Medical Oncology Module 2

A patient with history of depression has breast cancer.

Which anti-depressant should be avoided when using Tamoxifen?

Which of the following is a known side effect of Aromatase inhibitor?

In postmenopausal women with early breast cancer, ER positive.What is the best adjuvant therapy?

You are seeing a 46 year old lady in clinic with a new diagnosis of stage IV breast cancer with supraclavicular, axillary lymph node and liver metastases.

She is HER2 positive and has a good functional status.

What would be the best treatment option for her?

In women with metastatic breast cancer with HER2 overexpression, ER/PR positive.

What is the best treatment?

In premenoupausal women with metastatic breast cancer, ER/PR+ve.Which of the following is the most effective agent in reducing estrogenic stimulation of the tumor?

Which of the following tumor characteristics confers a poor prognosis in patients with breast cancer?

A patient with breast cancer on chemotherapy and tamoxifen develops pulmonary embolism. Which medication is most likely to cause this?

A cancer patient develops acute heart failure following the administration of a large dose chemotherapy agent as part of a bone marrow transplant regimen. Clinically has pericarditis and pericardial effusion.

Which chemotherapy agent is most likely cause?

What is the mechanism of action of aprepitant?

A 23 year old man with non-Hodgkin’s lymphoma had just completed chemotherapy 10 days ago and now presents with neutropenic sepsis but without any features of systemic compromise. He has a history of anaphylaxis with penicillin.

What would be the antibiotic of choice?

What is the mechanism of action of ondansetron?

Which of the following serotonin antagonist has the highest affinity for the 5-HT3 receptor?

What is the rationale for reducing the dose of dexamethasone when given in combination with aprepitant in the treatment of chemotherapy induced nausea and vomiting(CINV)?

A patient is planned to have intravenous vincristine for the first time.What is the recommended anti-emetic regime before starting chemo?

A patient who previously received radiotherapy,develops a rash over this area after receiving a certain chemotherapy agent.

Which chemotherapy agent is responsible?

In certain type of cancer such as breast cancer, neoadjuvant chemotherapy is given prior to surgery.

What is the role of neoadjuvant chemotherapy?

A 17 year old man recently completed chemotherapy for rhabdomyosarcoma. On routine testing the following results were obtained: Serum Sodium 134 mmol/L [135-145 mmol/L] Creatinine 39 mmol/L [18-58 mmol/L] Potassium 3.4 mmol/L [3.5-5.0 mmol/L] Calcium 2.46 mmol/L [2.20-2.70 mmol/L] Chloride 114 mmol/L [97 – 109 mmol/L] Phosphate 0.44 mmol/L [1.07 – 2.03 mmol/L] Bicarbonate 13.9 mmol/L [20.0 – 28.0 mmol/L] Magnesium 0.93 mmol/L [0.65 – 1.05 mmol/L] Urea 4.9 mmol/L [2.1 – 8.4 mmol/L] Albumin 42 g/L [33 – 49 g/L] Urinalysis: protein ++ glucose +++

The drug most likely to have caused these abnormalities is:

Which one of the following phases in the cell cycle is characterized by increased production of microtubules?

In assessment of cancer patients, the Karnofsky performance scale (KPS) best correlates with:

Which type of primary tumour is most commonly associated with the syndrome of inappropriate antidiuretic hormone (SIADH)?

The occurrence of gynaecomastia in patients with testicular cancer is most likely to arise through which one of the following mechanisms?

An adolescent 16 year old female has been treated successfully with radiotherapy for Hodgkin’s disease, which one of the following tumour is most likely to occur when she reaches adulthood (After more than 10 years following treatment)?

A 57-year-old woman who had a right mastectomy for breast cancer three years ago presents with progressive low back discomfort. Examination reveals no evidence of recurrent or metastatic breast cancer. Neurological examination is normal except for an equivocal right plantar reflex. Bowel and bladder function are normal. X-rays show generalised increase in radiolucency and reduced height of two lumbar vertebrae. MRI shows spinal cord compression. Her ECOG performance status is 1.

Which one of the following is the most appropriate management?

Which of the following carries the best prognosis in operable breast cancer?

A 35-year-old woman seeks your advice about her risk of developing breast cancer. Which one of the following would place her at greatest risk of developing breast cancer?

A 63-year-old woman with metastatic breast cancer with skeletal metastases presents with dry cough and shortness of breath. Six weeks ago she completed palliative radiotherapy to her T5 vertebra because of painful metastatic involvement. She is currently receiving tamoxifen. On examination she is afebrile and her chest auscultation reveals fine crepitations in the left upper zone. Her chest X-ray is shown below.

The most appropriate next step in her management is to:

Which one of the following would be a relative contraindication to the use of raloxifene (a selective oestrogen receptor modulator) in a perimenopausal woman?

What is the main advantage of chest wall radiotherapy following lumpectomy and axillary clearance of a 2 cm node-negative, receptorpositive breast cancer?

A 36-year-old woman presents with breast cancer and multiple liver metastases one year after resection of a right breast tumour. The presence of which of the following would likely to confer a benefit of using Trastuzumab (Herceptin)?