Medical Oncology Module 3

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

Which of the following tumour 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 normalization of which tumour marker predicts the best overall survival?

A 70 year old man has a diagnosis of castrate resistant metastatic prostate cancer with metastasis to the nodes and bones. He has been started on oral Abiraterone 1g daily along with prednisone 5mg 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 median survival of metastatic renal cell carcinoma?

Where does 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?

In a patient 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 non-seminomatous testicular germ cell tumour with vascular invasion (High risk).

Since his surgery, he has been highly anxious and have been worried about the risk of recurrence and have 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.

So in this situation, what would be the most appropriate next step in 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:

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?

Which of the following cancers have 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 tumor at the age of 12. The therapeutic regimen included cisplatin, etoposide (also known as VP-16), and bleomycin. 

Three years following successful treatment for a testicular germ cell tumor with a regimen comprising cisplatin, etoposide, and bleomycin, a 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 tumors following successful chemotherapy?

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

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 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?

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

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