noted. What is the AJCC staging?
- A. T3 N3 M0 (Correct Answer)
- B. T2 N3 M0
- C. T3 N2 M0
- D. T2 N2 M0
Surgical Oncology Principles Explanation: ***T3 N3 M0***
- The primary tumor (T) is classified as **T3** because its greatest dimension is greater than 4 cm (or any tumor with depth of invasion > 10 mm).
- The nodal involvement (N) is classified as **N3** (specifically **N3a**) because any lymph node greater than 6 cm, regardless of number, qualifies as N3a per **AJCC 8th Edition** staging.
- This is the correct staging based on the clinical findings provided.
*T2 N3 M0*
- This is incorrect because a tumor > 4 cm automatically classifies as **T3**, not T2.
- **T2** is reserved for tumors > 2 cm but ≤ 4 cm with depth of invasion ≤ 10 mm, or tumors ≤ 2 cm with depth of invasion > 5 mm and ≤ 10 mm.
- While the N3 classification is correct, the T staging is wrong.
*T3 N2 M0*
- This is incorrect because although **T3** is correct for a tumor > 4 cm, the nodal classification is wrong.
- Any lymph node > 6 cm is classified as **N3a**, not N2.
- **N2** classifications require all involved nodes to be ≤ 6 cm in size.
*T2 N2 M0*
- This is incorrect as both the T and N classifications are inaccurate.
- A tumor > 4 cm is **T3**, not T2.
- Lymph node(s) > 6 cm are **N3a**, not N2.
- This represents understaging of both the primary tumor and nodal disease.
Surgical Oncology Principles Indian Medical PG Question 2: Radiotherapy is most useful in:
- A. Melanoma
- B. Pancreatic carcinoma
- C. Osteosarcoma
- D. Seminoma (Correct Answer)
Surgical Oncology Principles Explanation: ***Seminoma***
- **Seminoma** is a highly **radiosensitive** tumor, making radiotherapy a cornerstone of its treatment, especially for localized disease and in adjuvant settings.
- Due to its chemosensitivity and radiosensitivity, even advanced seminoma often responds well to treatment, leading to **high cure rates**.
*Melanoma*
- **Melanoma** is generally considered **radioresistant**, meaning that it does not respond well to conventional doses of radiation.
- Treatment primarily involves **surgical excision**, immunotherapy, and targeted therapies.
*Pancreatic carcinoma*
- **Pancreatic carcinoma** is notoriously **radioresistant** and has a poor prognosis, with limited effectiveness of standalone radiation therapy.
- Treatment often involves a combination of **surgery**, chemotherapy, and sometimes concurrent chemoradiation, though outcomes remain challenging.
*Osteosarcoma*
- **Osteosarcoma** is primarily managed with **surgical resection** and **neoadjuvant/adjuvant chemotherapy**, as it is relatively radioresistant.
- Radiotherapy is typically reserved for unresectable tumors, palliative care, or when surgery is contraindicated.
Surgical Oncology Principles Indian Medical PG Question 3: 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
Surgical Oncology Principles 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.
Surgical Oncology Principles Indian Medical PG Question 4: Which of the following is the platinum-based chemotherapeutic agent used as first-line treatment for ovarian carcinoma?
- A. Cyclophosphamide
- B. Methotrexate
- C. Cisplatin (Correct Answer)
- D. Dacarbazine
Surgical Oncology Principles Explanation: ***Cisplatin***
- **Cisplatin** is a platinum-based chemotherapy drug that forms **DNA cross-links**, inhibiting DNA synthesis and leading to the death of rapidly dividing cells, making it highly effective against **ovarian carcinoma**.
- It is a cornerstone of chemotherapy regimens for ovarian cancer, often used in combination with other agents such as paclitaxel.
*Methotrexate*
- **Methotrexate** is an **antimetabolite** that inhibits dihydrofolate reductase, thereby interfering with DNA synthesis.
- While it is used in various cancers like leukemia, lymphoma, and some solid tumors (e.g., breast cancer, gestational trophoblastic disease), it is **not a primary recommended drug for ovarian carcinoma**.
*Cyclophosphamide*
- **Cyclophosphamide** is an **alkylating agent** that causes DNA damage, leading to cell death.
- It is used in many cancers, including lymphoma, breast cancer, and some leukemias, but it is **not a first-line or primary agent for ovarian carcinoma** in contemporary treatment guidelines.
*Dacarbazine*
- **Dacarbazine** is an **alkylating agent** primarily used in the treatment of **malignant melanoma** and Hodgkin lymphoma.
- It is **not indicated for the treatment of ovarian carcinoma**.
Surgical Oncology Principles Indian Medical PG Question 5: Which one of the following is not a component of THORACOSCORE?
- A. Performance status
- B. Complication of surgery (Correct Answer)
- C. Priority of surgery
- D. ASA grading
Surgical Oncology Principles Explanation: ***Complication of surgery***
- THORACOSCORE is a **risk prediction model** for thoracic surgery used to estimate the *probability of mortality and significant morbidity*, but it does not account for the complications of surgery itself as a component.
- The score uses **pre-operative patient characteristics** and co-morbidities to predict outcomes, not post-operative events.
*Performance status*
- **Performance status**, such as the **ECOG scale**, is a crucial component of THORACOSCORE, reflecting the patient's general health and functional capacity prior to surgery.
- A lower performance status (indicating poorer functional ability) increases the predicted risk in THORACOSCORE.
*Priority of surgery*
- The **priority of surgery** (e.g., elective, urgent, emergency) is an important factor in THORACOSCORE, as emergency procedures generally carry a higher risk.
- This variable helps to capture the urgency and associated physiological stress on the patient at the time of presentation for surgery.
*ASA grading*
- The **American Society of Anesthesiologists (ASA) physical status classification system** is a component of THORACOSCORE, assessing the patient's overall health status and anesthetic risk.
- A higher ASA grade (indicating more severe systemic disease) contributes to a higher predicted risk in the THORACOSCORE model.
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