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Quiz on Medical Oncology
1. Which of the following is TRUE for cancer of the esophagus?
(1) Adenocarcinoma has a better outcome compared to squamous cell carcinoma of the esophagus.
(2) HER2+ over expression is an adverse prognostic factor similar to breast cancer.
(3) The incidence of esophageal cancer is higher in African-American compared to Caucasian men.
(4) The lifetime risk of being diagnosed with esophageal cancer is 1%.
2. Which of the following statement about the molecular biology of esophageal cancer is TRUE?
(1) EGFR over expression correlates with poor prognosis including poor response to chemotherapy.
(2) Presence of p53 point mutation correlates with response to induction chemotherapy and predicts survival after esophagectomy.
(3) Reduced expression of E-cadherin correlates with progression from Barrett esophagus to dysplasia and finally to adenocarcinoma.
(4) All of above
3. Which of the following syndrome is usually associated with intestinal type of gastric cancer?
(1) Lynch syndrome
(2) Li-Fraument syndrome
(3) Familial adenomatous polyposis syndrome
(4) Peutz-Jeghers syndrome
4. Which of the following gene mutations is associated with the highest gastric cancer risks?
5. A 48-year-old male who was diagnosed with adenocarcinoma of the stomach underwent partial gastrectomy. PET-CT prior to surgery shows no evidence of distant disease. He had of 18 lymph nodes removed involved with cancer. Margins were negative for cancer. The pathologic stage is ITB (T3 NI tumor). He was referred to you to discuss adjuvant treatment options. He has an ECOG performance status of ‘I’. What is the best treatment modality?
(1) Chemotherapy with Carboplatin and Paclitaxel
(2) There is no evidence for benefit from adjuvant treatment in this case.
(3) SFU and leucovorin, followed by 45 Gy in 25 fractions plus concurrent 5FU and leucovorin.
(4) Check for HER2 over expression and if positive, treat with cisplatin/SFU plus trastuzumab.
6. Which of the following statements regarding pancreatic cancer is TRUE?
(1) At diagnosis, about one-third have evidence of distant metastases.
(2) Activation of the KRAS oncogene plus inactivation of tumor suppressor genes (TP53, DPC4, pl6, and BRCA 2) are associated with the development of pancreatic cancer.
(3) Pancreatic intraepithelial neoplasms (PanINs) are intraductal proliferative epithelial lesions that will not progress to pancreatic cancer.
(4) Patients with advanced pancreatic cancer will have high levels of CA 19-9 if they are Lewis antigen-a or-b negative.
7. A 71-year-old woman undergoes Whipple resection for a T3NIMO pancreatic adenocarcinoma. Postoperative recovery was uneventful, and she starts adjuvant therapy 7 weeks later with gemcitabine given intravenously weekly for 3 weeks, followed by a 1-week break. In a follow-up visit after her first cycle, she reports a 5-lb weight loss, nausea, decreased appetite, and diarrhoea with floating stools. What should be done next?
(1) Increase pancreatic enzyme supplementation
(2) Admit the patient for small bowel obstruction
(3) Hold chemotherapy for 1 week and follow up on symptoms
(4) CT scan of the chest, abdomen, and pelvis to rule out metastatic disease
8. A 45-year-old man with unintentional weight loss is diagnosed with metastatic adenocarcinoma of the pancreas. Which of the following chemotherapy regimens would be appropriate first-line treatment choice in this otherwise healthy patient with normal organ function?
(2) FOLFIRINOX (SFU, leucovorin, irinotecan, and oxaliplatin)
(3) 5FU with radiation
(4) FOLFOX (SFU + leucovorin + oxaliplatin)
9. Which one of the following statements about adjuvant therapy for biliary cancers is TRUE?
(1) Based on retrospective data it appears patients may benefit from adjuvant chemotherapy.
(2) Adjuvant radiation is superior to chemotherapy alone.
(3) Adjuvant therapy can improve overall survival for patients with RO resections.
(4) Fluoropyrimidine-based chemoradiation is standard because it is superior to radiation alone.
10. Which of the following statements is CORRECT regarding hepatoblastoma?
(1) This is the most common primary cancer of the liver in adults.
(2) Hepatoblastoma is a chemoresistant tumor.
(3) Patients with this tumor have a poor outcome after liver transplantation, with a 5-year survival rate of 20%.
(4) The peak incidence of hepatoblastoma is within the first 2 years of life.
11. A 52-year-old man is admitted to the hospital due to new onset of symptomatic ascites and jaundice. He is an alcoholic and has no history of medical care prior to this encounter. He is mildly encephalopathic. Serum total bilirubin is 5.6 mg/dL and INR is 2.1. He is diagnosed with unresectable metastatic hepatocellular carcinoma and alcoholic cirrhosis after an extensive work up. The patient’s family arrives and would like to discuss treatment options. Your recommendation will be?
(1) Gemcitabine and oxaliplatin.
(4) Hospice or supportive care alone
12. Which of the following is TRUE regarding GISTs?
(1) The most common mutation associated with GIST involves gain of function mutation in KIT proto-oncogene
(2) Both tumor size and mitotic index predict response to imatinib therapy.
(3) Gastric GISTs are associated with relatively worse outcomes compared with small intestinal GISTs.
(4) Patients with metastatic GIST tumors harbouring exon 9 mutations have a better prognosis and response to imatinib compared with those with exon 11 mutation.
13. A 60-year-old previously healthy woman noted abdominal distension and discomfort for 6 months, associated with nausea and vomiting. Computed tomography (CT) scan shows a 20 x 25-cm abdominal mass, and exploratory laparotomy demonstrated a pedunculated mass arising, from the stomach. No other metastases were found. A partial gastrectomy was done, and pathology revealed a gastrointestinal stromal tumor (GIST) which strongly stains for CD117 and CD34. Sixty mitoses were seen per 50 high-power field (HPF). After she recovers from surgery, what would be your recommendation for further treatment?
(1) Observation with serial scans
(2) Imatinib 400 mg PO daily for 1 year
(3) Imatinib 400 mg PO daily for at least 3 years
(4) Sunitinib 50 mg 4 weeks on/2 weeks off therapy for 5 years
14. Familial and genetic syndromes associated with GIST is?
(1) Cowden syndrome
(2) Li-Fraumeni syndrome
(3) Lynch syndrome
15. What is the most common type of small bowel malignancy?
16. Which of the following are characteristic of primary intestinal mucosal-associated lymphoid tissue (MALT) lymphoma?
(1) Association with Hashimoto thyroiditis
(2) The majority of patients present with advanced stage disease
(3) Most common in women
(4) Associated with the translocation
17. Which gene is associated with hereditary nonpolyposis colorectal cancer (HNPCC)?
(3) STKI 1
18. A 65-year-old woman presented with intermittent constipation and diarrhea associated with abdominal cramping. A colonoscopy revealed a near obstructing mass and biopsy showed a villo-glandular polyp. She underwent an exploratory laparotomy and resection of a 5 x 5-cm circumferential necrotic and fungating mass. Pathology revealed a moderately differentiated adenocarcinoma invading into the pericolonic fat with 2 of 30 positive lymph nodes. Margins were negative. CT scan showed no evidence of metastatic disease. After recovery from her surgery, based on current evidence, what adjuvant treatment would you recommend?
(1) 5FU with leucovorin x 6 months
(2) Irinotecan with SFU (FOLFIRI) x 6 months
(3) Oxaliplatin with SFU (FOLFOX) x 6 months
(4) Oxaliplatin with SFU (FOLFOX) and bevacizumab x 6 months
19. A 52-year-old teacher presents with a 2-month history of rectal bleeding. A rectal examination revealed a palpable non-obstructing mass 5 cm from the anal verge. Subsequent colonoscopy confirmed a friable, tethered mass biopsy that showed moderately differentiated adenocarcinoma. Transrectal ultrasound revealed a T3NI1 cancer. CT scans of the chest, abdomen, and pelvis revealed no metastatic sites. Which of the following treatment strategies would you recommend?
(1) Total mesorectal excision (TME) alone
(2) TME followed by chemotherapy
(3) TME followed by chemoradiation
(4) Neoadjuvant 5FU-based chemoradiation followed by TME and adjuvant chemotherapy
20. Which genetic change is associated with resistance to treatment with cetuximab?
(1) KRAS mutation
(2) EGFR over expression
(3) KRAS wild type
(4) MLHI inactivation
21. Which of the following associated with loss of VHL function is most likely to lead to tumor angiogenesis?
(1) Modulation of NF-kB activity and downregulation of JUNB
(2) Increase in matrix metalloproteinases
(3) Increase in hypoxia inducible factor (HIF)
(4) Destabilization of microtubule formation
22. Inactivation or alteration in which of the following tumor suppressor genes is implicated in the pathogenesis of invasive bladder cancer?
(4) All of the above
23. A 76-year-old man with chronic obstructive pulmonary disorder and diabetes mellitus presents with back pain and confusion. Workup reveals extensive metastatic disease in the lungs, bones, and liver and a 6-cm tumor in the kidney. There is no evidence of cord compression. Laboratory studies reveal a calcium level of 11.5 mg/dL, lactate dehydrogenase (LDH) of 600, and a creatinine level of 2.0 mg/dL. Based on MSKCC risk factors, this patient would be considered:
(1) No risk
(2) Low risk
(3) Intermediate risk.
(4) Poor risk.
24. Which of the following is the most common molecular abnormality seen In patients with prostate cancer?
(1) KRAS mutation
(2) BRAF mutation
(3) p53 mutation
(4) Chromosomal translocations involving TMPRSS2
25. Which of the following is CORRECT about neoadjuvant chemotherapy (NACT) for urinary bladder transitional cell carcinoma?
(1) Three cycles of methotrexate, vinblastine, doxorubicin, and cisplatin before cystectomy are a standard of care.
(2) Gemcitabine/carboplatin should be considered to decrease the risk of renal failure with cystectomy.
(3) NACT increases the risk of surgical complications of cystectomy.
(4) NACT should always be used with an organ preservation approach but is optional if cystectomy is chosen.
26. A 65-year-old man has been receiving combined androgen ablation with leuprolide and bicalutamide for 4 years for biochemical recurrence after radical prostatectomy. His PSA has increased from an undetectable nadir to 1.1 ng/mL on serial measurement over the period of 6 months. The PSA then continues to increase 2 months later to 2.5, with serum testosterone of 10 ng/mL. Bone scan and CT of the abdomen/pelvis do not reveal any metastatic disease, and he remains asymptomatic. The most appropriate therapy option is:
(1) Continue current treatment regimen and active surveillance.
(2) Docetaxel-based chemotherapy.
(3) Start enzalutamide.
(4) Discontinue bicalutamide
27. Which of the following statements about the androgen receptor is most CORRECT?
(1) The majority of its activity in prostate cancer is due to its cytoplasmic effects.
(2) Up-regulation of androgen receptor expression has been linked to prostate cancer development.
(3) Castration leads to complete inactivation of all androgen receptor-mediated pathways.
(4) Castrate-resistant prostate cancer (CRPC) is associated with up-regulation of androgen receptor expression.
28. A 26-year-old man presents with cough and a left testicular mass. Work-up reveals multiple retroperitoneal lymph nodes and several lung nodules. Serum hCG is 80 mlU/mL, AFP is normal. Pathologic diagnosis of the testicular mass is pure seminoma. What is the best management decision?
(1) Two cycles of BEP (bleomycin, etoposide, cisplatin)
(2) Three cycles of BEP
(3) Four cycles of BEP
(4) Three cycles of EP
29. A 23-year-old male presents with painless enlargement of the testis and cough. Ultrasound reveals an intratesticular mass. CT scan of the chest, abdomen, and pelvis reveals multiple retroperitoneal nodes, liver metastases, and multiple pulmonary nodules, AFP is 16,000 ng/mL, beta-hCG is 200 mlU/mL At the start of the third cycle of BEP, the patient is asymptomatic. AFP has decreased to 200, beta-hCG is undetectable. What is the next step in management?
(1) Complete four cycles of BEP
(2) Change treatment to salvage therapy with TIP
(3) Repeat CT scans for assessment of disease response
(4) Consider tandem high-dose therapy with stem cell rescue
30. A 32-year-old man previously treated for testicular cancer 3 years ago with four cycles of BEP now presents with pancytopenia. Evaluation reveals acute 3 myelogenous leukemia (AML). What : is the likely chromosome abnormality associated with this leukemia?
(3) 13q deletion
(4) 11q23 translocation
31. Which of the following feature is most characteristic of type I endometrial cancers?
(1) Most of these cancers have serous or clear cell histology.
(2) Risk factors include unopposed estrogen, anovulation, and obesity.
(3) They are rarely (less than 5% of cases) associated with microsatellite instability.
(4) The precursor lesion is preneoplastic atrophic endometrium
32. A 40-year-old woman is diagnosed with invasive cervical cancer. She has a 5-cm cervical tumor with parametrial involvement, and evidence of hydronephrosis on imaging. Her cancer is stage ITIB. You elect to treat her with combined chemotherapy and radiation. Which of the following applies to the treatment of locoregionally advanced cervical cancer?
(1) Randomized trials — involving patients with locally advanced cervical cancer have failed to demonstrate a benefit of chemotherapy in addition to standard radiation therapy.
(2) Carboplatin appears to be the most appropriate agent to combine with radiation therapy for cervical cancer and this should be followed by hysterectomy.
(3) Paclitaxel with cisplatin is an acceptable regimen to combine with radiation therapy and has demonstrated improved survival.
(4) Weekly cisplatin with radiation therapy appears as active as other regimen with manageable toxicity.
33. After receiving definitive concurrent chemo-radiotherapy for stage IIIB cervical cancer, a patient develops a recurrence in the cervix, 18 months from the completion of therapy. Imaging studies suggest no extrapelvic disease. What would you recommend?
(1) Referral back to the radiation oncologist for consideration of further radiation
(2) Chemotherapy with combined cisplatin and topotecan
(3) Chemotherapy with combined cisplatin and paclitaxel
(4) Referral for consideration of radical surgery
34. A 55-year-old patient with a history of abnormal Pap smears presents for evaluation of a 3-cm vulvar mass. The mass is located 1 cm lateral to the clitoris on the right and has an ulcerated appearance. She states she noticed it 2 years ago and has tried many different ointments to help control the itching and irritation. This was recently biopsied to reveal invasive squamous cell carcinoma. What treatment would you recommend?
(1) Neoadjuvant chemoradiation followed by local resection
(2) Concurrent chemoradiation
(3) Radical vulvectomy with bilateral inguinal lymphadenectomy
(4) Local resection followed by radiation and/or chemotherapy
35. The most active (improved disease- free and overall survival) chemotherapy regimen as determined in randomized clinical trials in women with advanced or recurrent endometrial cancer with measurable disease is:
(1) Doxorubicin plus paclitaxel
(4) Ifosfamide plus paclitaxel
36. A 35-year-old woman presents to you for recommendations regarding therapy of her newly diagnosed mucinous ovarian cancer. This was a S-cm, grade 1, left-sided mass that was incidentally found at the time of surgery for endometriosis as part of an infertility workup. The ovary was removed, and the operative note states that there was no evidence of tumor on the external surface of the ovary or elsewhere in the abdomen, but full surgical staging was not performed. A postoperative computed tomography (CT) scan of the abdomen and the pelvis is unremarkable, and CA-125 is within normal limits. Pelvic examination is unremarkable. The patient would like to have children but does not want to compromise her survival. What should be your advice to the patient?
(1) She is unlikely to have any residual cancer or a recurrence, and further surgery or chemotherapy is not needed.
(2) Because her CT scan and CA-125 are normal, she is unlikely to have any residual disease, and further surgery is not needed. However, because the mucinous subtype of ovarian cancer has a very poor prognosis, she will require three to. six cycles of carboplatin/ paclitaxel chemotherapy.
(3) She should have complete surgical staging, if possible, via laparoscopy, with the option of preserving her uterus and contralateral ovary if there is no further evidence of tumor, which Is associated with a >90% chance of 5-year survival and does not require chemotherapy.
(4) She should have complete surgical staging, including TAH/BSO. If no further disease is found, she will need only three cycles of carboplatin/paclitaxel chemotherapy, but if there is disease outside the ovary, she will need six cycles
37. Which of the following increases the risk of a woman developing ovarian cancer?
(1) Use of oral contraceptives for >5 consecutive years
(4) Tubal ligation
38. A 50-year-old woman presents with a pelvic mass. She is found to have a tumor of low malignant potential. With TAH/BSO and staging, there is no gross disease but the washings were positive on final pathology and there was one positive lymph node, making her disease stage IIIC. What is the most appropriate therapy postoperatively?
(1) Intraperitoneal cisplatin and Intravenous (IV) taxane
(2) IV platinum and a taxane
(3) Hormonal therapy with tamoxifen or an aromatase inhibitor
(4) No further therapy
39. A 51-year-old woman presents to you for recommendations regarding the treatment of her recurrent ovarian cancer. She was optimally debulked for stage IC serous ovarian carcinoma and completed six cycles of carboplatin/paclitaxel 36 months ago with a clinical complete remission. She now has recurrent ascites, which is histologically positive for tumor compatible with her original primary. CT scan shows peritoneal carcinomatosis and a pelvic mass. What should your advice to her be?
(1) Prognosis of recurrent ovarian cancer is poor. She may achieve short-term benefit from chemotherapy although hospice is a reasonable option.
(2) Tamoxifen has a 40% chance of response.
(3) She has a very high likelihood of disease shrinkage and symptom palliation with further platinum based chemotherapy.
(4) She has a chance of cure with autologous stem cell transplant.
40. A 45-year-old woman has undergone surgical resection followed by adjuvant chemotherapy for her stage HIC ovarian cancer. She is now in complete remission and is interested in further treatment to reduce the risk of recurrent disease. Which of the following would you recommend?
(1) Maintenance treatment with single-agent paclitaxel for 12 months
(2) Ask tor BRCA 1 & 2 mutation and if positive advise PARP inhibitor
(3) Maintenance treatment with single-agent topotecan
(4) Maintenance treatment with bevacizumab
41. What percentage of breast cancers is caused by germline mutations?
42. Li-Fraumeni syndrome is characterized by which clinical features?
(1) Lobular breast cancer, gastric cancer
(2) Breast cancer, soft tissue sarcoma, central nervous system tumors, adrenocortical cancer, leukemia, prostate cancer
(3) Breast cancer, hamartoma, thyroid cancer, oral mucosa cancer, endometrial cancer, brain tumors
(4) Male breast cancer, pancreas cancer, gall bladder cancer, pharynx cancer, gastric cancer, melanoma, prostate cancer
43. Which of the following statements about Luminal A subtype of breast cancer is TRUE?
(1) It is more common in premenopausal women
(2) Luminal A breast cancers frequently carry TP53 mutations
(3) It is characterized by high- expression levels of ER-related genes and low expression of the HER2 cluster and proliferation associated genes.
(4) It has a worse prognosis than other molecular subtypes of breast cancer.
44. Which of the following scenarios are considered a contraindication to the use of tamoxifen?
(1) Major surgical procedure within the previous 6 months
(2) A history of deep vein thrombosis, stroke, pulmonary embolism, or transient ischemic attack
(3) A 60-year-old woman with bilateral asymptomatic cataracts
(4) A 65-year-old woman currently on an SSRI for hot flashes
45. Which of the following statement about DCIS is TRUE?
(1) DCIS accounts for 15% to 30% of mammographically detected cancers.
(2) DCIS is most common in women aged 40 to 59 years.
(3) Younger women have a lower rate of local recurrence after local therapy
(4) Sentinel lymph node biopsy should be performed routinely during breast-conservation surgery for non-palpable DCIS.