Medical Oncology Module 3

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

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

An 81-year-old female has had surgery for early stage breast cancer (node negative) and the tumour is ER+ (oestrogen receptor positive) and HER+ (herceptin receptor positive). She also has congestive cardiac failure for which she takes frusemide and candesartan.

Which of the following treatment approaches would most improve her life expectancy?

A 42-year-old woman has recently had a mastectomy after being diagnosed with breast carcinoma. Her paternal grandmother had ovarian carcinoma in her early fifties. She has a 32-year-old well sister. Apart from advising her on appropriate adjuvant therapy,

the next most important issue you should also discuss with her is:

A 30 year old female patient presents with early breast cancer.Which of the following is the most appropriate reason NOT to undergo breast conservation surgery?

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 median survival of metastatic renal cell carcinoma?

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

What is the first line treatment of metastatic renal cell carcinoma?

In a patient who have been started on Sunitinib for metastatic renal cell cancer, which of the following is a good indicator of response to this medication?

A 20-year-old man presents with 3-month history of progressive non-productive cough and increasing shortness of breath that has not improved despite 2 weeks 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 mm Hg, pulse rate is 72/min, and respiration rate is 18/min. The lungs are clear. The remainder of the physical examination is normal.

His CXR 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 a Lactate dehydrogenase of 310 U/L, α-Fetoprotein 1289 ng/mL and β-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 a post resection of a stage I nonseminomatous testicular germ cell tumour with vascular invasion (High risk).

What is the most appropriate next step in his management?

A 23-year-old man have just undergone a radical inguinal orchidectomy for a stage I nonseminomatous testicular germ cell tumour with no vascular invasion (low risk). As part of the active surveillance program, how frequent should he be followed up in clinic in his first year of surgery?

Which of the following feature would strongly support the presence of a non-seminoma germ cell tumor 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:

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

A 15-year-old male was successfully treated for a testicular germ cell tumour at twelve years of age. Therapy consisted of cisplatin, etoposide (VP-16) and bleomycin.

The most likely long-term complication of the therapy is:

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

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

Which of the following malignancy is most commonly associated with bony metastases?

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

A 15 year old male undergoing induction for acute lymphoblastic leukaemia is at risk of tumour lysis syndrome due to a high white cell count. Twelve hours following initial chemotherapy, the following investigations were obtained: Calcium 2.0 mmol/L [2.15-2.65] Phosphate 3.0 mmol/L [1.3-2.3] Lactate Dehydrogenase (LDH) 9800 U/L [500-920] Uric Acid 0.4 mmol/L [0.1-0.3] Urinary pH 7.8 Urinary specific gravity 1018 Urinary nitrates +3

Which one of the following metabolites is most likely to precipitate within the renal tubules in the patient?

The risk of tumour lysis syndrome is most likely related to:

What is the most common mechanism of acute renal failure in tumour lysis syndrome?

In adults with recently diagnosed lymphoma, which one of the following therapies is ineffective in reducing the risk of acute kidney injury as a result of tumour lysis syndrome?

Among the following type of malignancies, which one carries the lowest risk for developing tumour lysis syndrome?

A 15 year old man has a massive abdominal Burkitt lymphoma. What is the most useful treatment to prevent tumour lysis syndrome?

26 year old man has been treated with two previous chemotherapy regimens for metastatic sarcoma. On assessment, he appears tired and requiring 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 likely to be useful in the staging of which type of malignancy?

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

Which of the following feature would strongly support the presence of a non-seminoma germ cell tumor compared to a seminoma?Elevated alpha fetoprotein

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:

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

The Human Papilloma Virus (HPV) is associated with which type of malignancy?

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

What would be the most appropriate next step in management?