Mock Medical Oncology Module 3

Which biomarker is the most independent risk factor for the incidence of immune checkpoint inhibitor (ICI)-associated myocarditis?

Among the following malignancies and their associated tumour markers, which one predicts the best overall prognosis with the normalisation of its tumour marker?

Which of the following tumours is least likely to respond to chemotherapy?

A 78-year-old man presents with multiple sites of significant bone pain due to metastatic prostate cancer. He refuses bilateral orchidectomy. A decision is made to start a luteinising hormone-releasing hormone (gonadotrophin-releasing hormone) agonist.

Which one of the following best describes the likely subsequent clinical events?

The normalisation of which tumour marker predicts the best overall survival?

A 70-year-old man has a diagnosis of castration-resistant metastatic prostate cancer with metastases to the lymph nodes and bones. He has been started on oral abiraterone 1 g daily along with prednisone 5 mg twice daily.

What is the rationale for giving prednisone together with abiraterone?

What is the most common cell type in renal cell carcinoma?

Which of the following is NOT a risk factor for renal cell carcinoma?

What is the approximate median overall survival of patients with metastatic renal cell carcinoma (mRCC) in the contemporary era of immune checkpoint inhibitors and targeted therapies?

Where do the tumour cells in renal cell carcinoma arise from?

What is the recommended first-line treatment for metastatic renal cell carcinoma in patients with intermediate to poor risk disease?

A 45-year-old man with metastatic renal cell carcinoma is undergoing treatment with an immune checkpoint inhibitor. Two months into the therapy, he develops severe diarrhoea and abdominal pain. A colonoscopy reveals ulcerative lesions, and biopsies confirm the presence of immune-mediated colitis.

Which of the following is the most appropriate initial management for this patient?

In a patient on sunitinib for metastatic renal cell cancer, which of the following is a good indicator of response to this medication?

A 54-year-old college professor with high-risk, resected renal cell carcinoma (RCC) has completed adjuvant therapy with pembrolizumab. During a routine follow-up visit, the patient inquires about the rationale behind choosing pembrolizumab over other agents for adjuvant therapy.

Which of the following best supports the use of pembrolizumab as adjuvant therapy in this clinical scenario?

A 58-year-old male with metastatic renal cell carcinoma (RCC) has been receiving treatment with a vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGF-R TKI). He presents to the clinic with complaints of progressive fatigue, cold intolerance, and unintentional weight gain over the past two months. His physical examination is notable for dry skin, bradycardia, and delayed ankle reflexes. Laboratory investigations reveal elevated serum thyroid-stimulating hormone (TSH) levels with low free thyroxine (T4).

Which of the following is the most likely complication of VEGF-R TKI therapy in this patient?

A 20-year-old man presents with a 3-month history of progressive non-productive cough and increasing shortness of breath that has not improved despite a 2-week course of antibiotics. There is no history of fever, chills, or weight loss. On physical examination, temperature is 37.1°C, blood pressure is 120/68 mmHg, pulse rate is 72/min, and respiration rate is 18/min. The lungs are clear. The remainder of the physical examination is normal.

His chest X-ray shows multiple pulmonary nodules consistent with metastatic disease. CT scan of the chest confirms metastatic lesions in the lungs and retroperitoneal lymphadenopathy. Testicular ultrasonography shows a slightly enlarged right testicle.

Laboratory studies show lactate dehydrogenase 310 U/L, alpha-fetoprotein 1289 ng/mL, and beta-human chorionic gonadotropin 6247 mU/mL.

Which of the following is the most appropriate treatment?

A 23-year-old man is seen in an outpatient clinic following post-resection of a stage I non-seminomatous testicular germ cell tumour with vascular invasion (high risk). Since his surgery, he has been highly anxious and has been worried about the risk of recurrence and has been putting his job and marriage on hold until he can know for sure that his cancer has been “cured.” He is open to the idea of undergoing chemotherapy if offered.

What would be the most appropriate next step in management?

A 23-year-old man has just undergone a radical inguinal orchidectomy for a stage I non-seminomatous testicular germ cell tumour with no vascular invasion (low risk).

As part of the active surveillance programme, how frequently should he be followed up in clinic in his first year after surgery?

Which of the following features would most strongly support the presence of a non-seminoma germ cell tumour compared to a seminoma?

A 25-year-old man is evaluated post-resection of a stage I seminomatous testicular germ cell tumour with no vascular invasion (low risk).

The most appropriate next step in his management is:

A 38-year-old man has been recently diagnosed with right testicular cancer found on self-examination. He had a right orchidectomy performed 2 weeks ago. Histology confirms seminoma, pT1bNx. The maximum dimension of the lesion is 54 × 48 × 35 mm. The lesion appears to involve the rete testis. CT staging does not show any evidence of metastasis. His serum beta-HCG and alpha-fetoprotein are within normal limits.

What would be the most appropriate next step in management?

Which of the following cancers has the best chance of long-term survival even with the presence of metastasis?

A 15-year-old male presented with a history of successful treatment for a testicular germ cell tumour at the age of 12. The therapeutic regimen included cisplatin, etoposide (also known as VP-16), and bleomycin.

Three years following successful treatment, this 15-year-old male is at increased risk for which of the following long-term complications?

What is the leading cause of death for survivors of testicular tumours following successful chemotherapy?

Which of the following is the best diagnostic tool to detect early lung toxicity secondary to bleomycin?

A 26-year-old man has been treated with two previous chemotherapy regimens for metastatic sarcoma. On assessment, he appears tired and requires regular opioid analgesia. He needs to rest more than half the day in bed.

What is the patient’s ECOG performance status?

FDG-PET is least useful in the staging of which type of malignancy?

Which of the following gene mutations is associated with increased risk of breast cancer in males?

The human papillomavirus (HPV) is associated with which type of malignancy?

A 50-year-old male smoker presents with a persistent cough and unexplained weight loss over 2 months. On examination there is a palpable left supraclavicular lymph node.

Chest X-ray shows a “white-out” of the left hemithorax, and bronchoscopy reveals an undifferentiated carcinoma.

Serum neuron-specific enolase (NSE) is elevated.

What is the most likely diagnosis?

In the management of non-small cell lung cancer, what is the optimal treatment for a patient with resectable stage II disease?

A 65-year-old man presents for a routine health check-up. He has no specific complaints but is interested in cancer screening due to his age.

Considering the epidemiological trends in Australia, which of the following cancers is he most at risk of being diagnosed with?

A 32-year-old fit, active, non-smoking man presents with a persistent cough and mild exertional dyspnoea. CT reveals a 3 cm solitary pulmonary nodule in the left upper lobe with no mediastinal lymphadenopathy or distant metastasis on PET-CT (and negative brain imaging). Biopsy confirms small cell lung cancer.

Given his excellent performance status and clinically node-negative, very limited-stage disease, which of the following is the most appropriate initial treatment?

Which of the following does not have any role in the management of hypercalcaemia caused by bony metastasis secondary to prostate cancer?

In the management of metastatic castration-sensitive prostate cancer (mCSPC), which form of androgen deprivation therapy (ADT) is considered the mainstay of treatment with variable durability?

A 68-year-old man with de novo, high-volume metastatic castration-sensitive prostate cancer (mCSPC) is being considered for intensification of therapy. He has a performance status of 1 and no significant comorbidities.

In addition to androgen deprivation therapy (ADT), which of the following treatment strategies is most likely to improve his overall survival based on recent advances in the management of mCSPC?

Prostate-specific membrane antigen (PSMA) plays a significant role in the diagnosis and treatment of prostate cancer.

Which of the following statements best describes the role of PSMA in prostate cancer management?

When considering the treatment of metastatic castration-resistant prostate cancer (mCRPC), what is a potential benefit of using darolutamide over other androgen receptor inhibitors?